HomeMy WebLinkAboutHLP2023-004087ADDRESS
3000 Grapevine Mills
Pkwy., Shell
Grapevine, TX 76051
LEGAL
Grapevine Mills Addition
Blk 1 Lot 1r3
S
PERMIT HOLDER
Susan Bitros
5 State Helicopters Inc
(972) 636-4009
COLLABORATORS
•Susan Bitros
5 State Helicopters Inc
(972) 636-4009
OWNERS
•Grapevine Mills Mall
Lp
(317) 636-1600
TENANTS
•Grapevine Mills Shell
Building
INFORMATION FIELDS
**APPLICANT NAME (Individual)Susan Bitros
DATE & TIME OF HELICOPTER LIFT 11/19/2023 7:00 AM
RAIN DATE FOR HELICOPTER LIFT 11/30/2023 7:00 AM
READ AND SIGN
Any changes to the date of the lift (not including the rain date) will require a new
application to be submitted and reviewed.
November 15, 2023
Signature Date
City of Grapevine
PO Box 95104
Grapevine, Texas 76099
817) 410-3166
Helicopter Lift Permit
Project # 23-004087
Project Description: Helicopter Lift Permit [November 19, 2023
@ 7:30 a.m. with Raindate of November 30, 2023 @ 7:30 a.m.]
"Grapevine Mills Mall" Mechanical Permit 23-3377
Issued on: 11/15/2023 at 2:59 PM
MYGOV.US 23-004087, 11/15/2023 at 2:59 PM Issued by: Connie Cook
Page 1/2
ADDRESS
3000 Grapevine Mills
Pkwy., Shell
Grapevine, TX 76051
LEGAL
Grapevine Mills Addition
Blk 1 Lot 1r3
S
PERMIT HOLDER
John E. Smith
Dallas Mechanical Group
(972) 234-4822
COLLABORATORS
•John E. Smith
Dallas Mechanical
Group
(972) 234-4822
OWNERS
•Grapevine Mills Mall
Lp
(317) 636-1600
TENANTS
•Grapevine Mills Shell
Building
INSPECTIONS 3
1. Mechanical Duct
2. Mechanical Ceiling
3. Mechanical Final
INFORMATION FIELDS
**APPLICANT NAME (Individual)John Smtih
**APPLICANT PHONE NUMBER 9722344822
VALUATION 526175.00
Is Duct Work Being Installed?YES
FEE TOTAL PAID DUE
Mechanical Permit Fee
{Value}$ 2,905.53 $ 2,905.53 $ 2,905.53
TOTALS $ 2,905.53 $ 2,905.53 $ 0.00
READ AND SIGN
I HEREBY CERTIFY THAT THE FOREGOING IS CORRECT TO THE BEST OF
MY KNOWLEDGE AND ALL WORK WILL BE PERFORMED ACCORDING TO
THE DOCUMENTS APPROVED BY THE BUILDING DEPARTMENT AND IN
COMPLIANCE WITH THE CITY OF GRAPEVINE CODES REGULATING
CONSTRUCTION. IT IS UNDERSTOOD THAT THE ISSUANCE OF THIS PERMIT
DOES NOT GRANT OR AUTHORIZE ANY VIOLATION OF ANY CODE OR
ORDINANCE OF THE CITY OF GRAPEVINE.
I FURTHER CERTIFY THAT ALL WORK THAT IS REQUIRED TO COMPLY WITH
ANY FEDERAL, STATE, AND / OR LOCAL LAW REGARDING ENERGY
CONSERVATION WILL BE PERFORMED IN ACCORDANCE WITH THOSE
LAWS, AND THAT VERIFICATION OF ENERGY CODE COMPLIANCE SHALL BE
SUBMITTED TO THE CITY UPON REQUEST.
