HomeMy WebLinkAboutHLP2022-3297City of Grapevine
P.O. Box 95104
Grapevine, TX 76099
(817) 410-3166 Voice
(817) 410-3012 Fax
HELICOPTER LIFT PERMIT
Issue Date: September 20, 2022
PROJECT DESCRIPTION: Helicopter Lift for "Earthbound Trading Co. Inc." September 21, 2022 @7:30 a.m.
with Raindate of October 5, 2022 @ 7:30 a.m.
PROJECT #
HLP-22-3297
(817) 410-3010
Inspections
www.mygov.us
Permits
LOCATION TENANT LEGAL
3000 Grapevine Mills Pkwy.
Suite # 334
Grapevine, TX 76051
Earthbound Trading Co Inc Grapevine Mills Addition Blk
1 Lot 1r3
No. 1220 Tr 1R3
*41307097*
CONTRACTOR
5 State Helicopters Inc
285 Blackland Rd.
Fate, TX 75189
(972) 636-4009 Phone
(903) 303-7383 Fax
OWNER
Grapevine Mills Mall Lp
INFORMATION
**APPLICANT NAME Susan Bitros
**APPLICANT PHONE NUMBER 9726364009
APPROVAL CITY MANAGER YES
APPROVAL DEVELOPMENT SERVICES YES
APPROVAL RISK MANAGEMENT YES
County Tarrant
DATE & TIME OF HELICOPTER LIFT 2022-09-21 07:30 am
RAIN DATE FOR HELICOPTER LIFT 2022-10-05 07:30 am
Zoning CC - Community Commercial
MYGOV.US City of Grapevine | HELICOPTER LIFT PERMIT | HLP-22-3297 | Printed 09/20/22 at 3:12 p.m. Page 1 of 1
DATE:
TO:FAAOFFICE
REFERENCE:CONGESTED / CONTINGENCY - SAFETYPLAN
**SHOULD A WEATHER,MECHANICALORMATERIALDELAYBEEXPERIENCED,THISPLAN
ISAPPROVEDFORABOVELISTEDDATEPLUS14CALENDARDAYS.**
AIRCRAFTINFORMATION: N6BL
N4XY
SIKORSKY S-58T TRANSPORT CATEGORY
SIKORSKY S-58T TRANSPORT CATEGORY
^/<KZ^<z^ͲϱϴddZE^WKZdd 'KZzEϵsz
N170MC
EϲϬ
MESSERSCHMITT TRANSPORTCATEGORY
PILOTINFORMATION: ROBERTSMITH
PREPAREDBY:
APPROVED BY:
OPERATING CERTIFICATE #LDUL599B
285 BLACKLAND ROAD
FATE,TEXAS75189
(972) 636-4009
^/<KZ^<zh,ͲϲϬZ ^dZ/d d 'KZz
SHAWN HARRIS
COMMERCIALCERTIFICATE # 3493515
ATP # 2727633
NORTH TEXAS FSDO
&$3$
Grapevine Mills Mall- Earthbound
3000 Grapevine Mills Pkwy
Grapevine, TX
CMS /Nextech
3923 Morse St. Suite 101
Denton, TX 76208
James (Matt) Overton -
321-473-0392
James (Matt) Overton
321-473-0392
6HSWHPEHU, 2022
6HSWHPEHU, 2022
7:30AM - 9:30AM
Susan Bitros
STEVEN L MOODY
Digitally signed by STEVEN L
MOODY
Date: 2022.09.19 09:24:12 -05'00'
LOAD DESCRIPTION
HAZMAT: YES (DOT-SP 16606 & DOT-SP 20490) NO
ROOFTOP UNITS
MATERIALS
EQUIPMENT
OTHER:
NUMBER OF TOTAL LIFTS (RANGE)
WEIGHT RANGE PERCENTAGE OF LIFT ABILITY OF AIRCRAFT
LOAD AERODYNAMIC: YES NO
LENGTH OF ATTACHING GEAR (FROM HOOK TO BOTTOM OF LOAD)
BUILDING OCCUPIED DURING LIFT: YES NO
* IF YES, ESTIMATED LOAD PENETRATION OF FLOORS
AREA CONSIDERED CONGESTED: YES NO
OPERATING CERTIFICATE # LDUL599B
285BLACKLANDROAD
FATE,TEXAS75189
(972) 636-4009
85'
XX
XX
XX
XX
2 - 10
300 3,000 71%
APPROVED
NTX FSDO SW19
STEVEN L
MOODY
Digitally signed by
STEVEN L MOODY
Date: 2022.09.19
09:23:00 -05'00'
285 BLACKLAND ROAD
FATE, TEXAS 75189
(972) 636-4009
______ CONGESTED COMMERCIAL AREA
______ CONGESTED RESIDENTIAL AREA
______ 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 in a 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 building ŝŶƐŝĚĞƚŚĞŽƉĞƌĂƚŝŽŶĂůĂƌĞĂwill be vacant during operations.
