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Home My WebLink AboutCO2020-1917 UNDER CONSTRUCTION CORRECTION LETTER PW OR LD NEEDED TD NO LETTER WAITING FIRE HOLD CODE C/O CHECK LIST C/O PERMIT# P20 ADDRESS: BUSINESS NAME: (� BUSINESS lPROPERTY CHANGE NAME /OWNER NEW CONST/ADDITION PERMIT# -XZNEW TENANT/OCCUPANT REMODEL/ALTERATION PERMIT#;�F? ISSUE DATE FINAL DATE �/ . APPLICATION FORM COMPLETED V 2. ZONING MAP COPIED &WORKORDER FORM COMPLETED 3. HAZARDOUS MATERIAL SAFETY DATA SHEETS TO FIRE DATE (SCAN TO C/O IN MYGOV-IF LARGE SET,ALSO SCAN TO LF&FORWARD SET TO FIRE) FIRE DEPARTMENT APPROVAL OF HAZARDOUS MATERIAL DATE 5. ZONING CHECKED &COMPLETED ON APPLICATION 6. BUILDING INSPECTION SCHEDULED DATE / I TIME %. �� !'►� —L�7. FIRE DEPT. INSPECTION SCHEDULED DATE 1/.. _`� TIME FIRE INSPECTOR: 8. CITY SECRETARY(ALCOHOL) NOTIFICATION DATE: 9. HEALTH INSPECTION NOTIFICATION DATE: 10. PUBLIC WORKS INSPECTION E-MAIL DATE 11. LOT DRAINAGE INSPECTION E-MAIL DATE �(12. CORRECTION LETTER SENT DATE ,^J-JA3. BUILDING INSPECTORS SIGN OFF LETTER: YES / NO /14. FIRE DEPARTMENTS SIGN OFF LETTER: YES / NO 15. HEALTH DEPARTMENT SIGN OFF 16. CITY SECRETARY(Alcohol License Sign Off) ✓I� +�� I� �� 17. PUBLIC WORKS SIGN OFF 18. LOT DRAINAGE SIGN OFF V 19. LANDSCAPING SIGN OFF 20. BUILDING OFFICIALS SIGNATURE 21. C/O CERTIFICATE ISSUED ELECTRIC RELEASED: _ SCAN CERTIFICATE TO MYGOV: CONDITIONS TO BE TYPED ON C/O? YES/Nt, MAILED: O:IFORMSIDSCOINFOR MATIONICKLIST 12/30/041 R-11111,11115,5118 GAPEjE, DATE OF ISSUANCE: j'\ PERMIT# }C r : CERTIFICATE OF OCCUPANCY REQUEST FEE: $50.00 A'O FEE REQUIRED IF CERTIFICATE OF OCCUPAA'CY IS ASSOCIATED ff'ITH AN ACTT NE CURREA'T BUILDING PERAIIT ADDRESS OF OCCUPANCY: 1940 Enchanted Way Grapevine 76051 SUITE# Ste 101 LOT: BLOCK: 0, SUBDIVISION: Genesis Addition Block 2 Lot ****CERTIFICATE OF OCCUPANCY WILL NOT BE ISSUED WITHOUT LEGAL DESCRIPTION**** NAME OF BUSINESS: Crossover Health Medical Group, APC NEW OCCUPANT: YES NO NEW BUILDING/PROPERTY OWNER: YES NO NEW BUILDING: YES NO Z NEW BUSINESS NAME CHANGE: YES NO NUMBER OF EMPLOYEES: 5 FREIGHT FORWARDING: YES NO NEW BUSINESS OWNER: YES NO TYPE OF BUSINESS: Medical Office SQUARE FOOTAGE: ay7 (Example:Retail Clothing,/Attorney's Office/Office-Warchouse/Restaurant) NAME OF TENANT IPERSON'S NAMI'.1: Crossover Health Medical Group APC CURRENT MAILING ADDRESS: 101 W Avenida Vista Hermosa Ste 120 CITY/STATE/ZIP: San Clemente, CA 92672 PHONE NUMBER: 4084574455 PROPERTY OWNER: United Cellular Inc MAILING ADDRESS: 4924 Cambridge Rd CITY/STATE/ZIP: Fort Worth TX 76155 PHONE NUMBER: ♦ IS YOUR BUSINESS SUBJECT TO SALES TAX LANV?(if yes,provide cope of Sales Tax Certificate)---- YES NO ♦ WILL THERE BE ALCOHOLIC BEVERAGE SALES?(if yes,provide copy of Alcoholic Beverage Permit)-�'ES_NO ♦ PERMITS ARE REQUIRED FOR SIGNS. WILL ANY SIGNS BE INSTALLED?------------------- YES—_NO • WILL BUSINESS GENERATE ANY INDUSTRIAL WASTE DISCHARGE TO SEWER SYSTEM?------YES NO ♦ WILL OUTSIDE REFUSE/RECYCLING/COMPACTING CONTAINERS BE NECESSARY? (if yes,screening is required)----------------------------------------------------------- YES NO ♦ WILL THERE BE ANY OUTSIDE STORAGE(including storage of company/fleet vehicles),DISPLAY, USE OR DINING?