HomeMy WebLinkAboutCO2025-0041182
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WORKORDER FORM C011PJ__FTFA
MINN
t014R*1 I ME'Trimfly'A=m I a WI
UNDER CONSTRUCTION
TD — NO LETTER
SENT LETTER
PW OR LD NEEDED
PENDING FIRE
PENDING HEALTH
LANDSCAPING.," CODE�
H D
OL FILE
iii, 111, 11711,11 ii, II, I
:1111 f" In Nw , wo
my! W-41
HEALTH INSPECTION
CITY SECRETARY (ALCOHOL)
PUBLIC WORKS INSPECTION
LOT DRAINAGE INSPECTION
CORRECTION LETTER SENT
BUILDING INSPECTORS SIGN OFF
FIRE DEPARTMENTS SIGN OFF
HEALTH DEPARTMENT SIGN OFF
CITY SECRETARY (Alcohol License Sign Off)
PUBLIC WORKS SIGN OFF
LOT DRAINAGE SIGN OFF
LANDSCAPING SIGN OFF
BUILDING OFFICIALS SIGNATURE
C/O CERTIFICATE ISSUED
DATL TIME
DATE TIME
FIRE INSPECTOR:
NOTIFICATION DATE:
NOTIFICATIONDATE:
E-MAIL DATE
E-MAIL DATE
DATE
LETTER: YES / NO
LETTER: YES / NO
ELECTRIC RELEASED:
SCAN CERTIFICATE TO MYGW
YESINo MAILED:
C if ORNISMSCOINFORMATIMICKLIST
72/30/D4 k Rev 6/23/24
"P
PERMIT #:
CERTIFICATE OF OCCUPANCY RE 1' UEST
FEE: $50.00
,MV-ff E-REl- &VRMI
ADDRESS OF OCCUPANCY: 2201 Westgate Plaza, Grapevine, TX 76051 SUITE #
LOT: BLOCK- 2R Westgate Plaza
SUBDIVISION:
OF OCCUPANCY WILL NOT BE ISSUED WITHOUT LEGAL DESCRIPTIO
NAME OF BUSINESS: Key -Whitman Eye Center
NEWOCCUIIANT: YES NO NE�k'Rt'ILI)IN(s,'I*ROPERTI'ONI'N).":It' YES NO
NEW BUILDING: YES NO x NEW BUSINESS NAME CHANGE. YES NO —
NUMBER OF EMPLOYEES: 27 NE%N'Bt'SINFSS OWNER. �' I "� NO —
FREIGHT FORWARDING- YES —NO _x
TYPE OF BUSMESS: Medical Office : ; :' � I I I '� 11 -
**EF OFFICEIWAREHOUSE PROVIDE BREAKDOWN OF SQUARE FOOTAGES:
SF OFFICE: 9024 SF WAREHOUSE: "la TOTALSQUAREFOOTAGE:. 9024
NAME OF TENANT JW Eye Associates, PLLC
CURRENT MAILING ADDRESS: 2201 Westgate Plaza
CITY/STATE/ZIP: Grapevine, TX 76051
PROPERTY OWNER: Flagship CPT Grapevine Owner. LP
MAILING ADDRESS: 2701 Coltsgate Rd, Suite 300
CITY/STATE/ZIP: Charlotte, NC 28211
PHONE NUMBER: 615-289-7052
+ IS YOUR BUSINESS SUBJECT TO SALES TAX LAW? (if yes, provide copy of Sales Tax Certificate) -------
� )� '
NO —
# WILL THERE BE ALCOHOLIC BEVERAGE SALES? (if yes, provide copy of Alcoholic Beverage Permit) - - -
YES
NO x
+ WILL THERE BE FOOD SALES? (if yes, contact Tarrant County Health 817-321-4983 for more information) - -
YES
NO�
4 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 REFUSEIRECYCLING/COMPACTING CONTAINERS BE NECESSARY? (screening is required)
N
NO —
+ WILL THERE BE ANY OUTSIDE STORAGE (including storage of company/fleet vehicles), DISPLAY/ USE/DINING? YES
NO x
+ WILL ANY ALTERATIONS BE MADE TO THE SITE OR BUILDING? ----------------------------
YES —NO
x
+ IS BUILDING SPRINKLERED? ----------------------------------------------------------
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-x---
I HEREBY CERTIFY THAT THE FOREGOING IS CORRECT TOT E BEST OF MY KNOWLEDGE AND THE SAID
OCCUPANCY IS IN CONFORMANCE WITH THE INFORMATION HEREIN SET FORTH.
