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Home My WebLink AboutHLP2020-3885 GRAPEVINE Received OCT 28 202o FisCei Services OCTOBER 27, 2020 The attached application is for a Helicopter Lift Request. Please sign the attached memo and forward packet to the City Manager's Office. Once City Manager has signed please return to Connie Cook, Development Services. Location: 1600 W. College Street — Baylor Scott & White, October 31, 2020 at 8:00 a.m., with a rain date of November 14, 2020 at 8:00 a.m. Melanie Hill, Risk Manager MH Bruno Rumbelow, City Manager Thank you, Connie Cook Development Services (817) 410-3158 Permit will not be issued until FAA Approval has been received. 0.%CCOOM]nsWctiomVW impteonfoleoverl u MEMORANDUM CITY OF GRAPEVINE. TEXAS TO: BRUNO RUMBELOW, CITY MANAGER MELANIE HILL, RISK MANAGER FROM: DON DIXSON, BUILDING OFFICIAL SUBJECT: HELICOPTER LIFT REQUEST DATE: OCTOBER 27, 2020 Attached is a request for a helicopter lift scheduled for October 31, 2020 at 8:00 a.m. for 1600 W. College Street {Baylor Scott & White Medical} with a rain date of November 14, 2020 at 8:00 a.m. if it meets your approval, please sign below: City Manager Risk Manager Development Services Assistant DIMAter[out] , ilding Official FAA Approval 01CCOOKVnstrutlionslHelieoplerl,RoWIF1d0 HELICOPTER LIFT PERMIT GRA �i_Il i' Issue Date:October 29,2020 t le PROJECT DESCRIPTION: Helicopter Lift-October 31,2020 with Rain date of November 14,2020 @ 8:00 a.m."Baylor Scott&White-for T-Mobile" PROJECT# (817)410-3010 HLP-20-3885 Inspections Permit ections ww Permit v.us s City of Grapevine P.O.Box 95104 LOCATION TENANT LEGAL Grapevine,TX 76099 1600 W College St. Cellular Equipment on Roof Baylor Med Ctr Condo Blk n/a (817)410-3165 Voice Suite#Cell Lot 1 (e17)410-3012 Fax Grapevine,TX 76051 CONTRACTOR INFORMATION 5 State Helicopter's APPLICANT NAME Susan Bitros 285 Blackland Rd. **APPLICANT PHONE NUMBER 9726364009 Fate,TX 75189 APPROVAL CITY MANAGER YES (972)636-4009 Phone 634009 APPROVAL DEVELOPMENT SERVICESYES APPROVAL RISK MANAGEMENT YES OWNER County Tarrant Hrt Properties Of Texas Ltd DATE&TIME OF HELICOPTER LIFT 2020-10-31 08:00 am RAIN DATE FOR HELICOPTER LIFT 2020-11-14 08:00 am Zoning PCD-Planned Commerce Development :L BUILDING --- COMMERCIAL ALTERATION Issue Date:September 24,2020 PROJECT DESCRIPTION:Cell Tower Modifications"T-Mobile"[EQUIPMENT TO BE PLACED ON ROOF] PROJECT# (817)410-3010 WWW.mygov.us COMA-20-3429 Inspections Permits City of Grapevine --- LOCATION TENANT LEGAL Grapevine,,T TX 76099 9 Equipment P.O.Box 1600 W College St. Cellular E ment on Roof Baylor Med Ctr Condo Blk n/a X P Suite#Cell Lot 1 (817)410-3165 Voice Grapevine,TX 76051 (817)410-3012 Fax CONTRACTOR INFORMATION Nexius Solutions. Inc. •ZONING DISTRICT PCD 2595 Dallas Pkwy Suite 300 ••NAME OF BUSINESS T-Mobile Frisco,TX 75034 (972)581-9888 Phone "APPLICANT NAME Jennifer Scivally (703)935-0831 Fax "APPLICANT PHONE NUMBER 682-233-1290 (214)708-5788 Mobile ')Certified Energy Code Inspected YES 2)Accessibility Review N/A 3)Control Number OWNER 4)Asbestos Survey YES Hirt Properties Of Texas Ltd Acreage 3310 W End Ave Ste 700 Nashville,TN 37203-1097 County Tarrant Fire Sprinkler System? N/A AVAILABLE INSPECTIONS Square Footage • Final Fire Dept Inspection(required) • Building Final(required) VALUATION 