HomeMy WebLinkAboutCO2018-4028 UNDER CONSTRUCTION _
CORRECTION LETTER_
PW OR LD NEEDED _
TD NO LETTER_
WAITING FIRE_
HOLD _
CODE _
C/O CHECK LIST
C/O PERMIT # P18 - 406� 5(
ADDRESS: 0o�Q�
BUSINESS NAME:
BUSINESS PROPERTY
CHANGE NAME / OWNER NEW CONST/ADDITION PERMIT#
-NEW TENANT/ OCCUPANT REMODEL /ALTERATION PERMIT#
ISSUE DATE FINAL DATE
v 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
J� 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. CAPING SIGN OFF,
`X 20. BUILDING OFFICIALS SIGNATURE
�21. C/O CERTIFICATE ISSUED ELECTRIC RELEASED:
SCAN CERTIFICATE TO MYGOV:
CONDITIONS TO BE TYPED ON C/O? YES/ NO MAILED:
O 1FORMSOSCOINFORMATIONICKLIST
12=1041 Rev 11111,1111 6 6118
t `
Fran:Ashley Hayunga 1 Fax:(817)576-6865 To: Fax: (817)410-3012 Page 2 of 3 1011112018 9:49 AM
DEC102018 ll� l
DATE OF ISSUANCE: `
PERMIT N;
CERTIFICATE OF OCCUPANCY REQUEST
FEE: $50.00
NO FEE REQUIRED IF CERTIFICATE OFOCCUPANCY 1S ARVOCIATED WITH AN ACTIVE CURRENTBUMMING PERMIT
ADDRESS OF OCCUPANCY: 1 U04 Vk- SUITE N (5—K)
LOT:_ / 6' -3BLOCK' � SUBDIVISION: CIW�yVi A) !`fl 0L Ci� tt7i x
'***CERTIFICATE OF OCCUPANCY WILL NOT BE ISSUED WITHOUT LEGAL DESCRIPTION"*'
NAME OF BUSINESS: _Rllyn, filitar1� ere- tui -ie1`daS Sr-&4Rp
NEW OCCUPANT: YES_NOi NEW UILDING/PROPERT OWNER; 140 t�
NEWBUILDING: YFS NO t.r NEW BUSNTESSNAMECHANGE: YES—NO 4
NUMBER OF EMPLOYEES: 5 FREIGHT FORWARDING: YES—NO
N'EW I3USCNESS OWT ER: l'ES NO
TYPE OF US[ ESS: i.. +SQUARE FOOTAGE: /R
(Fsatnple;Iteta l 00thlog t Attorney's Offku f Omce-Wurehnasu I Itestau"110
NAME OF TENANT lPFRSON' i'tiAME1: V°tta�
CURRENT MAILING ADDRESS: /�o l Z�askr ,- { o
CIT'YtS1`A'TE2 /
TP: ( XT Y Q 7 ( 05 1 PHONE NUMBER: D�rl" ' YEg tt r
PROPERTY OWNER: _O{,4TF,X ?qtr-fir e'rS . LL--T1
MAILING ADDRESS: . { P i t,s _LQ�• D'�0 p to
CITU/STATE/ZIP:. &Ea i f'yt "Z 1DL PHONE NUMBER:
♦ IS YOUR BUSINESS SUBJECTTO SALES TAX LAW?(if yes,provide copy of Sates Tax Certificate)---- YES_ NO
♦ WILL THERE BE ALCOHOLIC BEVERAGE SALES?(iryes,provide copy of Alcoholic Beverage Permit)-YES_NO ✓'
PERMITS ARE REQUIRED FOR SIGNS, WILLANYSIGNSBEINSTALLED?-------------------YESNO u'-
s WILL BUSINESS GENERATE ANY INDUSTRIAL WASTEDISCHARGETO SEWER SYSTEM?-----. YES— NO
• WILL OUTSIDE REFUSEIRECYCLING/COMI PACTING CONTAINERS BE NECESSARY? s
(if yes,screeniagisrequired)-----------------------------------------------------------YES_ NO w
v WILL THERE BE ANY OUTSIDE STORAGE,DISPLAY,USEOR DINING:------------- ------- YES_ NO �
♦ WILL ANY ALTERATIONS BE MADE TO THE SITE OR BUILDING?------------------------- YES N77
7
♦ IS BUILDING SPRINI4LERED?------------------------------------------------------- YES V NO
• WILL BUSINESS STORE OR HANDLE HAZARDOUS MATERIALS Olt 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 --W
OCCUPANCY IS IN CONFORMANCE W ITU THE INFORMATtON HERF,IN SET FORTH.
(if access to the build'eagfspace is not provided aft the time of the scheduled inspection,a$42.00 re-inspection fee Will be charged)
FOR QUESTIONS ECALL(817it10-31G .