------------------------------------------------------------------ YES NO ♦ WILL ANY ALTERATIONS BE MADE TO THE SITE OR BUILDING?--------------- --------- YES NO ♦ IS BUILDING SPRINKLERED?------------------------------------------------------- YESV:NO_ ♦ WILL BUSINESS STORE OR HANDLE HAZARDOUS MATERIALS OR LIQUIDS? (if yes,provide list of types S quantities,along Frith material safety data sheets)----------------------YES_NO I HEREBY CERTIFY THAT THE FOREGOING IS CORRECT TO THE BEST OF MY KNOWLEDGE AND THE SAID OCCUPANCY IS IN CONFORMANCE WITH THE INFORMATION HEREIN SET FORTH. (If access to the building;/space is not provided at the time of the scheduled inspection,a$42.00 re-inspection fee will he charged) FOR QUESTIONS PLE AL 7)410-3165, SIGNATURE: PRINT NAME: Leticia Elisea PHONE#: � —� � EMAIL: Development Services Department The City of Grapevine* P.O.Box 95104*Grapevine.Texas 76099*(817)410-3165 Fax(817)410-3012* >•vww.g*rageyinctexas.goy O:F ORIAM SAPPIICATIONSIC/ 3/2 212 0 011Rev:5106,2107,4109.2113,1111 s.10116,8118 TEXAS SALL'S TAX Texas Sales Tax is charged and collected on sales within the State and Cite of Grapevine,Texas of"taxable items."Taxable items include both tangible personal property,specified services. If you are in a business that will be selling"taxable items" within the City of Grapevine,Texas you will be required to collect State and Local Sales Tax in the amount of 8.25%. A`'Seller or Retailer"means a person engaged in the business of making sales of"taxable items",the receipts from which are included in the measure of sales or use tax. The term,"place of business"includes any location at which three or more orders are received by the"Seller or Retailer in a calendar year.If an order is received at the place of business of a retailer in Texas,but delivery or shipment is made from a location within the state other than the retailer's place of business. State and local sales tax is due and is allocated to the city where the order was received. I have read the above and I understand that I will be required to provide a copy of the Sales Tax Permit to the City of Grapevine,Texas if the circumstance applies to my business. Texas Sales Tax NqAiber.• Will not be selling any items Signature: WHERE DO YOU WANT YOUR COMPLETED CERTIFICATE OF OCCUPANCY MAILED? ADDRESS: 393 N 9th Street CITY,STATE, ZIP: San Jose CA 95112 OFFICE USE TYPE OF CONSTRUCTION: - MQ>f4A� OCCUPANCY: DIVISION: ZONING DISTRICT: / CONDITIONAL USE: +�I PERMITTED USE: E� _ BUILDING DEPARTMENT: DATE: 1-7- BUILDING INSPECTOR: DATE: [ —3 ZONING APPROVAL: DATE: FIRE DEPARTMENT: DATE: LOT DRAINAGE INSPECTION: DATE: PUBLIC WORKS DEPARTMENT: DATE: HEALTH DEPARTMENT: DATE: CITY SECRETARY:_ DATE: LANDSCAPING APPROVAL: L- DATE: APPROVAL FOR ISSUANCE: DATE: . O:FORMSMAPPLICATIONSICI 312 212 0 011Rev:5106,210T,4109,2n 3,11115,10116,8118 CERTIFICATE OF OCCUPANCY L,' Issue Date:November 4,2020 }3.T E I y PROJECT DESCRIPTION:C/O[Medical Office]"Crossover Health Medical Group,APC"[BLDG.20-1720] PROJECT# (817)410-3010 www.mygov.us CO-20-1917 Inspections Permits City of Grapevine LOCATION TENANT LEGAL P.O.Box 95104 1940 Enchanted Way Crossover Health Medical Genesis Addition Blk 2 Lot 4 Grapevine,TX 76099 Suite#101 Group,APC (817)410-3165 Voice Grapevine,TX 76051 (817)410-3012 Fax CONTRACTOR INFORMATION Leticia Elisea *CONSTRUCTION TYPE IIB Sprinklered 101 W.Avenida Vista Hermosea Ste.