HomeMy WebLinkAboutCO2020-3601 UNDER CONSTRUCTION
9 CORRECTION LETTER_
PW OR LD NEEDED
TDJN LE-T_T_E_
AITING FIR
OLD
C/O CHECK LIST
C/O PERMIT # P20 - (00 1
ADDRESS: t� O G S.m�U-y� '� 1*- ID3
BUSINESS NAME:Q IkE & a
BUSINESS/PROPERTY IP e&«A-I ICS
CHANGE NAME OWNER NEW CONST/ADDITION PERMIT#
_ NEW TENANT/OCCUPANT _REMODEL/ALTERATION PERMIT#-'1:U,=350
ISSUE DATE al] FINAL DATE,�O 1-'j.I�L
1. APPLICATION FORM COMPLETED
AL2. ZONING MAP COPIED &WORKORDER FORM COMPLETED
ve-� 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)
/ 4. FIRE DEPARTMENT APPROVAL OF HAZARDOUS MATERIAL DATE
✓ 5. ZONING CHECKED &COMPLETED ON APPLICATION
✓ 6. BUILDING INSPECTION SCHEDULED DATE TIME
✓ 7. FIRE DEPT. INSPECTION SCHEDULED DATE TIME
FIRE INSPECTOR:
8. CITY SECRETARY(ALCOHOL) NOTIFICATION DATE:
9. HEALTH INSPECTION NOTIFICATION DATE:
�G 10. PUBLIC WORKS INSPECTION E-MAIL DATE
f1 1. LOT DRAINAGE INSPECTION E-MAIL DATE
12. CORRECTION LETTER SENT DATE
�13. BUILDING INSPECTORS SIGN OFF LETTER: YES / NO
V-1 14. FIRE DEPARTMENTS SIGN OFF LETTER: YES / NO
15. HEALTH DEPARTMENT SIGN OFF
6. CITY SECRETARY(Alcohol License Sign Off) JD%I.�o - , mpw
/ 17. PUBLIC WORKS SIGN OFF 13-- A�k�
laa n 7R4 (J)-
18 LOT DRAINAGE SIGN OFF
19. LANDSCAPING SIGN OFF �kD( D e -c
20. BUILDING OFFICIALS SIGNATURE Jal//44�D 0'�'.O�e� X Q�
21. C/O CERTIFICATE ISSUED ELECTRIC RELEASED:
SCAN CERTIFICATE TO MYGOV:
CONDITIONS TO BE TYPED ON C/O? YES/ NO MAILED:
O 1FORMSMSCOINFORMATIOMCKLIST
121301091 Rev 1111111A15,5118
GRy p �� DATE OF ISSUANCE: i7s 16
�P 2 Q ZO2 TllllRRtEY k 111VS1Le PERMIT#: az ti c)
CERTIFICATE OF OCCUPANCY REQUEST
FEE: $50.00
NO FEE REQUIRED IF CERTIFICATE OF OCCUPANCYIS ASSOCIATED WITHANACTIVE CURRENT BUILDING PERMIT
ADDRESS OF OCCUPANCY: /o a 5,N,I Lk M ti ' r SUITE# /0 3
LOT: BLOCK: SUBDIVISION� f r-o J y9 i/
*** CERTIFICATE OF OCCUPANCY WILL NOT BE IS UED WITHOUT LEGAL DESCRIPTION1* 5�p
NAME OF BUSINESS: if_IM(- S H�LCA "'J l f•� ' C ��L'a��' E
NEW OCCUPANT: YES_NO NEW BUILDING/PROPERTY OWNER: YES NO Z_
NEW BUILDING: YES NO k NEW BUSINESS NAME CHANGE: YES NO
NUMBER OF EMPLOYEE FREIGHT FORWARDING: YES NO
NEW BUSINESS OWNER: YES NO
TYPE OF BUSINESS: 0-) Si a rA SQUARE FOOTAGE: ($ 5
(Example:Retail Clothing/Attorney's Ofiic /Ottice-Warehouse/Restaurant)
NAME OF TENANT PERSON'S NAME]:
CURRENT MAILING ADDRESS: /03
CITY/STATE/ZIP: C2!� rx 7244b-" � PHONE NUMBER:�C7 3ru s` lv
S—s—
PROPERTY OWNER: IRC;c I /qr�r ce dt cs J� LT 0
MAILING ADDRESS: P Lh / 7 /'j� ,L1 C
CITY/STATE/ZIP: pie P!4 �rL��c.A� /��ls / -74 ( Lj PHONE NUMBER:
♦ IS YOUR BUSINESS SUBJECT TO SALES TAX LAW? (if yes,provide copy of Sales Tax Certificate)---- YES—NO X
♦ WILL THERE BE ALCOHOLIC BEVERAGE SALES? (if yes,provide copy of Alcoholic Beverage Permit)-YES_NO V.
♦ PERMITS ARE REQUIRED FOR SIGNS. WILL ANY SIGNS BE INSTALLED?------------------- YES_NO-;i
♦ 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)----------------------------------------------------------- YESNO x
♦ WILL THERE BE ANY OUTSIDE STORAGE(including storage of company/fleet vehicles),DISPLAY,
USE OR DINING?------------------------------------------------------------------ YES—NO X
WILL ANY ALTERATIONS BE MADE TO THE SITE OR BUILDING?------------------------- YES NO
♦ IS BUILDING SPRINKLERED?------------------------------------------------------- YES NO
♦ WILL BUSINESS STORE OR HANDLE HAZARDOUS MATERIALS OR LIQUIDS?