September 19, 2023
Signature Date
City of Grapevine
PO Box 95104
Grapevine, Texas 76099
817) 410-3166
Mechanical Permit
{VALUE}
Project # 23-003377
Project Description: Replacing 6 rooftop units, 8 smoke
exhaust fans with dampers and 10 gravity hoods with
dampers."Grapevine Mills Mall" (Shell Building)
Issued on: 09/19/2023 at 12:49 PM
MYGOV.US 23-003377, 09/19/2023 at 12:49 PM Issued by: Connie Cook
Page 1/2
3353 Peachtree Road NE, Suite 1000
Atlanta, GA 30326
Certificate of Insurance
Certificate Number:2.1
Issued By and Date:FEBRUARY 14, 2023 (BAR)
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, 2023 ⠀To:⠀FEBRUARY 15, 2024 ⠀
Policy Number:SASICOM60184923-03 ⠀
Issuing Company:STARR INDEMNITY & LIABILITY COMPANY ⠀
Starr 10284 (3/06)
ADDITIONAL INSURED ENDORSEMENT
This policy is amended as follows:
The provisions of this endorsement shall apply with respect to:ALL SCHEDULED AIRCRAFT ⠀
(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
⠀
⠀
All other provisions of this policy remain the same.
This endorsement becomes effective FEBRUARY 15, 2023 to be attached to and hereby made a part of:
SASICOM60184923-03
5-STATE HELICOPTERS, INC., CENTERPOINTE AEROSPACE AND AVIATION RESOURCES HOLDINGS
LLC
By STARR INDEMNITY & LIABILITY COMPANY
Endorsement No. TBA
Date of Issue FEBRUARY 14, 2023 (BAR) ⠀By
(Authorized Representative)
Policy No.
Issued to
3353 Peachtree Road NE, Suite 1000
Atlanta, GA 30326
Issued By and Date:FEBRUARY 14, 2023 (BAR)
(Authorized Representative)
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, 2023 ⠀To:⠀February 15, 2024 ⠀
Policy Number:SASICOM60184923-03 ⠀
Year Make and Model Reg
No.
Insured Value Deductibles
NIM / IM
Liability Limit Passenger Sublimit
1962 SIKORSKY S-58DT N9VY $650,000 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
1990 EUROCOPTER BK 117 B-
1
N170MC $850,000 10% OF IV / 10% OF IV $5,000,000 CSL INCL PAX
1985 SIKORSKY UH-60A N60A $1,800,000 10% OF IV / 10% OF IV $5,000,000 CSL INCL PAX
CAP#________
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/dd'KZz
SHAWN HARRIS
ZKZdDZK
sEtE
COMMERCIALCERTIFICATE # 3493515
ATP # 2727633
KDDZ/>Zd/&/d η ϮϴϬϳϭϮϱ
COMMERCIALCERTIFICATE # 3ϳϮϬϳϯϴ
111923
November 14, 2023
North Texas FSDO
November 19, 2023
7:30AM - 10:00AM
Grapevine Mills Mall
3000 Grapevine Mills Pkwy
Grapevine, TX 76051
Wesley Weaver
972-400-1361
Wesley Weaver
972-400-1361
Dallas Mechanical Group
18383 Preston Rd. Ste 410
Dallas, 75252
Susan Bitros
APPROVED
NTX FSDO SW19
Digitally signed by
MICHAEL S KIMBALL
Date: 2023.11.15 10:01:13
-06'00'
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
WWW.5STATE.COM
XX
XX
5 20
500 3,000 71%
XX
85'
XX (if yes see narrative)
XX
285 BLACKLAND ROAD
FATE, TEXAS 75189
(972) 636-4009
WWW.5STATE.COM
______ 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 a mall in a residential and 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 inside the operational area will be vacant during operations.
XX
XX
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 on November 19, 2023: 3000 Grapevine Mills Pkwy Grapevine, TX 76051
City Manager: Connie Cook 817-410-3155
Your message has been delivered to the following recipients:
Subject: 5 State Helicopter Lift of HVAC Equipment November 19, 2023 in Grapevine, TX at
approximately 7:30 AM - 10:00 AM.
