HomeMy WebLinkAboutCO2019-0559 UNDER CONSTRUCTION _
CORRECTION LETTER_
PW OR LD NEEDED_
TD NO LETTER_
WAITING FIRE _
HOLD
CODE_
C/O CHECK LIST
C/O PERMIT # P19 -ADcT!�;_Cj
ADDRESS: ! � 31 S. plc- L n
BUSINESS NAME: 0-) IC-he PL-LC
BUSINESS/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 0`2 / TIME c G CJ CL 1 rt
II FIRE DEPT. INSPECTION SCHEDULED DATE L )q TIME
FIRE INSPECTOR: A4 zk�,�5
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
4�/49-13. BUILDING INSPECTORS SIGN OFF LETTER: YES / NO
14. FIRE DEPARTMENTS SIGN OFF LETTER: YES / NO
15. HEALTH DEPARTMENT SIGN OFF
X16. CITY SECRETARY(Alcohol License Sign Off)
7. PUBLIC WORKS SIGN OFF
x/18. LOT DRAINAGE SIGN OFF
—Z,9. LANDSCAPING SIGN OFF
1/ 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 TORMS\DSCOINFORMATION\CKLIST
1213wu 1 Rae Ill 111 Ill 5,5,18
Gqy A�y VVINE DATE O F ISSUANCE:T E PERMIT#: rI LU ��
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: //39 C�Y, m,4_1A ° ZS-h SUITE# /,/3 y
LOT:Rte-!BLOCK:8 SUBDIVISION: ,�3cr. L.f/�i'7�ca�ia t� iU L; l ( ` [7•C n
****CERTIFICATE OF OCCUPANCY WILL NOT BE ISSUED�VITHOUT LEGAL DESCRIPTI ****
NAME OF BUSINESS: / rsLLZ� ��iAinB4/.lam F�c:�
NEW OCCUPANT: YES X NO NEW BUILDING/PROPERTY OWNER: YES NO
NEW BUILDING: YES NO= NEW BUSINESS NAME CHANGE: YES NO
NUMBER OF EMPLOYEE S� FREIGHT FORWARDING: YES NO
NEW BUS � Sf OWNER: YES NO
TYPE OF BUSINESS: ' ��� �/II ' a� ✓i��/ �J, SQUARE FOOTAGE:
(Example:Retail Clothing/Attorney's Office/Office-winehous / aurintt)
NAME OF TENANT [PERSON's
CURRENT MAILING ADDRESS: 5-, 127e4Z 1I Zr4 p .y
CITY/STATE/ZIP: 2,q pL ////✓Li k ��D.! PHONE NUMBER:
PROPERTY OWNER: (�„cl,�a�
MAILING ADDRESS `�rm'ChA�L r Flies < CaO L i r
CITY/STATE/ZIP: tl �i c� . % 9�`./G PHONE NUMBER 13- S-
b' - U7✓
�7 ♦ IS YOUR BUSINESS SUBJECT TO SALES TAX LAW?(if yes,provide copy of Sales Tax Certifica )---- YES�_NO
♦ WILL THERE BE ALCOHOLIC BEVERAGE SALES? (if yes,provide copy of Alcoholic Beverage Permit)-YES_NO X
♦ PERMITS ARE REQUIRED FOR SIGNS. WILL ANY SIGNS BE INSTALLED?------------------- YES_NO x
♦ WILL BUSINESS GENERATE ANY INDUSTRIAL WASTE DISCHARGE TO SEWER SYSTEM?------YES—NO X
♦ WILL OUTSIDE REFUSE/RECYCLING/COMPACTING CONTAINERS BE NECESSARY?
(if yes,screening is required)----------------------------------------------------------- YES—NO X
♦ WILL THERE BE ANY OUTSIDE STORAGE(including storage of company/fleet vehicles),DISPLAY,
USE ORDINING?------------------------------------------------------------------ YES NO x
♦ WILL ANY ALTERATIONS BE MADE TO THE SITE OR BUILDING?------------------------- YES NO X
♦ IS BUILDING SPRINKLERED?------------------------------------------------------- YES—NO X
♦ 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 P E CALL Sl fj 410-3165. /� /
SIGNATURE`! 1 '/� / /J�✓ PRINT NAMED"! .�>y'/ ///��`� /�J J A �•�f
/ f
/I
PHONE#: L/ 17— j616 7,5- L�, EMAIL:
OVER)
Development Services Department
The City of Grapevine *P.O.Box 95104 sl:Grapevine,Texas 76099 (817)410-3165
Fax(817)410-3012 *www.grapevinetexas.gov
O:FORMSID8APPLICATIONSIC/
312212001/Rev:5106,2/07,4109,2113,17%5,10116,8118
TEXAS SALES TAX
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 malting 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:
I
Signature:
WHERE DO YOU WANT YOUR COMPLETED CERTIFICATE OF OCCUPANCY MAILED?
