HomeMy WebLinkAboutCO2025-0033711 APPLICATION FORM COMPLETED
21. WORKORDER FORM COMPLETED
3. ENVIRONMENTAL NOTIFIED DATE TIME
(E-MAIL JIMMY BROCK &VALERIE FARRELL,,
4. HAZARDOUS MATERIACSAFETY DATA SHEETS TO FIRE DATE
(SCAN TO C/O IN MYGOV - IF LARGE SET. ALSO SCAN TO LF & FORWARD SET TO FIRE)
5. FIRE DEPARTMENT APPROVAL OF HAZARDOUS MATERIAL DATE
6 ZONING CHECKED & COMPLETED ON APPLICATION
7. BUILDING INSPECTION SCHEDULED
8. FIRE DEPT INSPECTION SCHEDULED
9.
HEALTH INSPECTION
CITY SECRETARY (ALCOHOL)
11.
PUBLIC WORKS INSPECTION
12.
LOT DRAINAGE INSPECTION
13.
CORRECTION LETTER SENT
14.
BUILDING INSPECTORS SIGN OFF
15.
FIRE DEPARTMENTS SIGN OFF
16.
HEALTH DEPARTMENT SIGN OFF
17.
CITY SECRETARY (Alcohol License Sign Off)
18.
PUBLIC WORKS SIGN OFF
LO I'DRAINAGE SIGN OFF
20.
LANDSCAPING SIGN OFF
21.
BUILDING OFFICIALS SIGNATURE
22.
C/O CERTIFICATE ISSUED
7
DATE
TIME
DATE TIME
FIRE INSPECTOR:
NOTIFICATION DATE:
NOTIFICATIONDATE:
E-MAIL DATE
E-MAIL DATE
DATE
LETTER: YES / NO
LETTER: YES / NO
ELEc rRIC RELEASED:
SCAN CERTIFICATE TO MYGOV:
MAILED:
G%r0RMS.DSG01NFCRMA110MCKL18T
12,*3OiU4 a Rev
ATE OF S _._.
CERTIFICATE OCCUPANCY
$50.00
/' , ,; i 1 ,
SUrTE
4,I)DRESS OF OCCUPANCY:
LOT: BLOCK:
I 1
****CERTIFICATE OF OCCUPANCY WILL NOT BE ISSUED WITHOUT LEGAL DESCRIPTION**l
NAMIE OF r
NEW OCCUPANT: 1, NEW BUILDING1PR6PjRTY OWNER:YES-NO
NEW BUILDING: YES N1 NEW BUSINESSI `YES -NO
NUMBER OF EMPLOYEES:I OWNER: 1
FORWARDING: 1
TWE OF i
**N OFFICE/WAREHOUSE PRII I I BREAKDOWN OF SQUARE1 1
SF 1 TOTAL SQUARE11
NAME OF TENANT
..... . ..
CURRENT MAILING ADDRESS:,
C /$ PHONENUMBER:
UPROPERTY
OWNER:
1J,A]LING ADDRESS-
CITY/STATEIZIDP:PHONE
IS YOUR BUSINESS SUBJECT TO SALES TAX LAW? (if yes, provide copy of Sales Tax Certificate) ------- YES
—NO
WILL I BE ALCOHOLICBEVERAGE provide copy of AlcoholicBeverage Permit)
is
iLL THERE BE FOODSALES?yes, contacti f ,I Health 498''formore information)NO
PERMITS ,E REQUIRED FORSIGNS. WILLINSTALLED?
i
WILL BUSINESS ' ,TE ANY INDUSTRIAL WASTE DISCHARGE TO
i,
WILL OUTSIDE REFUSEiRECyCLINGICOWACTING CONTAINERS• (screening ,, d, YES
NO
WILL THEREBE OUTSIDE r. (including r .;_ t, i,,n, !' !i 1
NO
WILL ANY ALTERATIONSBE MADETo THE SITE OR I ! 1
i'
BUILDING.. I r h YES
1'
0 WILL BUSE14ESS STORE OR HANDLE HAZARDOUS MATERIALS OR LIQUIDS?
YES
NO
(if yes, provide list 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 SAID
OCCUPANCY I CONFORMANCE I I i' i HEREIN 1'
(If access 1 the buflding/space is not provided i time of the scheduled inspection, a S50.00t;.. ! i be charged)
PRINT NAME.
