HomeMy WebLinkAboutCO2022-0291UNDER CONSTRUCTION
CORRECTION LETTER
PW OR LD NEEDED
TD NO LETTER
WAITING FIRE
HOLD
CODE
CIO CHECK LIST
C/O PERMIT # P22 - P
ADDRESS: A- GGi/Y�f
BUSINESS NAME:
BUSINESS /PROPERTY
CHANGE NAME / OWNER NEW CONST / ADDITION PERMIT #
NEW TENANT / OCCUPANT REMODEL / ALTERATION PERMIT #
ISSUE DATE FINAL DATE
APPLICATION FORM COMPLETED
h"' 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 6. BUILDING INSPECTION SCHEDULED DATE/1-4 TIME 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
11. LOT DRAINAGE INSPECTION E-MAIL DATE
12. CORRECTION LETTER SENT DATE
13. BUILDING INSPECTORS SIGN OFF LETTER: YES / NO
14. FIRE DEPARTMENTS SIGN OFF LETTER: YES / O
15. HEALTH DEPARTMENT SIGN OFF
16. CITY SECRETARY (Alcohol License Sign Off)
17. PUBLIC WORKS SIGN OFF
�.5 " LOT DRAINAGE SIGN OFF
119. LANDSCAPING SIGN OFF
20. BUILDING OFFICIALS SIGNATURE
21. C/O CERTIFICATE ISSUED ELECTRIC RELEASED: F E B 15 2022
SCAN CERTIFICATE TO MYGOV:
CONDITIONS TO BE TYPED ON r_In? YFA / Nn MAILED:
O:IFORMSIDSCOINFORMATIONICKLIST
12/301041 Rev.11\11,11115.5118
, . JAN 2 4 2022
DATE OF ISSUANC&F E B 2 2 202k
PERAIIT a bob
CERTIFICATE OF OCCUPANCY REQUEST
FEE: $50.00
NO FEE REQUIRED IF CERTIFICATE OF OCCUPANCY IS ASSOCIATED WITH AIV ACTIVE CURRENTBUH.DING PERMIT
ADDRESS OF OCCUPANCY: ! `f3 2 a.ri C &- r 7 e r Dr, Sumw� # 2 b 3
LOT: -1 R I BLOCK: 2 SUBDIVISION:. Pe. r k
****CERTIFICATE OF OCCUPANCY WILL NOT BE ISSUED WITHOUT LEGAL DESCRIPTION""
NAME OF BUSINESS: ■_ .� ;'• c� J
NEW OCCUPANT: YES _ j NO NEW BUILDINGfPROPERTY OWNER: YESNO ve
NO ve
NEW BUILDING: YES NOT NEW BUSINESS NAME CHANGE: � NO
NUMBER OF EMPLOYEES: - FREIGHT FORWARDING: YES NO �_
NEW BUSINESS OWNER:
TYPE OF BUSINESS: In e j i c a' 1 L
(Em,Vjw Reba eao*img lA rotas Ommi Omc-Wmrd�
NAME OF TENANT [PERSON'S N"E- : , fir+ : y+ o x 6
l Al
CURRENT MAILING ADDRESS: 3911 7 r•� w 4loC.. R 1 ..
- PHONE NUM30h , V 6 4- J 3-'-89L -&-
C T`Y/STATFJZIP: AJ I� `tV - 7.. a f 9
PROPERTY OWNER: 74 4v. R W G are— v
MAILING ADDRESS: { 6 'Sr. ,� .e •, �' �e r D r' m 46,
SQUARE FOOTAGE.- �-5 19
/AI'V15
3 i�33
CITY/STATE/ZIP: G .� �: 'T�'- .fit° PHONE NUMBER:
♦ IS YOUR BUSINESS SUBJECT TO SALES TAX LAW? (if yea, provide copy of Sales Tax Certificate) - - - - YES NO
♦ WILL THERE BE ALCOHOLIC BEVERAGE SALES? (if yes, Provide copy of Alcoholic Beverage Permit) -YES NO
♦ pERpAM 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 REFUSFJBECYCLINGJCOMPACTING CONTAINERS BE NECESSARY? ----------
YES NO ✓
(if yes, screening isrequred) -------------------------------------------------
♦ WILL THERE BE ANY OUTSIDE STORAGE (- - - ' ' ' "' +1� storage of company/fleet vehicles), DISPLAY,
USEOR DINING?------------------------------------------------------------------ YES NO ✓
♦ WILL ANY ALTERATIONS BE MADE TO THE SITE OR BUILDING? - - - - - - - - - - - - - - - - - - - - - - - - - YES NO
♦ ISBUILDING SPRU cruxW"?------------------------------------------------------- YES ✓ NO
♦ WILL BUSINESS STORE OR HANDLE HAZARDOUS MATERIALS OR LIQUIDS? _ .. - -YES N D
(if yea, provide Bat of types & quantities, along with material safety data sheets) - - - - - - - - - - - - - - - - -
I HEREBY CERTIFY THAT THE FOREGOING IS CORRECT TO THE BEST OF MY KNOWLEDGE AND THE SA Ill
OCCUPANCY IS IN CONFORMANCE WITH THE INFORMATION HEREIN SET FORTH.