SIGNATURE: " _/1
PRINTNAM?:
^7tIYfW � � 'CPHONE d: N7
SO�`F.It) Jf
DevOopment Services Department
The City or Grapevine*P.O.Box 95104*Grapevine,Textus 76099 (817)4103165
Fax(8 17)410-3012* www.gmpevinetexas.gov
JV2L=11A"-9PL10 .4%9.211
31392601/her:.466,9i67,dM9.9/19,/5/73,16/16
TEXAS SALES TAX
Texas Sales Tax is charged and collected on sales within the State and City of Grapevine,Texas of"taxable items."Taxable
Item 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"Seiler or Retailer"means a person engaged in the business of mating 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.[fan 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 Numbe 9
Signature:
WHERE D U WANT YOUR COMPLETED CERTIFICATE OF OCCUPANCY MAILED?
ADDRESS:11 dol wa�-Ck1(D{
CITY,STATE,ZIP: �i�Iyu I ne
OFFICE USE
TYPE OF CONSTRUCTION: Y"r/ OCCUPANCY: DIVISION:
ZONING DISTRICT:— IQ/ CONDITIONAL USE:
PERMITTED USE: TF.
BUILDING DEPARTMENT: DATE: 12. - 11-ze,
BUILDING INSPECTOR: DATE: Z
3l, � Q .
ZONING APPROVAL: DATE:
FIRE DEPARTMENT: t �L 0 Q j)A— DATE: ia I61 118
LOT DRAINAGE INSPECTION: DATE:
PUBLIC WORKS DEPARTMENT: DATE:
HEALTH DEPARTMENT: DATE:
CITY SECRETARY: DATE:
LANDSCAPING APPROVAL: DATE:.
APPROVAL FOR ISSUANCE: DATE:
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(_�_^-� CERTIFICATE OF OCCUPANCY
G1 A , '1i II i Issue Date:January 2,2019
}91 t, t R`z' PROJECT DESCRIPTION:C/O[Physician's Adminstrative Office]"Allcare Alliance/Allcare Physicians
— Group"
PROJECT# (817) 410-3010 www.mygov.us
CO-18-4028 Inspections Permits
City of Grapevine
P.O.Box 95104 LOCATION TENANT LEGAL
Grapevine,TX 76099 1601 Lancaster Dr. Allcare Alliance/Allcare Clearview Park Addition Blk 3
(817)410-3165 Voice Suite#B10 Physicians Group Lot 1 r
(817)410-3012 Fax Grapevine,TX 76051 Allcare Alliance/Allcare
Physicians Group
CONTRACTOR INFORMATION
Ashley Hayunga Canter *CONSTRUCTION TYPE VB
1601 Lancaster Dr., Ste B-10 *OCCUPANCY GROUP B
Grapevine, TX 76051 *ZONING DISTRICT PO
(817)576-6665 Phone
NAME OF BUSINESS Allcare Allilance/Allcare Physicians
OWNER Group
Oktex Partners Ltd TYPE OF BUSINESS Administrative Office
1601 Lancaster Dr Ste 170 **APPLICANT NAME Ashley Hayunga Canter
Grapevine,TX 76051-2107 **APPLICANT PHONE NUMBER 817-576-6665
ph. (817)481-7727 **TENANT NAME David DeJesus
AVAILABLE INSPECTIONS **TENANT PHONE NUMBER 817-576-6663
� Final Building C/O Inspection(required) *Sales Tax NO
� Final Fire Dept Inspection (required) *Sales Tax Number
� Landscaping (required)
� C/O APPROVED FOR ISSUANCE Alcoholic Beverage Sales NO
(required) Alterations NO
Change of Business Name NO
Change of Business Owner NO
County Tarrant
Fire Sprinkler System? YES
Freight Forwarding Business NO
Hazardous Material NO
Industrial Waste NO
New Building/Addition NO
New Building or Property Owner NO
New Occupant/Tenant YES
Number of Employees 5
Outside Refuse/Recycling NO
Outside Storage NO
Signs NO
Square Footage 1775
Zoning PO-Professional Office
FEES TOTAL=$50.00
Certificate of Occupancy $50.00
CERTIFICATE OF OCCUPANCY
WORKORDER
PERMIT # 18 - fZ�2,2 k
ADDRESS OF INSPECTION:
DATE OF INSPECTION: i TIME OF INSPECTION:
NAME OF BUSINESS:
TYPE OF BUSINESS:
USE OF BUILDING AND/OR PREMISES:
yv
REASON FOR APPLYING: --)/7,
CONTACT PERSON:
TELEPHONE NUMBER: S
COMMENTS/VIOLATIONS: J/ Cc ,nn Me�rS 1 S5 ctL 2. Y
**TO BE FILLED OUT BY BUILDING OFFICIAL"BU
ZONING DISTRICT OF INSPECTION LOCATION: / �
TYPE OF BUILDING: V � GROUP AND DIVISION:
ZONING RESTRICTIONS:
O.HRMS OSCOINPORMATION\VORKORDLR
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