HomeMy WebLinkAboutCO2021-2103UNDER CONSTRUCTION _
CORRECTION LETTER _
PW OR LID NEEDED _
TD NO LETTER _
WAITING FIRE _
HOLD _
CODE
C/O CHECK LIST
C/O PERMIT # P21
ADDRESS:
a _'3 "z' '.Z e�
BUSINESS NAME:
BUSINESS PROPERTY
_ CHANGE
NAME / OWNER _ NEW CONST / ADDITION PERMIT #
NEW TENANT / OCCUPANT REMODEL / ALTERATION PERMIT #
�1.
ISSUE DATE FINAL DATE
APPLICATION FORM COMPLETED
L/
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)
4.
FIRE DEPARTMENT APPROVAL OF HAZARDOUS MATERIAL DATE
5.
ZONING CHECKED & COMPLETED ON APPLICATION
1✓ 6.
BUILDING INSPECTION SCHEDULED DATE TIME /A
7.
FIRE DEPT. INSPECTION SCHEDULED DATE TIME
FIRE INSPECTOR:
8.
CITY SECRETARY (ALCOHOL) NOTIFICATION DATE:
9.
HEALTH INSPECTION NOTIFICATION DATE:
10.
PUBLIC WORKS INSPECTION E-MAIL DATE
1111.
LOT DRAINAGE INSPECTION E-MAIL DATE
✓�T2.
CORRECTION LETTER SENT DATE
13.
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)
17.
PUBLIC WORKS SIGN OFF
18
LOT DRAINAGE SIGN OFF
19.
LANDSCAPING SIGN OFF
20.
BUILDING OFFICIALS SIGNATURE
✓ 21.
7 7
C/O CERTIFICATE ISSUED ELECTRIC RELEASED: ' 1 U N 28 2021
SCAN CERTIFICATE TO MYGOV:
_
*CONDITIONS TO BE TYPED ON C/O? YES/NO MAILED:
O 1FORMSOSCOINFORMATIONICKUST
12130104\ Rev 11111.11V5.5118
JUN 18 ?071
DATE OF ISSUANCE:
PERMIT #: d ` - o? ) A 3
CERTIFICATE OF OCCUPANCY REOUEST
FEE: $50.00
NO FEE REQUIRED IF CERTIFICATE OF OCCUPANCY IS ASSOCIATED WITH ANACTIVE CURRENT BUILDING PERMIT
ADDRESS OF OCCUPANCY: Ire, E l /�Jn�.( SUITE # ')C)o
LOT: q2- BLOCK: SUBDIVISION:
****CERTIFICATE OF OCCUPANCY WILL NOT BE ISSUED WITHOUT LEGAL DESCRIPTION****
NAME OF BUSINESS: C .�,..% ,
NEW OCCUPANT: YES NO NEW BUILDING/PROPERTY OWNER: YES NO
NEW BUILDING: YES NO �— NEW BUSINESS NAME CHANGE: YES NO
NUMBER OF EMPLOYEES: FREIGHT FORWARDING: YES NO i
(a / NEW BUSINESS OWNER: YES NO
TYPE OF BUSINESS: o V C �Cw. i— SQUARE FOOTAGE: 103
(Example: Retail Clothing / Attorney's Office / Office -Warehouse / Restaurant),��
NAME OF TENANT [PERSON'S NAME]: N
CURRENT MAILING ADDRESS:
CITY/STATE/ZIP: / PHONE NUMBER:
PROPERTY OWNXR: LV4 hlwm� +r
MAILING ADDRESS: 636�K 9 b asp_
CITY/STATE/ZIP: S8 If-4 Ioz, t)ei; PHONE NUMBER: kt.) 3 3? 3t 3 3
♦ IS YOUR BUSINESS SUBJECT TO SALES TAX LAW? (if yes, provide copy of Sales Tax Certificate) - - - - YES _ NO
♦ WILL THERE BE ALCOHOLIC BEVERAGE SALES? (if yes, provide copy of Alcoholic Beverage Permit) - YES 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?------------------------------------------------------- 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 /
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/s s not provided at the time of the scheduled inspection, a $42.00 re -ins fiction fee witl be charged)
FOR QUESTIO P EA LL (817) 410.3165.
SIGNATURE: 1 _ PRINT NAME: "^ wh t ,7^i
PHONE #: 3 / 5 �/ ? EMAIL:
The City of Grapevine * P.O. Box 95104 * Grapevine, Texas 76099 * (817) 410-3165
Fax (817) 410-3012 * www.eraoevinetexas.eov
O: FOHMSmSAPPLICATIONS-FEES
3/20011aev:5106,2109,4109,013,11115,10/16,8118,10/20
TEXASSALESTAX
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.