PH 1 . I ,:
Building Services Department
The City of Grapevine * P.O. Box 95104 * Grapevine, Texas 76099
1 «f •r
coo RXAM =A"
111ma,
TEXAS
TAX
SAL,,,,,,,Sw
chargedTexas Sales Tax is and collected on sales withinthe r r City of r , of r ii
Taxable-
r,; include both tangible personal property, c r services. If youbusiness thatbe r ritems"
within the City of r , you be r r+ to collect State and Local Sales Tax in the amount of
"Seller or Retailer" means a persone a in the business of making"taxable items", the receipts from whichare
included in the measure of sales or use tax.
e term, "place of business" includes any location at which three.orore orders are received y the "Seller or Retailer
in a calendar year. If an order is received a place of business of a retailer in e , but delivery orshipment is made
locationfrom a the state oe than the retailer's place of business.and local sales tax is due and is allocatedt
e city ere the order was received.
L have r the aboveand ! understandrequired'r r r =r• MPr r• '
Grapevine, t circumstance 1 U T my business.
Texas Sales Tax Number:
OFFICE USE
TYPE OF CONSTRUCTION:_ OCCUPANCY:
ZONING
DISTRICT: -- .......... ..._......... ....e_..___ CONDITIONAL __.'. _._.._........__.....
141 tW411 6 1 10
CITY SECRETARY:
LANDSCAPING APPROVAL:
APPROVAL FOR ISSUANCE:
DATE:
_. .
City of Grapevine
Certificate of Occupancy
PO Box 95104
Project # 25-003371
Grapevine, Texas 76099
817) 410-3166
Project Description: C/O (Family Therapist Office) "Kate
Goodell Therapy, PLLC"
4ifp
Issued on: 11 /03/2025 at 2:58 PM
"14 41v,
ADDRESS
INSPECTIONS
3
Ca Holdings, LLC
1139 S ain St.
M
1. Final Fire Dept Inspection
3. Landscaping
Grapevine, TX 76051
2. Final Building C/O Inspection
LEGAL
INFORMATION FIELDS
By Invitation Only Condo
Blk B Lot B3
"NAME OF BUSINESS
Kate Goodell Therapy, PLLC
S
**TENANT NAME (individual)
Katie Goodell
15.25°/® Common Area
TENANT PHONE NUMBER
469-731-6005
PERMIT HOLDER
APPLICANT E-MAIL
Kate Goodell
—APPLICANT NAME (Individual)
Katie Goodell
Kate Goodell Therapy, P
APPLICANT PHONE NUMBER
469-731-6005
LLC
(469) 731-6005
Square Footage
2832
TYPE OF BUSINESS
Therapy Office
OWNERS
CONSTRUCTION TYPE
V
Holdings Lic Como
OCCUPANCY GROUP
B
TENANTS
*Sales Tax
NO
- Kate Goodell
Alterations
NO
Kate Goodell Therapy,
PLLC
Change of Business Name
NO
(469) 731-6005
Change of Business Owner
NO
Fire Sprinkler System?
NO
Freight Forwarding Business
NO
Hazardous Material
NO
Industrial Waste
NO
New Building / Addition
NO
New Building / Property Owner
NO
New Occupant / Tenant
YES
Number of Employees
1
Outside Refuse/Recycling
NO
Outside Storage
NO
Signs
NO
Page 1/2
MYGOV.US 25-003371, 11/0312025 at 2:58 PM Issued by: Amanda Robeson
malsigz=
INFORMATION FIELDS
* CONDITIONAL USE REQUIRED?
NO
* OCCUPANCY LOAD
19
* PERMITTED USE
YES
* ZONING DISTRICT
PO
FEE TOTAL
PAID DUE
Certificate of Occupancy $50.00
$50.00 $50.00
TOTALS $50.00
$50.00 $ 0.00
la 41100111103 �V
aff &RO'l-I'LEDGE APIIJ I MAI 6AIIJ UUGIVIPPARGY IS IN CONFORMANCE WITH
THE INFORMATION HEREIN SET FORTH.
>> (if access to the building/space is not provided at the time of schedule,.'
inspection, a $50.00 re -inspection fee will be charged)
FOR QUESTIONS or TO RECALL FOR INSPECTION, PLEASE CALL: (817) 410-
3165 or (817) 410-3166
November 03, 2025
Signature Date
Certificate of Occupancy
Project # 25-003371
Page 2/2
MYGOV.US 25-003371, 11/0312025 at 2:58 PM Issued by: Amanda Robeson
Mlll���W
G: , �FORMS,DSCOINFORMATION,WORKORDER
12/30/04 Rev. 5.23/2024