12500 What is use of Building/Structure? Cell Tower Zoning PCD-Planned Commerce Development FEES TOTAL=$329.59 `Building Permit Fee(Value) $ 199.75 Budding Permit,Plan Review $129.84 PAYMENTS TOTAL=$329.59 Nexius Solutions, Inc. (Mark Baysinger) Check on 0912212020 ($129 84) Note:CK2366 Nexius Solutions, Inc. (Mark Baysinger) Other on 09/24/2020 ($199 75) Note:CC3151 NOTICES 1)ALL work must be done in compliance with the 2006 INTERNATIONAL BUILDING CODE. 2)A copy of the signed permit and approved plans must be on site at all times. 3)The project address must be clearly posted at the job site. READ AND SIGN I hereby certify that the foregoing is correct to the best of my knowledge and all work will be performed according to the documents approved by the Building MYGOV.US City of Grapevine I BUILDING---COMMERCIAL ALTERATION I COMA-20-3429 1 Printed 10/27/20 at 1:14 p.m. Page 1 of 3 HOLD HARMLESS AND INDEMNITY AGREEMENT PROJECT ADDRESS: Baylor Scott& White Medical Center-Grapevine 1600 W. College Street Grapevine,TX 76051 NATURE OF OPERATION: Helicopter external lift operation of Cellular Equipment to the rooftop. DATE OF OPERATION: 31 October 2020 with rain date of 14 November 2020 with a 10 day grace period for each date mentioned. I, t,�rr fl4 fir,the undersigned, representing 5-State Helicopters, Inc., binding my heirs, executors, administrators, estate and assigns, do hereby agree to completely and wholly release indemnify the hold harmless the city of Grapevine, its officers, agents, independent contractors, and employees from any and all claims, damages, personal injury, including death, property damage, lawsuits and judgments, including court costs, expenses and reasonable attorney's fees, and all other expenses resulting from any and all activities conducted within the city of Grapevine,Texas. It is the understanding of all parties that this release, indemnity, and hold harmless agreement shall apply whether or not the claims, damages, harm, personal injury, including deaths, property damage, lawsuits, judgments, court costs, attorney's fees and any other expenses arise from the negligence of whatever nature, omissions, willful and intentional acts of this individual, company or company's officers, agents, employees, independent contractors,other representatives, invitee,licensee,or guests. I, the undersigned individual and/or company company's officer, certifies,warrants and represents that the individual whose signature appears below is duly authorized to execute this agreement on behalf of the firms, corporation, partnership or other entity who will operate within the city of Grapevine,Texas. In witness whereof,this agreement has been executed thisV day of 200+28P COMPANY:5-STATE HELICOPTERS, INC.� BY:04&d�.3printed) ��?y SS TITLE: AM' (signature) STATE OF Texas 0UNTYOF ROCkw811 This instrument was acknowledged before me on this the_9?7 da Y of 4t1d&.zolie NOTARY PUBLIC IN D FOR THE STATE OF My commission Tres a pa��gp, ``�o�pPY PLB i� SUSAN BTROS Signatur e, `�,'Notary Public, State of Texas :,9,.,,,,. rip Comm. Expires 08.26-2024 �''fu°�u'�` Notary ID 132643898 `^ M�Griff Certificate of Insurance ' Certificate No. 113043 Rev. Date:Oct 27,2020 This is to certify that the policy(ies)of insurance as described below have been issued to the Insured