(If access to the building/space is not provided at the time of the scheduled inspection, a $50.00 re -inspection fee will be charged)
FOR QUESTIONS or to RE -SCHEDULE, PLEASE CALL (817) 410-3165 or (817) 410-3166
SIGNATURE: 7P4,iW� 70f&6114, PRINTNAME: Miriam Moore
PHONE #: 214-754-0000 EMAIL:
Building Services Department
The City of Grapevine * P.O. Box 95104 * Grapevine, Texas 76099
(817) 410-3165 * (817) 410-3166
C:FORMSSSAPPUCAWONSFEESWO APP
11/21n4
TEXAS SALES TAX
r r1W46 r r 1 r ri. r s 1 1 ► 1i
1: r 1 •.a i r is / : '.
A "Seller or Retailer"meansperson i in the business of making sales1"taxablereceipts
included in the measureof 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 N er: 1752642175
Signature:
ADDRESS:11442 North Central Ex
pressway
CITY, STATE, ZIP: Dallas, TX 75243
TYPE OF CONSTRUCTION:/ DIVISIOM
ZONING DISTRICT: CONDITIONAL USE:
PERMITTED USE: ........... ._. OCCUPANT LOAD®
BUILDING DEPARTMENT: �'°m w_._, DATE:._ /
BUILDING INSPECTOR: ,r :� ._.: ATE:
ZONING APPROVAL: _ .......... ..... ._ .. _._.._..
FIRE DEPARTMENT: _ x
CITY SECRETARY: , ,,,,,..
LANDSCAPING APPROVAL: _
APPROVAL FOR ISSUANCE:
DATE:
DATE:
ATE:
DATE:
DATE OF ISSUANCE-
,GRA_k�VINE
PERNUT I
1 oil
CERTIFICATE OF OCCUPANCY RE011E.-ST
FEE: $50.00
NOFEE REQUIRrISO
0j,(,jjjqy(1y: 21CI 11yopme Phzq (Grqpcvin.c TX 76051 SUITE 0
ADDRESS OF (
LOT- 11, 1.11 BLOCK�- 21t SUBERVISiON: NN V;Q= MIL
I'VERTIFICItTEF OF OCCUPANCY WILL NOTBE ISSU'ED WITfI01 T LEGAL 4F',8CRTFT10N*$4--*
NAMEOFBUSINESS: JWE,eAMrs ociatcs:JILI,C
NEW, OCCUPANT,
YES NO
NEW B1J1fl.D1NG/J1R� IIIERTV OWNER:
YES_-[;;7L,N0—F—L
NEW BUILDINGz
YES NO
NEWBUSINESS N \ME CHANGE:
YES —E,
NUMMER OF EINVIPLOYEE& j
NEW BUSINESS c nVNEER:
Y I-,S J;n, NO -1
FREIGIFJ'FOR%� ARDING:
YES j—'—j— NO --E7-L
TYPE W BISINESS:
hAdval Wice
1 4-d�, Rv'W! A borr-zly`�i OITX-4- ;' t'
**1F OFFI(VIVAREHOUSE PROVIDE Bit
OF SQUIARI FOOTAGES
8F101FF10E-,-9_Q2j,---
SFN1VXRFJ-10[,S'F
N � �N TOTAL SQUARE FOOTAGE:,
9024
Cps) RRENTN'LAILING ADDRESS: 220 Angoutc pill;
CITWSTATEIZIP-, Grapevine,TX76051 PJ`10NEN1JN1BF1O 817410-2030
PROPERTYOWNER:
LIAM;A CH)RESS, 2701 r�oadl �$ifite
CATYNTATEIZIP- Cb �rb,ttc,, C 18; 11 P1 TONE NU NIBER� 6�5-D'%9-705,2
* IS AT(YUR BUS'INESS SUKWCT TO SALES TAX LAW? Ham, &W c"y of is elan >i\ ------ 17PS F ,Zj NO
4 T1,111A, THEIPIF BE A LCO110TAC HI VERAGE SALFS? f if yL5, provid„ copy of Alk'OhODCHCTC a`RM EN-Raft)YK9 NO
if yev, ('�Ont�t(!t TalTant ,3,3 fer
+ 1NVTLLTNERE BE FOOD SALE N'�'( a ore aIjffjrj3jA1jftn VES 9 NO Ey
* PERWIS ARF� REQk.T,1RFTJ 17; bR SKA& MJML ANYSIGNS BF INST a IAXD? ----- — -------------- N E S N 0