(If access to the buf dingfspace is not p ed at the time of the scheduled inspection, a 542.00 re inRaxtion fee will be
FOR QUESTIONS PLEASE CALL 410�165.
SIGNATURE:. PRINT NAME: �Jfi a S s 13 e� � r •� . .
:r-n%
PHONE � ..�' P 3
City of Grapevine * P.O. Box 95104 * Grapevine, Texas 76099 * (817) 410-3165
Fax (817) 410-3012 * ,.r v,`�,,t-..psancvinetexas.aov
a�0otlniw: a+oes�,yay+si�na,�ons,�+tat+�
meT.ec,,R,/i Rv,T1�
e
x
s Sales Taxis charged and coleebed au sales eswithin a e Stme and Chy vt Grsp�, Tens et" �'x
fie "nbk
s include butteb e pemnal proparty, spedi;ed services.It you sinein s � that wf be seaa m �whin the (Sty of Grapevine, Tezas you wffi be regWred to collect SlWe and Dona SmW Tax in the amount of L25` .
A "Sdkw or Romer" means a person engaged is the buAN= of sealdag saks of "tuabae itemd", a* reodko" tlr "wider are
isduded In the messme of sales or use x oa.
The tCrm, "pbm of bnsinese indkWles aQY In-cadoia at wbkb three or more orders are reedvW by the "SeEkT or Rs�
In a r7 I r %" I ' yew
. If an ardtr is l+eceived at the pl H ce of bnajaem Of a rdAcr In TWO, but ddivery Or ddP� is made
from a bestiou within the state other than the retailer's place of bud oem State sad MW ash tax is due and is to
the city wbere the order was received.
I have read the above and I m 1 t - psnd tbat I wN be regain d m pR ova a copy ct the Saks Tss Perodt to the Cliy of
Grapavise; Tres if the drcmmdaum appa m to aq baduem
32075958861
Tens Saks Tax N -
1010In=
WHERE DO YOU WANT YOUR COM ETED DTI
f ATE OF OCCUPANCY MAILED?
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CITY, STATE, zip. r. �, .. r�,r•,� `T`x-. r7S O A f)
OFFICE USE ONLY
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TYPE of cnNST�UCT�ON: . Tr,coo
CONDMONAL USE: ,
ZormNG Dasrl:�cT: .
. S OccupANT LOAD: 1 S
� ��p��� DAM.,
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DATE:
ZONING APPROVAL: , DA'I'E:
FIBS DEPAI: `� �a �N a.f�� -�C�.�_/� �}!� .� DATE:
r�
LOT DRAINAGE INSFEC1i4N: , DATE: �r
PUMJC WORKS DEPARTMENT: � DATS: -
HEALTH DEPAYZMRNT-. , DATE:
®,�.Y DATE:
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. M _VD INDU51 MIL-BLw ry: C•'Fip6O +1 .