for whom this Certificate is executed and is/are in force at this time.This Certificate is issued for information only and confers no rights upon the holder.This Certificate neither affirmatively nor negatively amends,extends or alters the coverage afforded by such policy(ies)or binder(s)stated herein. This certificate cancels and supersedes all previously issued certificates. Certificate Holder: City of Grapevine 200 S.Main Street Grapevine,TX 76051 Named Insured: 5 State Helicopters, Inc. 285 Blackland Road Fate,TX 75189-4746 Policy Type: Aircraft Hull&Liability and Aviation General Liability Policy Policy Period: February 15,2020 to February 15,2021 both days at 12:01am Local Standard Time at the address of the Named Insured shown above Insurer(s): Company Policy No(s). Endurance American Insurance Company through W.Brown and NAC6030702/NAF6030703 Associates Aircraft Covered: Sikorsky S58ET, N6BL;Sikorsky S58ET, N4XY;MBB/Kawasaki BK-117, N170MC Coverage&Limits Aircraft Liability Coverage Limit Combined Single Limit Bodily Injury, including Personal Injury and $5,000,000 each occurrence as respects MBB/Kawasaki BK-117 Property Damage Liability and Sikorsky S-58ET type aircraft. Cargo Legal Liability Coverage Limit Cargo Legal Liability including Slung Loads $500,000 each occurrence,subject to a deductible of$2,500 each claim. Ruth I rizedR�ve 7525 SE 24th Street,Suite 520,Mercer Island,Washington 98040 Phone:(206)232-9870-Fax:(206)232-9515 TATE 285 FATE, TEXAS ROAD FATE,TEXAS 75189 (972)636-4009 HELICOPTERS October 27, 2020 Connie Cook, City of Grapevine Attention: City Manager Reference: 5 State Helicopters Landing and Operations This letter, with the location, dates, and time of a helicopter external load operation that is being flown by 5 State Helicopters, Inc. is to ensure there are no restrictions or regulations preventing the helicopter from landing within the city limits of Grapevine, Texas. Date/Time of Job: Location: Contractor: October 31, 2020 Baylor Scott& White Medical Nexius Center 8:OOAM- 12:OOPM 1600 W. Colle e St. 2595 North Dallas Parkway Gra evine, TX 76051 Frisco, TX 75034 Helicopter Type: Sikorsky S58T, Kawasaki BK 117, Sikorsky UH-60 TRANSPORT CATEGORY Call Sign: N4XY (Blue), N6BL (Red), N170MC (Yellow) or N112HC (Green) Pilots: Bradford Ladue, Robert Smith,Andrew Smith, Steven Phelps or Shawn Harris 5 State Helicopters, Inc. assures the City of Grapevine, Texas that it will comply with all State, Federal and local regulations, holds and required permits and is licensed to do the type of work as described in this request. 5 State Helicopters, Inc. agrees to provide a Certificate of Insurance with liability coverage of$5,000,000.00 showing the City of Grapevine as an additional insured. Please feel free to contact 5 State Helicopters with any questions and/or concerns that you may have. Office: 972-636-4009 Please sign and e-mail back to: Office@5state.com SINCERELY, APPROVED /DISAPPROVED BY DATE . ATE HELICOPTERS wwau[mmo[e DATE: October 27, 2020 TO: FAA OFFICE North Texas FSDO REFERENCE CONGESTED CONTINGENCY-SAFETY PLAN DATE/TIME OF JOB JOBSITE INFORMATION CONTRACTOR INFORMATION DATE: October 31, 2020 ADDRESS: Nexius / Velex TIME FRAME: 8:ODAM-12:001PM Baylor Scott & White Medical Facility 2595 N. Dallas Parkway 1600 W. College St. Frisco, TX 