HomeMy WebLinkAboutCO2018-3571 UNDER CONSTRUCTION _
CORRECTION LETTER_
PW OR LD NEEDED_
TD NO LETTER_
WAITING FIRE _
HOLD
CODE_
C/O CHECK LIST
C/O PERMIT # P18 - 56_'21 L
ADDRESS: /oZ �U S• � �7.� �
BUSINESS NAME:
BUSINESS I PROPERTY
_CHANGE NAME / OWNER _ NEW CONST/ADDITION PERMIT#
NEW TENANT /OCCUPANT REMODEL/ALTERATION PERMIT#
ISSUE DATE FINAL DATE
�1. APPLICATION FORM COMPLETED
2. ZONING MAP COPIED &WORKORDER FORM COMPLETED
3. 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)
4. FIRE DEPARTMENT APPROVAL OF HAZARDOUS MATERIAL DATE
5. ZONING CHECKED & COMPLETED ON APPLICATION
—" 6. BUILDING INSPECTION SCHEDULED DATE TIME
7. FIRE DEPT. INSPECTION SCHEDULED DATE TIME
FIRE INSPECTOR:
8. CITY SECRETARY(ALCOHOL) NOTIFICATION DATE:
9. HEALTH INSPECTION NOTIFICATION DATE:
10. PUBLIC WORKS INSPECTION E-MAIL DATE
11. LOT DRAINAGE INSPECTION E-MAIL DATE
12. CORRECTION LETTER SENT DATE
13. BUILDING INSPECTORS SIGN OFF LETTER: YES / NO
_14. FIRE DEPARTMENTS SIGN OFF LETTER: YES / NO
15. HEALTH DEPARTMENT SIGN OFF
16. CITY SECRETARY(Alcohol License Sign Off)
17. PUBLIC WORKS SIGN OFF
-� 18. LOT DRAINAGE SIGN OFF
19. LANDSCAPING SIGN OFF
20. BUILDING OFFICIALS SIGNATURE
V 21. C/O CERTIFICATE ISSUED ELECTRIC RELEASED: -�
SCAN CERTIFICATE TO MYGOV:
CONDITIONS TO BE TYPED ON C/O? YES/NO MAILED:
O%FORMSIDSCOINFORMNTIONIMIST
1213WW I Re,l N 111115,5118
S E P 18 20 10 p A T�7� DATE OF ISSUANCE: S E P 118
,Gillr'S:C iGVI la�
`-'r E . s 'I PERMIT#:
CERTIFICATE OF OCCUPANCY REQUEST
FEE: $50.00
NO FEE REQUIRED IF CERTIFICATE OF OCCUPANCY IS ASSOCIATED WITH AN ACTIVE CURRENT BUILDING PERMIT
ADDRESS OF OCCUPANCY: /off F6 S7 SUITE# /yy
LOT: I BLOCK:_ SUBDIVISION: �W� 4f�, � l C y!'lCu." 6dd tilt
****CERTIFICATE OF OCCUPANCY WILL NOT BE ISSUED WITHOUT LFGAI;D SE CRIPTION****
NAME OF BUSINESS: T,-zxl-,t �&Zh -TN 692N CxJ=4[417]
NEW OCCUPANT: YES NO NEW BUILDING/PROPERTY OWNER: YES NO
NEW BUILDING: YES NO� NEW BUSINESS NAME CHANGE: YES=NO
NUMBER OF EMPLOYEES: 9 FREIGHT FORWARDING: YES NO
NEW BUSINESS OWNER: YES I/6
NO
TYPE OF BUSINESS: Mi4,C4-t_ Ofy� = SQUARE FOOTAGE: �
(Example:Retail Clothing/Attorney's Office/Office-Warehouse/Restaurant)
NAME OF TENANT (PERSON'S NANIEi: f /+L7}/ J SUtli2
CURRENT MAILING ADDRESS: 6J.1 l.1 �`�. L�9AA-k-
CITY/STATE/ZIP: /nt kt.AAA rwA,, 7x 74011 PHONE NUMBER: 667'p?34 609S
PROPERTY OWNER: GSSG Z}t�c Lq,n�s LL C
MAILING ADDRESS: /o1416C1 146 1 1k GT,
CITY/STATE/ZIP: r-r Wd,!-w- TX 74/ 797 PHONE NUMBER:
i
♦ IS YOUR BUSINESS SUBJECT TO SALES TAX LAW?(if yes,provide copy of Sales Tax Certificate)---- YES_ NO
♦ WILL THERE BE ALCOHOLIC BEVERAGE SALES?(if yes,provide copy of Alcoholic Beverage Permit)-YES_NO
♦ PERMITS ARE REQUIRED FOR SIGNS. WILL ANY SIGNS BE INSTALLED?-------------------YES NO
♦ WILL BUSINESS GENERATE ANY INDUSTRIAL WASTE DISCHARGE,TO SEWER SYSTEM?----- YES—NO �C
♦ WILL OUTSIDE REFUSE/RECYCLING/COMPACTING CONTAINERS BE NECESSARY?
