HomeMy WebLinkAboutCO2018-4361 UNDER CONSTRUCTION
CORRECTION LETTER_
PW OR LID NEEDED_
TD NO LETTER_
WAITING FIRE_
HOLD _
CODE_
C/O CHECK LIST
C/O PERMIT # P18 -_
ADDRESS:
BUSINESS NAME:
BUSINESS/PROPERTY
-CHANGE NAME / OWNER NEW CONST/ADDITION PERMIT#
NEW TENANT/OCCUPANT REMODEL/ALTERATION PERMIT#_\I ( p
,
ISSUE 4FE r 4p 5 20 1f►(� �FINAL DATE lT-1'1 n
�/ 1. APPLICATION FORM COMPLETED
1%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)
a_ —a
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:
J 9. HEALTH INSPECTION NOTIFICATION DATE:
10. PUBLIC WORKS INSPECTION E-MAIL DATE
11. LOT DRAINAGE INSPECTION E-MAIL DATE
12. CORRECTION LETTER SENT DATE
p �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
�8. LOT DRAINAGE SIGN OFF
9. LANDSCAPING SIGN OFF
20. BUILDING OFFICIALS SIGNATURE FEB 19 2019
21. C/O CERTIFICATE ISSUED ELECTRIC RELEASED:
SCAN CERTIFICATE TO MYGOV:
CONDITIONS TO BE TYPED ON C/O? YES/NO MAILED:
O:IFORMSOSCOINFOR"TIONICKLIST
1 MUM 1 Re,11111,11 15.5/18
DATE OF ISSUANCE: AAA-L
Nov v 1 '9 7- 18 GRAPEVINE,
�/
T E s A S PERMIT#: 19 7,'
j
CERTIFICATE OF OCCUPANCY REQUEST
FEE: $50.00
NO FEE REQUIRED IF CERTIFICATE OF 0CCUPANCYIS ASSOCIATED WITH ANACTIVE CURRENT BUILDING PERMIT
ADDRESS OF OCCUPANCY: 2020 West State Highway 114 SUITE# 340
LOT: °� � BLOCK: SUBDIVISION: 42�Mo
****CERTIFICATE OF OCCUPANCY WILL NOT BE ISSUED WITHOUT LEGAL DESCRIPTION T,***
NAME OF BUSINESS: nr Saira Mnmin
NEW OCCUPANT: YES X_NO NEW BUILDING/PROPERTY OWNER: YES NO X
NEW BUILDING: YES NO,y_ NEW BUSINESS NAME CHANGE: YES NO 6�
NUMBER OF EMPLOYEES: FREIGHT FORWARDING: YES NO_X
NEW BUSINESS OWNER: YES NO
TYPE OF BUSINESS: Medical Office SQUARE FOOTAGE: 3,012
(Example:Retail Clothing/Attorney's Office/Office-Warehouse/Restaurant)
NAME OF TENANT [PERSON'S NAME]: _Dr, Saira Momin
CURRENT MAILING ADDRESS: t-9 o-,,—?0 /., . S&k &,y �_1, t /
Ci ZRI` � � �D(CITY/STATE/ZIP: L �C I k '%00S PHONE NUMBER:
PROPERTY OWNER:
Welltower
MAILINGADDRESS: _4201 Coit Rd Suite 307
CITY/STATE/ZIP: Fri$00, Texas 75035 PHONE NUMBER: 469-907-3803
* 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 Z
* PERMITS ARE REQUIRED FOR SIGNS. WILL ANY SIGNS BE INSTALLED?-------_---------- YES_NO y%��
* 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
* WILL THERE BE ANY OUTSIDE STORAGE(including storage of company/fleet vehicles),DISPLAY,
USE OR DINING?--------------'---------------------------------------------------- YES NO
* WILL ANY ALTERATIONS BE MADE TO THE SITE OR BUILDING?------------------------- YES �NO
* IS BUILDING SPRINKLERED?------------------------------------------------------- YES,/
* WILL BUSINESS STORE OR HANDLE HAZARDOUS MATERIALS OR LIQUIDS? i
(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 QUESTION LEASECAIM(817)410-3165. _
SIGNATURE:q 1 �� PRINT NAME:
PHONE#: f /, �7 7L EMAIL:
(OVER)
Development Services Department
The City of Grapevine* P.O.Box 95104* Grapevine,Texas 76099 (817)410-3165
Fax(817)410-3012* www.arai)evinetexas.gov
MFORMSIDSAPPLICATIONSIC/
3/22/2001/Rev:8/06,2107,0/09,2118,11116,10 116,8/18
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 To umbe
Signature: w
WHERE DO YOU WAN COMPLETED� /
CERTIFICATE OF OCCUPANCY MAILED?