#120 *OCCUPANCY GROUP B San Clemente,CA 92672-0000 *OCCUPANCY LOAD 25 (408)457-4455 Phone *PERMITTED USE Yes OWNER *ZONING DISTRICT CC United Cellular Inc Crossover Health Medical Group, 4924 Cambridge Rd **NAME OF BUSINESS APC Fort Worth,TX 76155-1000 **TYPE OF BUSINESS Medical Office ph. (214)207-0105 **APPLICANT NAME Leticia Elisea AVAILABLE INSPECTIONS "APPLICANT PHONE NUMBER 408-457-4455 w Final Building C/O Inspection(required) *"TENANT NAME Leticia Elisea r Final Fire Dept Inspection(required) **TENANT PHONE NUMBER 408-457-4455 w Landscaping(required) C/O APPROVED FOR ISSUANCE *Sales Tax NO (required) *Sales Tax Number Alcoholic Beverage Sales NO Alterations NO Change of Business Name NO Change of Business Owner NO County Tarrant Fire Sprinkler System? YES Freight Forwarding Business NO Hazardous Material NO Industrial Waste NO New Building/Addition NO New Building or Property Owner NO New Occupant/Tenant YES Number of Employees 5 Outside Refuse/Recycling NO Outside Storage NO Signs NO Square Footage 2478 Zoning CC-Community Commercial READ AND SIGN ep fJ �a 4 t � E " YY a ' .r mho owSNw•wa m � o If }f ar ;OZYJ ryy �� ,1' u O rv` s fN Wpa iOn t-i _ 3 AtlMO31NVH8N3 �• W � e� • rthg Or fd�. lY y�a.� '.� _ - �r8'1Lb• Tr�H. oy yJ'ti`N'�%b 8NY'?t. e Tz N�s)y a .5 •FO TyTsh b''�N est)�dbyJ �� MB�S. • , y fie. 5171W NIa3dVe9/66YZ n Z Wd•LX3'8N•TZPNS IZI AMN 91Y[5 �h: h C' 85•) 3 - e`D2� 2/QmtW Y .CNSN M Tbi•HSN .a 6b QpQ M NAH:14 AAA jsd � " 83.5F9.M/•Q(.BS IZt , Ta^ZM1s, •635•EB_ENTER•BAO•PBO N ^ cc I X / � . 1'i W �sYPef fk . Z N� '1i� R p � \f ~ /� ✓ S� d W-Gy MPEVIriE Z ;y0 me -$ 9rhJ, 111 w piy f �� 3 \/ram EL- z yyxxti e {j��f •O� V.�=pP 4 � �-' if vary 1, ei m CERTIFICATE OF OCCUPANCY WORKORDER. PERMIT# 20 ADDRESS OF INSPECTION: DATE OF INSPECTION: TIME OF INSPECTION: NAME OF BUSINESS: C� TYPE OF BUSINESS: USE OF BUILDING AND/OR REMISES: _ �, REASON FOR APPLYING: CONTACT PERSON: C.�� TELEPHONE NUMBER:40 COMMENTSNIOLATIONS: **TO BE FILLED OUT BY BUILDING OFFICIAL** ZONING DISTRICT OF INSPECTION LOCATION: TYPE OF BUILDING: f GROUP AND DIVISION: ZONING RESTRICTIONS: O:FORMS DSCOINFORMATION WORKORDER 12 30 04 Rev.1 17 2006 L U'N Q i O C C U o O cc O p0 � 0 LO QOO U � LO d Una 3 c`6CDX0r C N E N m C C Q U N O := N ' + Corn d Z) � LLL CL v C �I O �L @ Q L ° U 0 c c) ♦ ' o ° m v O >a) 0') o d O•- 25 m O •� 0) N O N c LL 0 i i To ° C70 O °� o • , w EO ' � o U', O.Cco 0- a 2 0LU CoQ y U d N V UO •L L C C O YLL aac4) E N�� V E n/ 000E (� wW �'°' C.CU Q V } V NN O N CL m v i N N O a1 w - C: c O = E C O t m /(y1�y a a•°` ` co W W Lo U cis a'5 �5 0 L m = cm C1 tr- to y j O w Cf3 G dy = r r C Q ° 47=0-a) m L Q} O 7 O- O {a aM 7 C r C M ° ~ O v ?� L m a +. 7 U C7 C -! ` N LTJZ.- r a) 47� U] c) m U_ N ti v N R UO o m a C) a U r V] C7 U j y� a C HU 3 w p c 0 0 O N 1 J