(if yes,screening is required)-----------------------------------------------------------YES_ NO �C
♦ WILL THERE BE ANY OUTSIDE STORAGE,DISPLAY,USE OR DINING:--------------------- YES_ NO K
♦ WILL ANY ALTERATIONS BE MADE TO THE SITE OR BUILD ING?------------------------- YES NO
♦ IS BUILDING SPRINKLERED?------------------------------------------------------- YES_NOX
♦ 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 TO THE 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$42.00 re-inspection fee will be charged)
FOR QUESTIONS/PLEASE CALL(817)410-3165. Kyle Bradfield, RPA, FMA, HEMI, CHIM."A
SIGNATURE: ��71i ^ �y�- I PRINT NAME: I':"° i^r, 2a1 BS's F glYpe2 iS
PHONE#: 0 36,`605;L EMAIL:
(OVER)
Development Services Department
The City of Grapevine*P.O.Box 95104 *Grapevine,Texas 76099*(817)410-3165
Fax(817)410-3012 * www.grapevinetexas.gov
O:FORMSIOSAPPLICATION5IC/
0/22/2001/Rev:5/06,2107,4/09,2113,11/15,10116
TEXASSALESTAX
Texas Sales 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: Al-(� _Kyle Bradfield, PPA, FMA, HEM, CHFM
Signature: Dirktore�-Est=ate Engineering
i`" Ma —
WHERE; D(I YOU WANT YOUR t uMPLETED ('LRT'IFIC'ATE OF 0CCUPAN('1 MAILED?
ADDRESS: C2TI "F-Iphu y o7dc)
CITY, STATE, ZIP: vLe-SS Tie- 76 U 9 g
OFFICE USE
TYPE OF CONSTRUCTION: V. .. . _ _. .__ OCCUPANCY: DIVISION:
ZONING DISTRICT: Je� --
CONDITIONAL USE:
PERMITTED USE: _� –� -- --
BUILDING DEPARTMENT: _ _.. - — DATE:
BUILDING INSPECTOR: _ _ DATE:
ZONING APPROVAL: -_ DATE:
FIRE DEPARTMENT: DATE:
LOT DRAINAGE INSPECTION: DATE:
PUBLIC WORKS DEPARTMENT: _--_— _ DATE;
HEALTH DEPARTMENT:_ _ DATE:
CITY SECRETARY: — _ i_ DATE:
LANDSCAPING APPROVAL: DATE:
APPROVAL FOR ISSUANCE: _ DATE:
O:F ORMSMSAP PLICATIONSICI
312212000m 5108,2)0],4109,2113,11115,10118
CERTIFICATE OF OCCUPANCY
(�1�A SI111T1j' Issue Date:September 19,2018
�T 8` ` A s K� PROJECT DESCRIPTION:CIO[Medical Office]"Texas Health Family Care#447"[NAME CHANGE ONLY]
PROJECT# (817)410-3010 www.mygov.us
CO-18-3571 Inspections Permits
City of Grapevine
LOCATION TENANT LEGAL
P.O.Box 1280 S Main St. Texas Health Family are Twelve Eighty Main Addition
Grapevine,,TX TX 76099 Suite#100 #447 y 131k 1 Lot 1 y
(817)410-3165 Voice Grapevine,TX 76051 Texas Health Family Care
(817)410-3012 Fax #447
CONTRACTOR INFORMATION
Kyle Bradfield *CONSTRUCTION TYPE VB
