HomeMy WebLinkAboutCO2026-002230UNDER CONSTRUCTION
TD - NO LETTER
SENTLETTER
PW OR LD NEEDED
PENDING FIRE
PENDING HEALTH
LANbSCAPING / CODE
FILE
1,6119-Y44 M 1 *1 1
L
APPLICATION FORM COMPLETED
2, WORKORDER FORM COMPLETED
3. ENVIRONMENTAL NOTIFIED DATE TIME
(E-MAIL JIMMY BROCK
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)
5, FIRE DEPARTMENT APPROVAL, OF HAZARDOUS MATERIAL DATE
6 ZONING CHECKED & COMPLETED ON APPLICATION
7, BUILDING INSPECTION SCHEDULED
8, FIRE DEPT INSPECTION SCHEDULED
12
13
14
15
16
17
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
ELECTRIC RELEASED.
SCAN GER1 HCATE TO MYGOV
MAILED.
( 'T ( aN� I , A N I *"g� I A s)i
DATE OF ISSUANCE:
T 7
PERMIT #:
M4
V
CERTIFICATE OF OCCUPANCY Ry 11
QVEST
FEE: $50.00
ry L, A Tj A -'VTTZ17
EkFANJILrtNG7PLqUffi
ADDRESS OF OCCUPANCY: . . ...... SUITE#
LOT: BLOCK: SUBDIVISION:
4 . . .... .... . . i
CERTIFICATE OF OCCUPANCY WILL NOT BE ISSUED WITIR)UT LEGAL DESCRIPTION""
NAME OF BUSINESS:
NEW OCCUPANT: YES NO— NEW BUILDING/PROPERTY OWNER: YES — No
NEW BUILDING: YES NO NEW BUSINESS NAME CHANGE: YES --NO._,�_ ',,-
NUMBER OF EMPLOYEES:
NEW BUSINESS OWNER: YES- NO
FREIGHT FORWARDING: YES—NO—
TYPEOFBUSINESS:
**IF OFFICE[WAREHOUSE PROVIDE BREAKDOWN OF SQUARE FAGS:
SF OFFICE: SF WAREHOUSE: TOTALS QUAREFOOTAGE:
NAME OF TENANT:::
CURRENT MAILING ADDRESS:
:,j!
CITY/STATE/ZIEP: PHONE NUMBER:
PROPERTY OWNER:
MAIL INGADD RESS: V, k X., ------- --- --- --
71.
PHONE
CITY/STATE/ZIP: NUMBER:
. ....
+ IS YOUR BUSINESS SUBJECT TO SALES TAX LAW? (if yes, provide copy of Sales Tax Certificate) ------- YES NO T/
+ WILL THERE BE ALCOHOLIC BEVERAGE SALES? (if yes, provide copy of Alcoholic Beverage Permit) --- YES NO
4 WILL THERE BE FOOD SALES? (if yes, contact Tarrant County Health 817-321-4983 for more information) - - YES NO tam
4 PERMITS ARE REQUIRED FOR SIGNS. WILL ANY SIGNS BE INSTALLED? --------------------- YES NO 17
4 WILL BUSINESS GENERATE ANY INDUSTRIAL WASTE DISCHARGE TO SEWER SYSTEM? -------- YES NO V
4 WILL OUTSIDE REFUSE/RECYCLING/COMPACTING CONTAINERS BE NECESSARY? (screening is required) YES N07
4 WILL THERE BE ANY OUTSIDE STORAGE (including storage of company/fleet vehicles), DISPLAY/ USED YES NO -JL�
+ WILL ANY ALTERATIONS BE MADE TO THE SITE OR BUILDING? ---------------------------- YES NO t-"
0 IS BUILDING SPRINKLERED? ---------------------------------------------------------- YES -LL 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
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 QUESTION , S or to RE-SCHI'DULE, PLEASE CALL (817) 410-3165 or (817) 410-3166
SIGNATURE -
PRINT NAME:
PHONE #: EMAIL: . . . .....