Police: Mike Hamlin 817-410-3225
Your message has been delivered to the following recipients:
Subject: 5 State Helicopter Lift of HVAC Equipment 19 November 2023 in Grapevine, Texas at
approximately 7:30AM-10:00AM.
Fire: Darrell Brown 817-410-4400
Your message has been delivered to the following recipients:
Subject: 5 State Helicopter Lift of HVAC Equipment 19 November 2023 in Grapevine, Texas at
approximately 7:30AM-10:00AM.
ATC: Dallas Fort Worth Intl. Airport 972-615-2650
Your message has been delivered to the following recipients:
'
Subject: 5 State Helicopters lift operations 4 miles North of DFW on November ,19, 2023.
Best Regards,
5 State Helicopters5SHli
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CAP#________
DATE:
TO: FAA OFFICE
REFERENCE: CONGESTED / CONTINGENCY - SAFETY PLAN
** SHOULD A WEATHER, MECHANICAL OR MATERIAL DELAY BE EXPERIENCED, THIS PLAN
IS APPROVED FOR ABOVE LISTED DATE PLUS 14 CALENDAR DAYS. **
AIRCRAFT INFORMATION: N6BL
N4XY
SIKORSKY S-58T TRANSPORT CATEGORY
SIKORSKY S-58T TRANSPORT CATEGORY
SIKORSKY S-58T TRANSPORT CATEGORY N9VY
N170MC
N60A
MESSERSCHMITT TRANSPORT CATEGORY
PILOT INFORMATION: ROBERT SMITH
PREPARED BY:
APPROVED BY:
OPERATING CERTIFICATE #LDUL599B
285 BLACKLAND ROAD
FATE, TEXAS 75189
(972)636-4009
SIKORSKY UH-60A RESTRICTED CATEGORY
SHAWN HARRIS
ROBERT MROZ
EVAN DEWAN
COMMERCIAL CERTIFICATE # 3493515 ATP # 2727633 COMMERCIAL CERTIFICATE # 2807125
COMMERCIAL CERTIFICATE # 3720738
111923
November 14, 2023
North Texas FSDO
November 19, 2023
7:30AM - 10:00AM
Grapevine Mills Mall 3000 Grapevine Mills Pkwy Grapevine, TX 76051
Wesley Weaver972-400-1361 Wesley Weaver972-400-1361
Dallas Mechanical Group18383 Preston Rd. Ste 410 Dallas, 75252
Susan Bitros
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
285 BLACKLAND ROAD
FATE, TEXAS 75189
(972) 636-4009
WWW.5STATE.COM
XX
XX
5 20
500 3,000 71%
XX
85'
XX (if yes see narrative)
XX
285 BLACKLAND ROAD
FATE, TEXAS 75189
(972) 636-4009
WWW.5STATE.COM
______ 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 a mall in a residential and 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 inside the operational area will be vacant during operations.
XX
XX
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 on November 19, 2023: 3000 Grapevine Mills Pkwy Grapevine, TX 76051
City Manager: Connie Cook 817-410-3155
Equipment November 19, 2023 in Grapevine, TX at
approximately 7:30 AM - 10:00 AM.
Police: Mike Hamlin 817-410-3225
Your message has been delivered to the following recipients:
2023 in Grapevine, Texas at
approximately 7:30AM-10:00AM.
Fire: Darrell Brown 817-410-4400
Your message has been delivered to the following recipients:
Subject: 5 State Helicopter Lift of HVAC Equipment 19 November 2023 in Grapevine, Texas at
approximately 7:30AM-10:00AM.
ATC: Dallas Fort Worth Intl. Airport 972-615-2650
Your message has been delivered to the following recipients:
'
miles North of DFW on November ,19, 2023.