� i � l 1 inch = 4U0 feet Grid Page: o .. D '°• � _
City of Grapevine
P.O. Box 95104
Grapevine, TX 76099
(817) 410-3166 Voice
(817) 410-3012 Fax
CONTRACTOR
chris bogard
1643 Lancaster, Ste. #201
Grapevine, TX 76051-0000
(214) 837-0495 Phone
CERTIFICATE OF OCCUPANCY
Issue Date: February 22, 2022
PROJECT DESCRIPTION: C/O [Medical Clinic] "Genesis Lifestyle" [LANDSCAPING]
PROJECT #
CO-22-0291
LOCATION
1643 Lancaster Dr.
Suite # 203
Grapevine, TX 76051
OWNER
HR Acquisition Of San Antonio
3310 West End Ave Ste 700
Nashville, TN 37203
AVAILABLE INSPECTIONS
Final Building C/O Inspection (required)
► Final Fire Dept Inspection (required)
► Landscaping (required)
► C/O APPROVED FOR ISSUANCE
(required)
(817) 410-3010 www.mygov.us
Inspections Permits
TENANT LEGAL
Genesis Lifestyle Clearview Park Addition Blk 2
Lot 1 R1
Acres 2.1521
INFORMATION
* CONDITIONAL USE REQUIRED?
NO
* CONSTRUCTION TYPE
IIB - Sprinklered
* OCCUPANCY GROUP
B
* OCCUPANCY LOAD
15
* PERMITTED USE
YES
* ZONING DISTRICT
CC
** NAME OF BUSINESS
Genesis Lifestyle
** TYPE OF BUSINESS
Medical Clinic
**APPLICANT NAME
Chris Bogard
**APPLICANT PHONE NUMBER
214-837-0495
**TENANT NAME
Alex Spinoso
**TENANT PHONE NUMBER
760-835-8962
*Sales Tax
YES
*Sales Tax Number
32075958861
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
Zoning
FEES
ID ly
CC - Community Commercial
TOTAL = $ 50.00
CERTIFICATE OF OCCUPANCY
WORKORDER
PERMIT # 22 -
ADDRESS OF INSPECTION:�-
DATE OF INSPECTION: � �r T` v Z �' TIME OF INSPECTION:
NAME OF BUSINESS:
TYPE OF BUSINESS: Q�
USE OF BUILDING AND/OR !PREMISES:
REASON FOR APPLYING:
CONTACT PERSON:
TELEPHONE NUMBER: ' g.3 9" 7 I S
COMMENTSNIOLATIONS:
/vrecJ base o-ic �,'IP-f--� 11,reeJ vPri�{r� /OGat��►� o-�"
!,•Jot fete `ea-fT- and Q,CLPss -to L,-Ja-ter heaf-ef-
� [ [ C6� to -F� d �`� r .mac c e �n Q IV �S � I' i n i rx. i �,n� I -,.•� 2 -�1I1-- Z
**TO BE FILLED OUT BY BUILDING OFFICIAL**
ZONING DISTRICT OF INSPECTION LOCATION: OCCUPANT LOAD:
TYPE OF BUILDING:.T$,cPZJ Vle.L GROUP AND DIVISION: 0
ZONING RESTRICTIONS: y 1
Y: A jo"rc- ro i.alspecTO M : Fee-+'t c J r0 - A& 2.9 �l SO 63 t)EFO Io
OFORMS DSCOINFORMATION WORKORDER
2 10
04 R- 1 17 2006
ZA
City of Grapevine
CERTIFICATE OF OCCUPANCY
s City of Grapevine
This Certificate Of Occupancy is hereby issued pursuant to Section 109 of the 2006 International Building Code And Chapter 64 of the
_i City Of Grapevine Comprehensive Zoning Ordinance. At the time of inspection, this building or space was found to be in compliance
with the applicable Building and Zoning Ordinances of the City of Grapevine. Any change in use, tenant and/or owner of this
building/space shall first require a new Certificate of Occupancy.
PERMIT ID # CO-22-0291
Tenant / Business Property Owner
Genesis Lifestyle `'' - ty , pp rr HR Acquisition Of San Antonio
1643 Lancaster Dr. iL� 1 ~ 3310 West End Ave Ste 700
Suite # 203 ►'. T i Nashville TN 37203
Grapevine TX 76051
i
1
Use Classification Medical Clinic Issued By:
Occupancy Group B
Construction Type IIB - S rinklered� 22�2Z
p Don Dixson, Building Official Date
Occupancy Load 15
Zoning District CC - Community Commercial
i
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