75034 Grapevine, TX 76051 JOBSITE CONTACT: Andrew Allen CONTACT: Andrew Allen PHONENUMBER: 972-740-0720 PHONENUMBER: 972-740-0720 **SHOULD A WEATHER,MECHANICAL OR MATERIAL DELAY BE EXPERIENCED,THIS PLAN IS APPROVED FOR ABOVE LISTED DATE PLUS 14 CALENDAR DAYS. ** AIRCRAFT INFORMATION: N6BL SIKORSKY S-58T TRANSPORT CATEGORY Ill SIKORSKYS-58T TRANSPORT CATEGORY N170MC KAWASAKI SK-117 TRANSPORT CATEGORY PILOT INFORMATION: BRAD LADUE COMMERCIAL CERTIFICATE #2760587 ROBERTSMITH COMMERCIAL CERTIFICATE #3493515 ANDREW SMITH COMMERCIAL CERTIFICATE#3893823 SHAWN HAR_RISS 1 ATP#2727633 PREPARED BY: Susan Bltros Digitally signed by STEVEN L STEVEN L MOODY MOODY Date:2020,10.28 11:57:14-05'00' APPROVED BY: OPERATING CERTIFICATE#LDUL599B 285 BLACKLAND ROAD FATE,TEXAS 75189 (972) 636-4009 APPROVED 5 OgNTX FSDO SW 19 HEMONE LOAD DESCRIPTION HAZMAT: YES (DOT-SP 16606 & DOT-SP 20490) NO XX ROOFTOP UNITS MATERIALS XX EQUIPMENT XX OTHER: cellular equipment NUMBER OF TOTAL LIFTS (RANGE) 1 - 10 WEIGHT RANGE 500 - 1,000 PERCENTAGE OF LIFT ABILITY OF AIRCRAFT 24% LOAD AERODYNAMIC: YES NO XX LENGTH OF ATTACHING GEAR (FROM HOOK TO BOTTOM OF LOAD) _ 85' BUILDING OCCUPIED DURING LIFT: YES NO XX * IF YES, ESTIMATED LOAD PENETRATION OF FLOORS AREA CONSIDERED CONGESTED: YES XX NO OPERATING CERTIFICATE# LDUL599B 285 BLACKLAND ROAD FATE,TEXAS 75189 ( APPROVED NTX FSDO SW19 5.%flTECWEP RS M n AIAEAAXE9RNCE5 CONGESTED COMMERCIAL AREA CONGESTED RESIDENTIAL AREA XX CONGESTED AREA PROBABILITY/POSSIBILITY This is congested area operations. Items are located in staging area(s) on either transportable vehicles or ground surface. Item(s) to be placed on building/structure roof top(s) or designated areas. Direct flight path(s)from staging area(s)to placement area(s) will occur unless otherwise notated on provided maps. Lift(s) amount(s), description(s), order and placement could be altered by contractor personnel, however, pick up site and drop site shall not be outside the parameter of this request. Helicopter landing area(s) will be secured at all times (prior, during and departure). Flight path(s) during lift operations inside the designated operational area(s)will remain clear of unauthorized personnel, equipment, obstacles at all times. Flight path(s) will remain within operational area(s) at all times. The operational area(s) has been surveyed for hazard(s) and mitigated to the lowest risk level acceptable to, or able to obtain, by both 5 State Helicopters, Inc. and contractor(s). Should a unforeseen, or additional hazard(s) surface, lifting will immediately halt till the hazard(s) have been rectified or mitigated. Primary means of communication via radio will be maintained constantly during the operation. Secondary means of communication via hand signals will be immediately incorporated should radio communications fail. Appropriate ATC communications will be maintained by pilot in all possible and/or feasible situations. Narrative: Due to the job-site being a Medical facility in a residential and commercial area we classify this to be a potential congested area. However, all entrances will be blocked and controlled by security personnel so that no unauthorized persons shall enter or cross the operational area. The top 2 floors of the building(inside the operational area)will be vacant