(if yes,provide list of types&quantities,along with material safety data sheets)----------------------YES_NO X
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"e 'me of the scheduled inspection,a$42.00 re-inspection fee will be charged)
FOR QUESTIONS PLL(817) 0 1
SIGNATURE: PRINT NAME: f"kA 2 Zfx JY/fCL 45N
f
PHONE#: 17 Z :
The City of Grapevine * P.O.Box 95104 * Grapevine,Texas 76099 * (817)410-3165
Fax(817)410-3012 *www.grgpevinetexas.gov
O:FORMSMAPPLICATIOWC/
3/2212001/Rev:5/06,2/0],4/09,2/13,11/15,10/16,8/18
TEXAS SALES TAX
Texas Sales Tax is charged and collected on sales within the State and City 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.
�l9
Texas Sales Tax Number:
Signature:
WHERE DO YOU WANT YOUR COMPLETED CERTIFICATE OF OCCUPANCY MAILED?
ADDRESS: p D
CITY, STATE, ZIP:
OFFICE USE
TYPE OF CONSTRUCTION: \/ OCCUPANCY: ,HSDic l— DIVISION:
ZONING DISTRICT: CONDITIONAL USE: /V/4
PERMITTED USE: OCCUPANT LOAD: o2Q
BUILDING DEPARTMENT: �c/-'C DATE: 42- -2— 1�2
BUILDING INSPECTOR: Y t i " DATE: w i U.
ZONING APPROVAL: DATE:
FIRE DEPARTMENT: �a /dG� U l DATE: � �cSJj?U�yei
LOT DRAINAGE INSPECTION: DATE:
PUBLIC WORKS DEPARTMENT: DATE:
HEALTH DEPARTMENT: DATE:
CITY SECRETARY: DATE:
LANDSCAPING APPROVAL: �. DATE: b qSC -2d
APPROVAL FOR ISSUANCE: DATE:
0:FORM81O9APPLICATIONMCI
3122120011Rev:5/06,2/0],4/09,2113,11115,70/16,8118
- CERTIFICATE OF OCCUPANCY
i 1PE1 ]1Y Issue Date: December 18,2020
PROJECT DESCRIPTION:C/O(Medical Office)"Charles Mike Rios MD-Developmental Pediatrics"
(BLDG20.3511)
PROJECT# (817)410-3010 WWw.mygov.us
CO-20-3601 Inspections p Permits
City of Grapevine
P.O.Box 95104 LOCATION TENANT LEGAL
Grapevine,TX 76099
1100 S Main St. Charles Mike Rios MD- No.422William Dooley
(817)410-3165 Voice Suite#103 Developmental Pediatrics Survey Tr 1f01
(817)410-3012 Fax Grapevine,TX 76051
CONTRACTOR INFORMATION
Charles Mike Rios MD *CONSTRUCTION TYPE VB
1100 S. Main Street#103 *OCCUPANCY GROUP B-Medical
Grapevine,TX 76051
*OCCUPANCY LOAD 20
(972)786-6665 Phone
PERMITTED USE YES
*ZONING DISTRICT PO
OWNER NAME OF BUSINESS Charles Mike Rios MD-Developmental
Rebel Progenies II Ltd Pediatrics
6617 Precinct Line Rd Ste 200 TYPE OF BUSINESS Office
North Richland Hills, TX 761804389 **APPLICANT NAME Charles Mike Rios
AVAILABLE INSPECTIONS *"APPLICANT PHONE NUMBER 972-786-6665
� Final Building C/O Inspection (required) **TENANT NAME Charles Mike Rios MD
. Final Fire Dept Inspection (required) **TENANT PHONE NUMBER 817-310-5510
P Landscaping (required)
� C/O APPROVED FOR ISSUANCE Sales Tax NO
(required) *Sales Tax Number na
Alcoholic Beverage Sales NO
Alterations YES
Change of Business Name NO
Change of Business Owner NO
County Tarrant
Fire Sprinkler System? NO
Freight Forwarding Business NO
Hazardous Material NO
Industrial Waste NO
New Building/Addition NO
New Building or Property Owner NO
New Occupant/Tenant NO
Number of Employees 3
Outside Refuse/Recycling NO
Outside Storage NO
Signs NO
Square Footage 1158
Zoning PO-Professional Office
READ AND SIGN
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CERTIFICATE OF OCCUPANCY
WORKORDER
PERMIT # 20 - b0 1
ADDRESS OF INSPECTION: O O S CE E,t 7#�
DATE OF INSPECTION: TIME OF INSPECTION:
NAME OF BUSINESS: �ut)D � PC
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TYPE OF BUSINESS: o-k
USE OF BUILDING AND/OR PREMISES: 0 p�-k Ll L
REASON FOR APPLYING: C �� ��� SZ Lj Cat c L �CJC7`Cj
CONTACT PERSON: m l �4F R(. C)-)- �
TELEPHONE NUMBER:
COMMENTSNIOLATIONS:
**TO BE FILLED OUT BY BUILDING OFFICIAL**
r�
ZONING DISTRICT OF INSPECTION LOCATION: OCCUPANT LOAD: �O
TYPE OF BUILDING: V 1�5 GROUP AND DIVISION:
ZONING RESTRICTIONS:
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