XX
APPROVED
NTX FSDO SW19
STEVEN L
MOODY
Digitally signed by
STEVEN L MOODY
Date: 2022.09.19
09:21:52 -05'00'
285 BLACKLAND ROAD
FATE, TEXAS 75189
(972) 636-4009
Notification of Grapevine City Officials
5 State Helicopters has contacted the following city officials about the lift to be
performed on6HSWHPEHU, 2022: 000 Grapevine Mills Pkwy Grapevine, TX
City Manager: Connie Cook817-410-3155
Your message has been delivered to the following recipients:
on 6HSWHPEHU, 2022 in at approximately 7:0 AM
-9:0 AM.
Police: Mike Hamlin 817-410-3225
Your message has been delivered to the following recipients:
Subject: First Responders: 5 State Helicopter Lift of HVAC Equipment on 6HSWHPEHUin Grapevine, Texas at
approximately 7:0AM- 9:0AM.
Fire Chief: Darrell Brown817-410-4400
Your message has been delivered to the following recipients:
Subject: First Responders: 5 State Helicopter Lift of HVAC Equipment on 6HSWHPEHUin Grapevine, Texas at
approximately 7:0AM- 9:0AM.
ATC: Dallas Fort Worth Intl. Airport 972-615-2650
Your message has been delivered to the following recipients:
Subject: ATC Permission: 5 State Helicopters lift operations 4NM of KDFW on 6HSWHPEHU.
Best Regards,
5 State Helicopters
APPROVED
NTX FSDO SW19
STEVEN L
MOODY
Digitally signed by
STEVEN L MOODY
Date: 2022.09.19
09:20:43 -05'00'
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3353 Peachtree Road NE, Suite 1000
Atlanta, GA 30326
Certificate of Insurance
Certificate Number:2.1
Issued By and Date:FEBRUARY 15, 2022 (AR)
By
Starr 10200 (6/06)(Authorized Representative)
This is to certify that the policy(ies) listed herein have been issued providing coverage for the listed insured as further described. This certificate of insurance is not an insurance policy and does not amend, extend, or alter the coverage afforded by the policy(ies) listed herein. Notwithstanding any requirement, term or condition of any contract, or other document with respect to which this certificate of insurance may be concerned or may pertain, the Insurance afforded by the policy(ies) listed on this certificate is subject to all the terms, exclusions, and conditions of such policy(ies).
Aircraft:Reg Insured Deductibles
Year Make and Model No.Value NIM / IM Liability Limit
- SEE ATTACHED ⠀ $ $ $
FLEET SCHEDULE - ⠀ $ $ $
$ $ $
$ $ $
$ $ $
$ $ $
THE CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED, BUT SOLELY AS RESPECTS THE OPERATIONS OF THE NAMED INSURED.
THE INSURANCE EVIDENCED BY THIS CERTIFICATE SHALL NOT APPLY TO, AND NO PERSON OR ORGANIZATION TO WHICH COVERAGE IS
EVIDENCED IN THE CERTIFICATE SHALL BE INSURED FOR BODILY INJURY OR PROPERTY DAMAGE WHICH ARISES FROM THE DESIGN,
MANUFACTURE, MODIFICATION, REPAIR, SALE, OR SERVICING OF AIRCRAFT BY THAT PERSON OR ORGANIZATION.
Certificate Holder:CITY OF GRAPEVINE
200 S. MAIN STREET
GRAPEVINE, TX 76051
Named Insured:5-STATE HELICOPTERS, INC., CENTERPOINTE AEROSPACE AND AVIATION RESOURCES
HOLDINGS LLC
285 BLACKLAND ROAD
ROYSE CITY, TX 75189-4746
Policy Period: From:⠀FEBRUARY 15, 2022 ⠀To:⠀FEBRUARY 15, 2023 ⠀
Policy Number:SASICOM60184922-02 ⠀
Issuing Company:STARR INDEMNITY & LIABILITY COMPANY ⠀
3353 Peachtree Road NE, Suite 1000
Atlanta, GA 30326
Issued By and Date:FEBRUARY 15, 2022 (AR)
Certificate of Insurance – Fleet Schedule Attachment
Named Insured:5-STATE HELICOPTERS, INC., CENTERPOINTE AEROSPACE AND AVIATION RESOURCES
HOLDINGS LLC
285 BLACKLAND ROAD
ROYSE CITY, TX 75189-4746
Policy Period:From:⠀February 15, 2022 ⠀To:⠀February 15, 2023 ⠀
Policy Number:SASICOM60184922-02 ⠀
Year Make and Model Reg
No.