ADDRESS: b 2� � � J 1
CITY, STATE,ZIP: 6k(t)--)<0 V l�1�e� -7�L U
OFFICE USE
TYPE OF CONSTRUCTION: OCCUPANCY: D DIVISION:
ZONING DISTRICT: C� CONDITIONAL USE:
PERMITTED USE:
BUILDING DEPARTMENT: DATE: e�76wzotI3
BUILDING INSPECTOR: DATE: L�j!j
ZONING APPROVAL:, I, ���/�-- DATE:
FIRE DEPARTMENT: DATE: all Imo(
LOT DRAINAGE INSPECTION: DATE:
PUBLIC WORKS DEPARTMENT: DATE:
HEALTH DEPARTMENT: DATE:
CITY SECRETARY: DATE:
LANDSCAPING APPROVAL: �' W DATE: ell— Zb — Q
APPROVAL FOR ISSUANCE: / DATE:
0:F0RMSIDSAPPLICAT10N8kC1
312212001/Rev:5/06,210],4109,283,11/15,10116,8118
CERTIFICATE OF OCCUPANCY
r
' Issue Date:February 20,2019
e T 1: r l 1•�' PROJECT DESCRIPTION:C/O[Dr.'s Office]"Dr.Saira Momin"(BLDG 18.4360)
7 PROJECT# (817)410-3010 www.mygov.us
CO-18.4361 Inspections Permits
City of Grapevine
LOCATION TENANT LEGAL
P.O.Box 95104 2020 W State 114 Hwy. Dr.Saira Momin Baylor Medical Surgery
Grapevine,TX 76099
Suite#340 Center Elk 1 Lot 2r1
(817)410-3165 Voice Grapevine,TX 76051
(817)410-3012 Fax
CONTRACTOR INFORMATION
Tammy Bolinger *CONSTRUCTION TYPE IIA Sprinklered
1280 S.Main Street *OCCUPANCY GROUP B
Grapevine,TX 76051 *ZONING DISTRICT CC
(817)228-7847 Phone
**NAME OF BUSINESS Dr.Saira Momin
OWNER "*TYPE OF BUSINESS Medical Office
Hcri Baylor Grapevine Asc LC "*APPLICANT NAME Tammy Bollinger
4500 Dorr St **APPLICANT PHONE NUMBER 817-228-7847
Toledo,OH 43615 *"TENANT NAME Dr.Saira Momin
AVAILABLE INSPECTIONS **TENANT PHONE NUMBER 281-744-6708
w 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 YES
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 3012
Zoning CC-Community Commercial
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.
MYGOV.US City of Grapevine I CERTIFICATE OF OCCUPANCY I CO-184361 I Printed 02120/19 at 9:14 a.m. Page 1 of 3
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WORKORDER
PERMIT # 18 - 2Z3 6 r
ADDRESS OF INSPECTION: 0 y / let" k)
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DATE OF INSPECTION: TIME OF INSPECTION:
NAME OF BUSINESS:
TYPE OF BUSINESS:
USE OF BUILDING AND/OR PREMISES:
REASON FOR APPLYING:
CONTACT PERSON:
TELEPHONE NUMBER:
COMMENTS/VIOLATIONS: /lp
**TO BE FILLED OUT BY BUILDING OFFICIAL**
ZONING DISTRICT OF INSPECTION LOCATION: L-e(-
TYPE OF BUILDING: T � GROUP AND DIVISION:
ZONING RESTRICTIONS: r /�
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