3801 William D.Tate Ave.,Ste.#840 *OCCUPANCY GROUP B
Grapevine,TX 76051 *ZONING DISTRICT PO
(682)236-6095 Phone
*`NAME OF BUSINESS Texas Health Family Care#447
OWNER **TYPE OF BUSINESS Medical Office
CSSG Holdings,LLC —APPLICANT NAME Kyle Bradfield
12409 Dido Vista Ct —APPLICANT PHONE NUMBER 682-236-6095
Fort Worth,TX 76179-4563 **TENANT NAME Kyle Bradfield
ph.(817)310-0898 **TENANT PHONE NUMBER Kyle Bradfield
AVAILABLE INSPECTIONS *Sales Tax NO
F C/O APPROVED FOR ISSUANCE *Sales Tax Number
(required)
Alcoholic Beverage Sales NO
Alterations NO
Change of Business Name NO
Change of Business Owner NO
County Tarrant
Fire Sprinkler System? NO
Freight Forwarding Business NO
Hazardous Material NO
Industrial Waste NO
New Building/Addition NO
New Building or Property Owner NO
New Occupant/Tenant NO
Number of Employees 9
Outside Refuse/Recycling NO
Outside Storage NO
Signs NO
Square Footage 4691
Zoning PO-Professional Office
FEES TOTAL=$21.00
Certificate of Occupancy-NAME CHANGE $21.00
PAYMENTS TOTAL=$21.00
MYGOV.US City of Grapevine I CERTIFICATE OF OCCUPANCY I CO-18-3571 I Printed 09124118 at 11:27 a.m. Page 1 of 3
Kyle Bradfield(C/O Applicant Information)
Check on 0911812018 ($21.00)
Note,CK#67254
READ AND SIGN
I HEREBY CERTIFY THAT THE FOREGOING IS CORRECT TO THE BEST
OF MY KNOWLEDGE AND THE SAID OCCUPANCY IS IN CONFORMANCE
WITH THE INFORMATION HEREIN SET FORTH.
(If access to the building I space is not provided at the time of scheduled
inspection,a$42.00 re-inspection fee will be charged)
FOR QUESTIONS PLEASE CALL:(817)410-3165.
Signature Date
MYGOV.US City of Grapevine I CERTIFICATE OF OCCUPANCY I CO-18-3571 I Printed 09/24/18 at 11:27 a.m. Page 2 of 3
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CERTIFICATE OF OCCUPANCY
WORKORDER
PERMIT # 18 - 35V
ADDRESS OF INSPECTION: t
DATE OF INSPECTION: TIME OF INSPECTION:
NAME OF BUSINESS: f/�it� ) ° J - �/e t n zvy�
TYPE OF BUSINESS:
USE OF BUILDING AND/OR P`RREMISES:
REASON FOR APPLYING:
CONTACT PERSON:
TELEPHONE NUMBER:
COMMENTSNIOLATIONS:
**TO BE FILLED OUT BY BUILDING OFFICIAL**
ZONING DISTRICT OF INSPECTION �
SPECTION LOCATION: b
/
TYPE OF BUILDING: -13 GROUP AND DIVISION: ,5
ZONING RESTRICTIONS:
O'.MRXIi OSCOINIO1 JlnN WORA ROER
12 1004 Rev.11-2006
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