Insured Value Deductibles
NIM / IM
Liability Limit Passenger Sublimit
1985 SIKORSKY UH-60A N244AA $2,000,000 10% OF IV / 10% OF IV $5,000,000 CSL INCL PAX
1990 EUROCOPTER BK 117 B-
1
N170MC $850,000 10% OF IV / 10% OF IV $5,000,000 CSL INCL PAX
1957 SIKORSKY S-58T N4XY $650,000 10% OF IV / 10% OF IV $5,000,000 CSL INCL PAX
1962 SIKORSKY S-58DT N9VY $650,000 10% OF IV / 10% OF IV $5,000,000 CSL INCL PAX
Starr 10284 (3/06)
ADDITIONAL INSURED ENDORSEMENT
This policy is amended as follows:
The provisions of this endorsement shall apply with respect to:
(Only the clause(s) indicated by an "X" shall apply.)
The scheduled persons or organizations are included as additional insured.
The scheduled persons or organizations are the registered owner of
and are included as additional insured.
The scheduled persons or organizations are included as additional insured but only as respects liability
coverages.
The scheduled persons or organizations are included as additional insured under liability coverages, but only as
respects operations of the named insured.
The scheduled persons or organizations are included as additional insured but only as respects operations of the
named insured.
The insurance extended by this endorsement shall not apply to, and no person or organization named in the
schedule shall be insured for bodily injury or property damage which arises from the design, manufacture,
modification, repair, sale, or servicing of aircraft by that person or organization.
Schedule:
Name
Address
CITY OF GRAPEVINE
200 S. MAIN STREET
GRAPEVINE, TX 76051
Name
Address
Name
Address
All other provisions of this policy remain the same.
This endorsement becomes effective FEBRUARY 15, 2022 to be attached to and hereby made a part of:
SASICOM60184922-02
5-STATE HELICOPTERS, INC., CENTERPOINTE AEROSPACE AND AVIATION RESOURCES HOLDINGS
LLC
By STARR INDEMNITY & LIABILITY COMPANY
Endorsement No. TBA
Date of Issue FEBRUARY 15, 2022 (AR) ⠀By
(Authorized Representative)
Policy No.
Issued to
9-21-22 10-05-22
EarthBound Ste# 334 3000 Grapevine Mills Pkwy Grapevine, TX 76051
19th September 2
Shawn Harris
TEXAS Rockwall
19th September 2
TEXAS
08-26-2024
Operational Area
Flight Path
Landing Area
Staging area
Emergency Area
Blocked Areas
32°58’ 07.4”N
97°02’ 29.2”W
Grapevine Mills Mall
Earthbound &Camille La Vie
3000 Grapevine Mills Pkwy
Grapevine,TX 76051
Date of Lift:
09/21/2022
Time:
7:30AM
32°58'07.4"N
97°02'29.2"W
Grapevine Mills Mall
Earthbound
3000 Grapevine Mills Pkwy
Grapevine, TX 76051
Date of Lift:
09/21/22
Time:
7:30AM
32°58'07.4"N
97°02'29.2"W
Helicopter will not
Be more than 125’
Above a 40’ building
When air lifting
Equipment to the
Roof.
Pilot will contact
Dallas Fort Worth
Airport.
Grapevine Mills Mall
Earthbound
3000 Grapevine Mills
Pkwy Grapevine, TX
76051
Date of Lift:
09/21/22
Time:
7:00AM
Operational Area
Flight Path
Landing Area
Staging area
Emergency Area
Blocked Areas
32°58’ 07.4”N
97°02’ 29.2”W
Grapevine Mills Mall
Earthbound &Camille La Vie
3000 Grapevine Mills Pkwy
Grapevine,TX 76051
Date of Lift:
09/21/2022
Time:
7:30AM
32°58'07.4"N
97°02'29.2"W
Grapevine Mills Mall
Earthbound
3000 Grapevine Mills Pkwy
Grapevine, TX 76051
Date of Lift:
09/21/22
Time:
7:30AM
32°58'07.4"N
97°02'29.2"W
Helicopter will not
Be more than 125’
Above a 40’ building
When air lifting
Equipment to the
Roof.
Pilot will contact
Dallas Fort Worth
Airport.
Grapevine Mills Mall
Earthbound
3000 Grapevine Mills
Pkwy Grapevine, TX
76051
Date of Lift:
09/21/22
Time:
7:00AM