4 AVILL BUSINESS (3ENERA I I ,ANY INN USTRLA1. WAS.Tr JASCHARGE'i 0 SEO1,-,T—SYSTr�,M? -------- 11,S NO
0 W11 1. EMT= R EFUSI ;ftECYCLINCuff ONIPACTMG (INTADWRS BE % EETSSARY? fscreenigfa if, °equiFcd) YES
_LJN0=
HE A NY 01. ITS f DF STOR AGE (41.cludblgstong,, of companyAl ii xThkAM, DISPLA Y/ k xSEJ)JN (N(; I FS NO
0 IVML ANY ALTERA; WNS HE elAI)E T0111F, SITE OR Ht"LIMNKV ------ y 1'�s iN o
4 IS BUMDING SPRINX1ZHED? -- ------------ --------- ------------- YES NO
0 'MILL BUSINESS ,�TORF. OR. HANDLE HAZARDOUS �EATFRI kLS OR, lAQuIDS?
(KW& PMO& HA car qpn S; quWdK€ . ahmg muh mwcrial sarety dut"I sheeh) -------- — — ------------- y F S NC'?
I [-TET1EP,1'CI,JRT1FY THAT THE FOREGOING IS CORRECT TO THE BEST OF Nn KNOMIXDGE AND THE SAH)
0C,C'UTP,,kNCY IS IN'(7ONFORMANC.RWITIT THE,
(if A,Cess if, ike buildhig)'space is not provided at the 10e pf the scheduled inspe�ction, fee will be chwinged)
FOR QUE's 11ONS or to RE-SCREDULL, PLEASE CALL (8171� flO-3165 or (8171410-3166
Andm" -a Hum�
PRINT NANIE,: ,
PHONE t QQ, Q40226 EAKIL: ,A)oren-a 1": ecrexws,
Fs
The CNN M CkspeWne + P.0, Box 95104 + (3rape T "?,as 7609-,
(817) 410-3165 * (Sl7),110-3166
vnion YAWann VAN-0
TEXAS SALES TAX
Texas Sales Tax a� eharged and collected on sales within the State and City (if Grapevine, Texas (if 11tax-abi i6tems:Taxable
its include of f,'14 I gible personal property, specified services. If you are in a business that will be seP4'og "taxable items"
within the City of Grakvine, Texas you will be required to collect State and Local Sales Tax in the wsr"itint of 8,25%,
A "Setter or Retaflee'meO� a person engaged in the business of making sales of "taxable items",,,6e receipts from which are
included in the measure of ss or use tax.
The term, "place of business" itludes any location at which three or more orders are rectivosiby the "Seller or Retailer
in a calendar year. Iran order ls° eceivcd at the place of business of a ref!ifler in Texas, bul,Oelivery or shipment is made
from a location within the state otl r than the retailer's place of bwiaw,s. State and lotj'sales tax is due and is allocated to
the city where the order was receiv,:d.
I have read tea ove and I tan derstand'�Jwat I will he required to provide a copy ot 41'e Sales Tax Permit to the City or
Grapevine, Texas if the circumstance applies to my business,
4-7
Texas Sales Tax Number: .. 5,
ft-w
Signature: �,h. ,M
"T 7
L2
2201 Westgate Plaza
ADDRESS:
CITYSTATE, ZIP: Grapevine, TX 76051
,
... . ..... ........... . .... I
OFFICE kr�,E
TYPE OF CONSTRUCTION: OCO,.:,,ANCY: DIVISION:
ZONING DISTRICT: CONDITIONAL USE:
PERMITTED USE: OCCUPANTLOAD-
BUILDING DEPARTMENT: �i �ATE:
J1.