during operations. The Parking garage will be vacant inside the operational area. 285 BLACKLAND ROAD FATE,TEXAS 75189 (972) 636-4009 285 5 BLACKLAND ROAD AAFATE,TEXAS 75189 APPROVED HELICO (972) 636-4009 NTX FSDO SW 19 IS ARE#ANEStANCES Notification of Grapevine City Officials 5 State Helicopters has contacted the following city officials about the lift to be performed on October 31, 2020: 1600 W. College St. Grapevine, TX 76051 City Manager: Connie Cook 972-216-6404 Your message has been delivered to the following recipients: ' Subject: 5 State Helicopter Lift of cellular Equipment 31 October 2020 in Grapevine, Texas at approximately 8:00AM-12:00PM. Police: Mike Hamlin972-216-6230 Your message has been delivered to the following recipients: ' Subject: 5 State Helicopter Lift of cellular Equipment 31 October 2020 in Grapevine,Texas at approximately 8:OOAM-12:OOPM. Fire Chief: Darrell Brown 972-329-8316 Your message has been delivered to the following recipients: Subject: 5 State Helicopter Lift of cellular Equipment 31 October 2020 in Grapevine, Texas at approximately 8:OOAM-12:OOPM. ATC: DFW Airport 972-615-2605 ' Subject: 5 State Helicopters lift operations 4 miles North West of DFW on October 31, 2020. Best Regards, 5 State Helicopters Baylor Scott&White Medical Center-Grapevine r -- 1600 W.College St. ►�; N Grapevine,TX 76051 Date of Lift: - g 10/31/2020 yy} x Time: - 8:OOAM 320 56' 04.8"N 970 05' 35.2"W t _ e Opeaa[ionalprea � EligFt PatM1 • _ Lantlln6 A,ea � S�agingarea � — EmergenryA,ea � Blocked Areas x � _ / "♦ La°yea i Baylor Scott&White Medical Center-Grapevine + ` 1600 W.College St. - Grapevine, TX 76051 Dale of 20 B ALTITUDE A COMPLEX AND BRAPEVME�Ir N 10/31/2/2020 NORTH LAKE SHOULD BE AT OR BELOW 1:N MILLS FEET MSL WHEN OFW IN NORTH FLOW AND MALL W �I(04) AT OR BELOW 8 FEET MSL WHEN OFW -`` Time: SOUTH Flow 32° 56' 04.8"N .�. ,II 914 M 8:OOAM 97° OS' 35.2"W �'i 1076 Lahc (4� (Pvt) (499) 13AYLOR SCOTT&WHITE U GRAPEVINE ' 714 L GRAPEVINE I 1 12j W �• o• HH 636 e, �,. BA' IRVING 0 TO Rs. EAST TOWER �. r 6' '• .} a,, T IFREOUENCY 127.5 COLLEYVILLE ♦ c,1 /\ —WEST TOWER c 99O FRIEOUENCY 134.9 \ �°- NO SVFR 9 TF9 (370) 360 z DALLAS-FT WORTH INTL(OFW) 348 dT-124.15126.55127.5134.9 •• ••• .•'�\ N ? ATIS123,775 '— 606 L 122.95 831 2 NORTH FLOW:dHERWTE-183 MUST;NOT BE - '4OE�(409)�' .�N UTILIZED TO FLY THROUGH THE FINAL�APPROACH — W bldg5 ,COURSE TO RUNWAYS 35R,35C,351?•156 R,AND 36L Z / EULESS �� 7' C_ % I MAVERICK •n• •^ (31 BEDFORD FAT LTITUDE BETWEEN PENNINGTONIFIELD AND`� 113.1 Ch 78 TTT =_ 1� VING MALL SHOULD BE AT OR BELOW IOW , 110 Helicopter will not (PVt) r^. EET MSL WHEN DFW'IS IN SOUTH,"FLOW AND Be more than 125' T CAMPUS O RTHEAST �121 OR BELOW 800 FEET MSL WHE' PWISIN• ct �� Above a 100'building ORTH FLOW `LWhen air Aing 183 AIR oR7 Equipment to the / O Fwv a RUE Roof ( ) r< k,yt- ,�"`�•'�d � Aiwilltact: ecuulurmu HARRIS H E B 18 1' I Mall DFW rport •�.w O m � A •1� . - -•F a2d. ,. r lAr {`�- mill f I AIP&RQVELfq V.- o_._-_I N,I-NurihweS!•Ht.y---_ --4 z. y ��r;;``yy • !. �� ^ bDO S1Ron + S JR� W. n N �- � Heather S j \ Q, Surre -Lm y I mw Q_• 3 34674 97-093101 v R •� J p r E _� I Eato n-L-n—a 'BgoO / It -o.., � -t e �d ins•St' H 9 - -_ yyl-l7a',las Rd P �• List;fai,BFvd-- �eN�:+G_a�t.�— _ j SA ��.. _. .. ysza o v N od5 r, 4� f R Mi I � It • lid,,