Best Regards,
5 State Helicopters
NO FLY
ZONE
Operational Area
Flight Path
Landing Area
Staging area
Emergency Area
Blocked Areas
Light Poles
Power Lines
Secondary
Emergency
Area
Grapevine Mills Mall
3000 Grapevine Mills Pkwy
Grapevine, TX 76051
Date of Lift:
11/19/2023
Time:
7:30AM
32° 57’ 56.8”N
97° 02’ 34.8”W
Grapevine Mills Mall
3000 Grapevine Mills Pkwy
Grapevine, TX 76051
Date of Lift:
11/19/2023
Time:
7:30AM 32° 57’ 56.8”N
97° 02’ 34.8”W
Grapevine Mills Mall
3000 Grapevine Mills Pkwy
Grapevine, TX 76051
Date of Lift:
11/19/2023
Time:
7:30AM
32° 57’ 56.8”N
97° 02’ 34.8”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.
285 BLACKLAND ROAD
FATE, TEXAS 75189
(972) 636-4009
November 14, 2023
Connie Cook 817-410-3155, City of Grapevine
Attention: City Manager
Reference: 5 State Helicopters Landing and Operations
This letter, with the location, dates, and time of a helicopter lift of equipment/materials that is
being flown by 5 State Helicopters, Inc. is to ensure there are no restrictions or regulations
preventing the helicopter from landing within the city limits of Grapevine, Texas.
Helicopter Type: Sikorsky S58T, Kawasaki BK 117 TRANSPORT CATEGORY
Sikorsky UH-60 Restricted Category
Call Sign: N4XY (Blue), N6BL (Red), N9VY (Orange), N170MC (Yellow) or N60A (Black)
Pilots: Robert Smith, Robert Mroz, Evan DeWan, Stefan Hiltbrunner or Shawn Harris
5 State Helicopters, Inc. assures the City of Grapevine, Texas that it will comply with all State,
Federal and local regulations, holds and required permits and is licensed to do the type
of work as described in this request.
This form releases the City from the responsibility of vacating the building/jobsite of
unauthorized personnel per FAA Regulations while the helicopter is working.
Please sign and e-mail back to:
SINCERELY,
The City releases responsibility to the operator 5 State Helicopters and the contractor
mentioned above for the exclusion and maintain the exclusion of unauthorized
personnel at the above location during lift operations.
BY____________________________ DATE________________________
Please feel free to contact 5 State Helicopters with any questions and/or concerns that you may have.
Date / Time of Job: Location: Contractor:
November 19, 2023 Grapevine Mills Mall Dallas Mechanical Group
7:30AM - 10:00AM 3000 Grapevine Mills Pkwy 11925 N. Stemmons Fwy Suite 130
Grapevine, TX 76051 Dallas, TX 75234
NO FLY
ZONE
Operational Area
Flight Path
Landing Area
Staging area
Emergency Area
Blocked Areas
Light Poles
Power Lines
Secondary
Emergency
Area
Grapevine Mills Mall
3000 Grapevine Mills Pkwy
Grapevine, TX 76051
Date of Lift:
11/19/2023
Time:
7:30AM
32° 57’ 56.8”N
97° 02’ 34.8”W
Grapevine Mills Mall
3000 Grapevine Mills Pkwy
Grapevine, TX 76051
Date of Lift:
11/19/2023
Time:
7:30AM 32° 57’ 56.8”N
97° 02’ 34.8”W
Grapevine Mills Mall
3000 Grapevine Mills Pkwy
Grapevine, TX 76051
Date of Lift:
11/19/2023
Time:
7:30AM
32° 57’ 56.8”N
97° 02’ 34.8”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.
Shawn Harris
ROCKWALLTEXAS
3
TEXAS
08-26-2024
Grapevine Mills Mall 3000 Grapevine Mills Pkwy Grapevine, TX 76051
11-19-23 11-30-23
14th November 3
14th November