BUILDING INSPECTOR- DAi
ZONING APPROVAL: 2: DATE:
FIRE DEPARTMENT -
LOT DRAINAGE INSPE( 'I ION:
PUBLIC'WORKS DEPA RTNIENT:
HEALTH DEPARTX4ENT:
CITY SECRETiy4Y:
LANDSCE API>,G APPROVAL -
APPROVAL FOR ISSUANCE:
DATE:
DATE
DATE:
DATE:
DATE:
DATE-
it of Grapevine
Certificate of Occupancy
PO Box 95104
Project # 25-004118
Grapevine, Texas 76099
817) 410-3166
Project Description: C/O (Medical Office) "Key -Whitman Eye
q
Center"
Issued on: 12/16/2025 at 10:26 AM
1,:" 41 W
ADDRESS
INSPECTIONS
4
2201 Westgate PIz, 100
Grapevine, TX 76051
1. Final Fire Dept Inspection 3. Landscaping
2. Final Building C/O Inspection 4. C/O APPROVED FOR ISSUANCE
LEGAL
Westgate Plaza Blk 2r
INFORMATION FIELDS
Lot 1
*41432703*
j --NAME OF BUSINESS
Key -Whitman Eye Center
**TENANT NAME (individual)
Miriam Moore
PERMIT HOLDER
Andrea Boren
**TENANT PHONE NUMBER
817-410-2030
Key -Whitman Eye Cente
APPLICANT E-MAIL
r
"APPLICANT NAME (Individual)
Alexis Rubal
(817) 410-2030
**APPLICANT PHONE NUMBER
817-366-7211
COLLABORATORS
Square Footage
9024
- Miriam Moore
*Sales Tax Number
17526462175
(214) 754-0000
TYPE OF BUSINESS
Medical Office
OWNERS
* CONSTRUCTION TYPE
IIB - SPRINKLED
- Flagship CPT
* OCCUPANCY GROUP
B
Grapevine Owner LP
*Sales Tax
YES
TENANTS
Alcoholic Beverage Sales
NO
• Andrea Boren
Alterations
NO
Key -Whitman Eye
Change of Business Name
YES
Center
(817) 410-2030
Change of Business Owner
YES
Fire Sprinkler Svstem?
YES
Freight Forwarding Business
NO
Hazardous Material
NO
Industrial Waste
NO
New Building / Addition
NO
New Building / Property Owner
YES
New Occupant / Tenant
NO
Number of Employees
27
Outside Refuse/Recycling
YES
Page 1/2
MYGOV.US 25-004118, 12/16/2025 at 10:26 AM Issued by: Amanda Robeson
mzzm•�
INFORMATION FIELDS
Outside Storage
NO
Signs
YES
Square Footage - Office
9024
* CONDITIONAL USE REQUIRED?
NO
* OCCUPANCY LOAD
91
• PERMITTED USE
YES
• ZONING DISTRICT
cc
FEE TOTAL
PAID DUE
Certificate of Occupancy $50,00
$50.00 $50.00
TOTALS $50.00
$50.00 $0.00
I AEREBT CERTIFTTAAT TAE FOREGOING IS CORRECT TO THE BEST OF
MY KNOWLEDGE AND THAT SAID OCCUPANCY IS IN CONFORMANCE WITH
THE INFORMATION HEREIN SET FORTH.
>> (if access to the building/space is not provided at the time of scheduled
inspection, a $50.00 re -inspection fee will be charged)
FOR QUESTIONS or TO RECALL FOR I
3165 or (817) 410-3166
Signature
Certificate of Occupancy
Project # 25-004118
Page 2/2
MYGOV.US 25-004118, 12/16/2025 at 10:26 AM Issued by: Amanda Robeson
L
..........
�nicr�el:�•T�:�
**TO BE FILLED OUT BY BUILDING OFFICIAL**
ZONING DISTRICT OF INSPECTION LOCATION: C.-C- OCCUPANT LOAD:
TYPE OF BUlLDING:lC -!S FiZ(A)KLERSOGROUP AND DIVISION:
ZONING RESTRICTIONS:
('t ORKAS\1)8('(',"NFORNIKrI)N�k�Vo;'KoPDL R
12 XV04 Rev 5,2�2024