ADDRESS: �l�
CITY, STATE, ZIP
�I�, � ' ' /nl�/� /✓� �
OFFICE USE ONLY*** � �xxrxx � ��� � xxx� xx �
TYPE OF CONSTRUCTION: V G/ OCCUPANCY: DIVISION:
ZONING DISTRICT: e2 CONDITIONAL USE: fVA
PERMITTED USE: !eJ
BUILDING DEPARTMENT: DATE:
BUILDING INSPECTOR: DATE:
ZONING APPROVAL: DATE: r�
FIRE DEPARTMENT: DATE:
LOT DRAINAGE INSPECTION: DATE:
PUBLIC WORKS DEPARTMENT: DATE:
HEALTH DEPARTMENT: DATE:
CITY SECRETARY: DATE:
J
LANDSCAPING APPROVAL: �. , DATE: `]� �,d�— 1e(
APPROVAL FOR ISSUANCE: DATE:—;-
O:FORMSMAPPLIGATIOWC1
3122120011Rev:5106,2107,6109,2113,11/15,10/16,8118
(�j7AT17 CERTIFICATE OF OCCUPANCY
Q711 Hr '�11i Issue Date:February 20,2019
..1 11 I ti PROJECT DESCRIPTION:C/O(Medical Office)"Michelle Shamblin PLLC"
—1 r—
PROJECT# (817)410-3010 WWW.mygoV.Us
CO-19.0559 Inspections Permits
City of Grapevine
LOCATION TENANT LEGAL
P.O.Box ,TX 1139 S Main St. Michelle Shamblin, PLLC B Invitation Only Condo Elk
Grapevine,TX 76099 Y y
Grapevine,TX 76051 8 Lot B3
(817)410-3165 Voice 15.25%Common Area
(817)410-3012 Fax
CONTRACTOR INFORMATION
Lisa Michelle Shamblin *CONSTRUCTION TYPE VB
1135 S. Main Street *OCCUPANCY GROUP B
Grapevine,TX 76051 *ZONING DISTRICT PO
(817)416-7500 Phone **NAME OF BUSINESS Michelle Shamblin PLLC
"*TYPE OF BUSINESS Office
OWNER '*APPLICANT NAME Lisa Michelle Shamblin
Laub Carolyn N&Sam Edward 20 **APPLICANT PHONE NUMBER 817-416-7500
3460 Ullman St **TENANT NAME Michelle Shamblin,PLLC
San Diego,CA 92106 **TENANT PHONE NUMBER 817-416-7500
AVAILABLE.INSPECTIONS *Sales Tax NO
• Final Building C/O Inspection(required) *Sales Tax Number
• Final Fire Dept Inspection(required)
• Landscaping(required) Alcoholic Beverage Sales NO
• C/O APPROVED FOR ISSUANCE Alterations NO
(required) 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 YES
Number of Employees 3
Outside Refuse/Recycling NO
Outside Storage NO
Signs NO
Square Footage 2832
Zoning PO-Professional Office
FEES TOTAL=$50.00
Certificate of Occupancy $50.00
PAYMENTS TOTAL=$50.00
MYGOV.US City of Grapevine I CERTIFICATE OF OCCUPANCY I CO-19-05591 Printed 02/20/19 at 10:18 a.m. Page 1 of 3
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CERTIFICATE OF OCCUPANCY
WORKORDER
PERMIT # 19-OG Lf`'!
ADDRESS OF INSPECTION: � 39 S, n�tiLn s+
DATE OF INSPECTION: 2(//l TIME OF INSPECTION: /, (jPjCt I'ti1
NAME OF BUSINESS: MnnC-KGl Lam' S- amb i i n PL-LL
TYPE OF BUSINESS:
USE OF BUILDING AND/OR PREMISES: l '
REASON FOR APPLYING: M e u-) 1 11CI rl�
CONTACT PERSON: L l CCU O- c.-h E l l e) S hacnlo h ('\
TELEPHONE NUMBER: S k`1 -" jf, S-Uo
COMMENTS/VIOLATIONS: No ✓I o L* ,,a nu op grE/ yoo 9//9
**TO BE FILLED OUT BY�BUILDING OFFICIAL**
ZONING DISTRICT OF INSPECTION LOCATION: V C)
TYPE OF BUILDING: \1 e GROUP AND DIVISION:
ZONING RESTRICTIONS:
/y-A,
O.FORMS USCOINEOR,MAHON\VORAOROER
12 N 04 Rev.1 17 2006
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