Texas Sales Tax Number:
Signature:
WHERE DO YOU WANT YOUR COMPLETED CERTIFICATE OF OCCUPANCY MAILED?
ADDRESS:
CITY, STATE, ZIP:
OFFICE USE ONLYx x xx * x****x x** x***
TYPE OF CONSTRUCTION: V g OCCUPANCY
ZONING DISTRICT: t-C--
PERMITTED USE: A 10 OCC(lPA4x—f
BUILDING DEPARTMENT:
BUILDING INSPECTOR: G/tLz V v
ZONING APPROVAL:
FIRE DEPARTMENT:
LOT DRAINAGE INSPECTION:
PUBLIC WORKS DEPARTMENT:
HEALTH DEPARTMENT:
CITY SECRETARY- j
LANDSCAPING APPROVAI /l i
APPROVAL FOR ISSUANCE1
A-114- DIVISION:
CONDITIONAL USE: &b�l
OCCUPANT LOAD: // /L/�/4
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE: J�
DATE:
DATE: /!o ' 3�1Z
0: FORWDSAPPUGATIONS-FEES
312001/Rev:5/06,2/09,4/09,P113,11/15,10/16,8/18,10/20
City of Grapevine
P O Box 95104
Grapevine, TX 76099
(817) 410-3165 Voice
(817) 410-3012 Fax
CONTRACTOR
Dawn Przybylski
1650 W. Northwest Hwy.
Grapevine, TX 76051-0000
(817)337-3433 Phone
OWNER
L/e Aa Investments Llc
718 Muir Dr
Mountain View, CA 94041
CERTIFICATE OF OCCUPANCY
Issue Date: June 30, 2021
PROJECT DESCRIPTION: C/O Clean & Show
PROJECT#
CO-21-2103
LOCATION
2321 Ira E Woods Ave.
Suite # 200
Grapevine, TX 76051
AVAILABLE INSPECTIONS
Final Building C/O Inspection (required)
Landscaping (required)
C/O APPROVED FOR ISSUANCE
(required)
(817)410-3010
Inspections
TENANT
Clean & Show
ph. (817) 416-3991
INFORMATION
* CONDITIONAL USE REQUIRED?
* CONSTRUCTION TYPE
* OCCUPANCY GROUP
' OCCUPANCY LOAD
* PERMITTED USE
* ZONING DISTRICT
" NAME OF BUSINESS
** TYPE OF BUSINESS
**APPLICANT NAME
I *'APPLICANT PHONE NUMBER
**TENANT NAME
**TENANT PHONE NUMBER
*Sales Tax
*Sales Tax Number
Alcoholic Beverage Sales
Alterations
Change of Business Name
Change of Business Owner
County
Fire Sprinkler System?
Freight Forwarding Business
Hazardous Material
Industrial Waste
New Building / Addition
New Building or Property Owner
New Occupant/Tenant
Number of Employees
Outside Refuse/Recycling
Outside Storage
Signs
Square Footage
Zoning
FEES
www.mygov.us
Permits
LEGAL
D F W Business Park Addition
Bilk 1 Lot 9a
N/A
VB
No Occupancy
N/A
N/A
CC
Vacant
Clean and Show
Dawn Przybylski
817-337-3433
Vacant
000-000-0000
NO
NO
NO
NO
NO
Tarrant
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
1933
CC - Community Commercial
TOTAL = $ 50.00
MYGOV US City of Grapevine I CERTIFICATE OF OCCUPANCY I CO-21-2103 I Pnnted 07/01/21 at 831 a.m Page 1 of 3
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CERTIFICATE OF OCCUPANCY
WORKORDER
PERMIT # 21 - o;� 16 - i
ADDRESS OF INSPECTION: 32 J
DATE OF INSPECTION: �o/o��/o�.?� TIME OF INSPECTION: Il% &v Coilt�
NAME OF BUSINESS:
TYPE OF BUSINESS:
USE OF BUILDING AND/OR PREMISES:
REASON FOR APPLYING:'
CONTACT PERSON:
TELEPHONE NUMBER: SJ/ %- �33
COMMENTS/VIOLATIONS:
ObA Ok -(-j rr I r asL �✓
**TO BE FILLED OUT BY BUILDING OFFICIAL**
ZONING DISTRICT OF INSPECTION LOCATION: CC- OCCUPANT LOAD:
TYPE OF BUILDING: vis
ZONING RESTRICTIONS:
GROUP AND DIVISION
A114
A) 0 OC.0 UPA./C Y
0 MRMSUSCOIPFORMATIONWORROR ER
12
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