Building Services Department
The City of Grapevine * P.O. Box 95104 * Grapevine, Texas 76099
(817) 410-3165 (817) 410-3166
C: ORMSISSAPPLICATIONS-FMSTOAPP
11121124
(Rov.4-1318)
Name of purchaser, firm or agency as shown on permit Phone (Area code and number)
South Main Social Club, LLC 817-614-5420
Address (Street & number, P.O. 6ox or Route number)
1900 S. Main Street, Suite 105
City, State, ZIP code
Grapevine, TX 76051
Texas Sales and Use Tax Permit Number (must contain I I digits)
3 2 � �1,0 5.8 1 6 2 2
Out-of-state retailer's registration number or Federal Taxpayers Registry (RFC) numberfor retailers based in Mexico
(Retailers based in Mexico must also provide a copy of their Mexico registration form to the seller.)
• �-Jlw is suleft-ir - # . -1 - ,
items described below or on the attached order or invoice) from:
Seller:
Street address:
City, State, ZIP code:
Description of items to be purchased on the attached order or invoice:
Mahjong Sets, Mats, Gifts & Accessories, etc.
Description of the type of business activity generally engaged in or type of items normally sold by the purchaser:
Retail gift and accessories sales, hosted events, open play and league activities as well as alternative event space
The taxable items described above, or on the attached order or invoice, will be resold, rented or leased by me within the
geographical limits of the United States of America, its territories and possessions or within the geographical limits of the United
Mexican States, in their present form or attached to as taxable items to be sold.
I must pay sales tax on the items at the time of use based upon either the purchase price or the fair market rental value for the
period of time used.
/ understand that it is a criminal offense to give a resale certificate to the seller for taxable items that I know, at the time of purchase,
are purchased for use rather than for the purpose of resale, lease or rental, and depending on the amount of tax evaded the offense
may range from a Class C misdem&nor to a felony of the second degree.
sign Purchas z-, Title 1 Date
h
A ere Managing Partner 6104/2026
This certificate should be furnished to the supplier.
Do not send the completed certificate to the Comptroller of Public Accounts.
0 1 -300
(Rev.7-25/22) TEXAS SALES AND USE TAX PERMIT
This permit is not transferable, and this side must be prominently displayed in your place of business.
may —W6TXCW—s—spy W&S P',a mziau
resale certificate A cartifficale, is necessary to document why tax is not collected on a sale
TAXPAYER NAME, BUSINESS LOCATION NAME and PHYSICAL LOCATION
SOUTH MAIN SOCIAL CLUB LLC
SOUTH MAIN SOCIAL CLUB LLC
1900 S MAIN.ST STE 105
You must Madt anew permit it there is a change or
ownership, location or business location name.
Type of permit
SALES AND USE TAX
Taxpayer number
3-21058-6162--2
Location number
GRAPEVINE TX 76051-4094 00001
TARRANTCOUNTY ----- ----------- --- ------- ---- - ---- ------------- ---
T-
NAICS: 713990 All Other Amusement and Recreation Industries
WE SHOW THIS BUSINESS IN THE FOLLOWING LOCAL SALES TAX AUTHORITIES
CITY: GRAPEVINE EFF: 06/04/2026
SPD: GRAPEVINE CRIME CONTROL EFF: 06/04/2026
06/04/2026
Kel ' 4Hcock
Acting Comptroller of Public Accounts
You may need to collect sales andlor use tax for other local taxing authorities depending on your type of business.
For additional information, see "Collecting Local Safes and Use Ta.;ie'section on the back of this document.
If you have any questions regarding sales tax visit our website at www. Comptroller. Texas. Gov or call us at 800-252-5555.
Detach hero and crominentiv disalav vour A)ermit oniv. Retain the Dortion below for vour records.
The information printed on your permit is public information. It must be accurate and current. If there is an error,
make corrections on the form below by entering your taxpayer name and taxpayer number and your corrected
information for incorrect items only. Detach the form and mail it to:
111 E. 1 7th Street
Austin, TX 78774-0100
4 Oil, 0 �11
Toms Sales and Use Tax Permit Corrections Form
Taxpayer name shown on the permit
SOUTH MAIN SOCIAL CLUB LLC
Taxpayer number shown on the permit
321o586i622 --- --- ---
Correct business location name
Correct business location (no P.O. Box or directions accepted)
0
city
Correct taxpayer name. r
a
Correct mailing address
0
Location number shown on the permit
0000 1.-
ff you need to make changes to
your local sales tax authorities
or to the NAICS code printed
on your permit, see information
on the back of this form.
State ZIP code County
Daytime phone (Asa code and number)
City State ZIP code i Federal Employer Identification Number
JOE en
If you are no longer in business, enter the date of your last business transaction.
11 - - - :
Taxpayer or authorized agent
sign Date
here
000000222
City of Grapevine
Certificate of Occupancy
PO Box 95104 Project # 26-002230
Grapevine, Texas 76099 Project Description: C/O (Retail Store & Event Space) "South
917) 410-3166 Main Social Club, LLC"
ADDRESS
1900 S Main St., 105
Grapevine, TX 76051
Instl Blk 6 Lot 11
PERMIT HOLDER
Dorian Stacy
l/,;�lvxjlv4�
LLC
(817) 614-5420
OWNERS
- Stacy-Gv Ll+
TENANTS
- Yard Art Patio and
Fireplace
Issued on: 07/08/2026 at 1:07 PM
INSPECTIONS
1. Final Fire Dept Inspection
2. Fin.91 Building C/O Insgectim
**NAME OF BUSINESS
**TENANT NAME (individual)
**TENANT PHONE NUMBER
APPLICANT E-MAIL
"APPLICANT NAME (Individual)
—APPLICANT PHONE NUMBER
Square Footage
*Sales Tax Number
TYPE OF BUSINESS
CONSTRUCTION TYPE
OCCUPANCY GROUP
*Sales Tax
Alcoholic Beverage Sales
Alterations
Change of Business Name
Change of Business Owner
Fire Sprinkler System?
Freight Forwarding Business
Hazardous Material
Industrial Waste
New Building / Addition
New Building / Property Owner
New Occupant / Tenant
Number of Employees
Outside Refuse/Recycling
2
3. Landscaping
APPROVED FOR ISSUANCI
South Main Social Club, LLC
Dorian Stacy
817-614-5420
Dorian Stacy
817-614-5420
1539
32105861622
Retail Store& Event Space
1113 - SPRINKLERED
B/A-3/A-2
YES
NO
NO
NO
NO
YES
NO
NO
NO
NO
NO
YES
2
NO
- Page 1/2
MYGOV.US 26-002230, 07/0812026 at 1:07 PM Issued by: Amanda Robeson
MB10190=-
INFORMATION FIELDS
Outside Storage
Signs
* CONDITIONAL USE REQUIRED?
* OCCUPANCY LOAD
* PERMITTED USE
* ZONING DISTRICT
FEE
Certificate of Occupancy
I
TOTAL PAID DUE
$50.00 $50.00 $50.00
$50.00 $50.00 $0.00
o--> (if access to the building/spac is not provided at the time of scheduled
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
Signature
Certificate of Occupancy
Project # 26-002230
MYGOV.us 26-002230, 07/08/2026 at 1:07 PM
July 08, 2026
Date
Page 2/2
Issued by: Amanda Robeson
TEXAS SALES, TAX
TexasSales Tax is charged and collected on sales within the State and City of Grapevine, Texas of "taxable items." Taxable
items include both tangible personal property, specified services. If you are in a business that will be selling "taxable items"
within the City of Grapevine, Texas you will be required to collect State and Local Sales Tax in the amount of 8.25 %.
A "Seller or Retailer" means a person engaged in the business of making sales of "taxable items", the receipts from which are
included in the measure of sales 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 Number: 4A
Signature:
ADDRESS:
CITY, STATE, ZIP:
OFFICE USE ONLY***
: DIV
TYPE OF CONSTRUCTIOOCCUPANCYISION:
N: ,
-4,
PERMITTED USE:
BUILDING DEPARTMENT:
BUILDING INSPECTOR:
FIRE DEPARTMENT:
CONDITIONAL USE:
OCCUPANT LOAD:
DATE:
DATE:
DATE:
DATE:
DATE:
DATE:
HEALTH DEPARTMENT: DATE:
CITY SECRETARY: DATE:
LANDSCAPING APPROVAL:_ t;''._ DATE:
. ......... ..
APPROVAL FOR ISSUANCE: DATE:
110%
uERITIFICATE OF OCCUPANCA
**TO BE FILLED OUT BY BUILDING OFFICIAL**
ZONING DISTRICT OF INSPECTION LOCATION: OCCUPANT LOAD: ......
TYPE OF BUILDING. GROUP AND DIVISION:
124004 Rt", 1,11,312(;24