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HomeMy WebLinkAboutCO2019-4994 UNDER CONSTRUCTION _ CORRECTION LETTER_ PW OR LD NEEDED_ TD NO LETTER_ WAITING FIRE_ HOLD_ CODE_ C/O CHECK LIST C/O PERMIT # P19 - 499� ADDRESS: ) U L4" ) L Q a *r �1�,Jf- az BUSINESS NAME: < XtCLLANIls.D 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) FIRE DEPARTMENT APPROVAL OF HAZARDOUS MATERIAL DATE u/ 5. ZONING CHECKED &COMPLETED ON APPLICATION 6. BUILDING INSPECTION SCHEDULED DATE ' . TIME a' 1)CJ A"-- 7. FIRE DEPT. INSPECTION SCHEDULED DATE I-', 3�) TIME a' LL)nry'- FIRE INSPECTOR: 8. CITY SECRETARY(ALCOHOL) NOTIFICATION DATE: 9. HEALTH INSPECTION NOTIFICATION DATE: �F 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 _214. 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 1"20. BUILDING OFFICIALS SIGNATURE L-'21. C/O CERTIFICATE ISSUED ELECTRIC RELEASED: 'r SCAN CERTIFICATE TO MYGOV: CONDITIONS TO BE TYPED ON C/O? YES/NO MAILED: 0 TORMSOSCOINFORM TIOWKLIST lmc8 \Re A1V1.1 N 5,5R8 C w DATE OF ISSUANCE: DEC 2 3 2019 V"yTY3thl x As PERMIT#: I l l CERTIFICATE OF OCCUPANCY REQUEST FEE: $50.00 NO FEE REQUIRED IF CERTIFICATE OF OCCUPANCYIS ASSOCIATED WITH ANACTIVE CURRENT BUILDING PERMIT ADDRESS OF OCCUPANCY: 16 9(3 ZAwccn57' SUITE# Zo LOT: / L BLOCK: Z SUBDIVISION: C y/C W A,-AC ""CERTIFICATE OF OCCUPANCY WILL NOT BE ISSUED WITHOUT LEGAL DESCRIPTION"" NAME OF BUSINESS: axe-r-vIr ve 1- ,motet vL- We- i S 5 NEW OCCUPANT: YES ✓ NO NEW BUILDING/PROPERTY OWNER: YES NO NEW BUILDING: YES NO ✓ NEW BUSINESS NAME CHANGE: YES NO 7 NUMBER OF EMPLOYEES: Z FREIGHT FORWARDING: YES NO t/ / p /ANEW BUSINESS OWNER: YES NO v TYPE OF BUSINESS: �" -�Dt,� 00_c� SQUARE FOOTAGE: Z/3 Z (Example:Retail Clothing/Attorney's Office/Office-Warehouse/ estauraw" / `/ NAME OF TENANT [PERSON'S NAME]: lqlvk kusX u)r,I,o,` CURRENT MAILING ADDRESS: / &3 ( L L NC c S der S C� Z 2(U CITY/STATE/ZIP: L Ncx�JJ% T)( PHONE NUMBER: PROPERTY OWNER: Gvev G/y �e�v 1 MAILING ADDRESS: '7 1©O ��e�I T 9 e /t t� e Ci ✓'e C) 5-- CITY/STATE/ZIP: CWe-t/t,vf / 7—C 7&05- / PHONE NUMBER: ql7 9'Z5_ ZS(11g ♦ 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 t/ ♦ WILL BUSINESS GENERATE ANY INDUSTRIAL WASTE DISCHARGE TO SEWER SYSTEM?------YES_NO ♦ WILL OUTSIDE REFUSE/RECYCLING/COMPACTING CONTAINERS BE NECESSARY? (if yes,screening is required)----------------------------------------------------------- YES NO I✓ ♦ 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 tr ♦ IS BUILDING SPRINKLERED?------------------------------------------------------- YES_✓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/ 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 rovided at the of the scheduled inspection,a$42.00 re-inspection fee will be charged) FOR QUESTIONS A (8 410 65. /' _ SIGNATURE: PRINT NA A (W NAME: Development Services Department The City of Grapevine *P.O.Box 95104 *Grapevine,Texas 76099*(817)410-3165 Fax(817)410-3012 CIE www.pTayevinetexas.gov O:FORMSIDSAPPLICATIONMCI 312212001/Rev:5/06,210T,4/09,2/13,11115,10/16,8118 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 Nupibq. Signature: !/ WHERE DO YOU WANT YOUR COMPLETED CERTIFICATE OF OCCUPANCY MAILED? ADDRESS: /61/ 3 Lc< vc�1 $tE� 5 iLe z O 1 CITY, STATE, ZIP: �✓a�1 e vim, TY 760 S t x*** r****** rx � * *( FOR OFFICE USE TYPE OF CONSTRUCTION:/I w L` S//I/.V��S OCCUPANCY: DIVISION: ZONING DISTRICT: � CONDITIONAL USE: A//A, PERMITTED USE:NII J J BUILDING DEPARTMENT: DATE: Z ZG - y ' BUILDING INSPECTOR�� � _ .- -- � _ -' DATE: 1/12 ZONING APPROVAL: DATE: FIRE DEPARTMENT: AILL gJI,3� �J DATE: 'a r LOT DRAINAGE INSPECTION: DATE: PUBLIC WORKS DEPARTMENT: DATE: HEALTH DEPARTMENT: DATE: CITY SECRETARY: DATE: LANDSCAPING APPROVAL: DATE: APPROVAL FOR ISSUANCE: DATE: O:FORMSIDSAPPLICATIONSICI 312212001/Rev:5106,2I07,6 09,2113,11/15,10116,fiH6 CERTIFICATE OF OCCUPANCY Issue Date:January 2,2020 PROJECT DESCRIPTION:C/O(Medical Office)"Executive Health&Wellness" PROJECT# (817)410-3010 WWW.mygov.us CO-19-4994 Inspections Permits City of Grapevine — LOCATION TENANT LEGAL P.O.Box 95104 1643 Lancaster Dr. Executive Health&Wellness Clearview Park Addition Blk 2 Grapevine,TX 76099 Suite#201 Lot 1 r1 (817)410-3165 Voice Grapevine,TX 76051 (817)410-3012 Fax CONTRACTOR INFORMATION Tim Lancaster *CONSTRUCTION TYPE IIA SPRINKLERED 4100 Heritage,Suite 105 *OCCUPANCY GROUP B Grapevine,TX 76051 _. (817)925-2569 Phone *ZONING DISTRICT CC **NAME OF BUSINESS Executive Health&Wellness OWNER '*TYPE OF BUSINESS Medical Office Evergreen-fern Ltd **APPLICANT NAME Tim Lancaster 4100 Heritage Ave Ste 105 **APPLICANT PHONE NUMBER 8179252569 Grapevine,TX 76051-5716 **TENANT NAME ph.(817)358-8600 Alok Kuslwaha **TENANT PHONE NUMBER 8173280349 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? 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 2 Outside Refuse/Recycling NO Outside Storage NO Signs NO Square Footage 2132 Zoning CC-Community Commercial FEES TOTAL=$50.00 Certificate of Occupancy $50.00 PAYMENTS TOTAL=$50.00 MYGOV.US City of Grapevine I CERTIFICATE OF OCCUPANCY I CO-19-4994 I Printed 01/02/20 at 10:33 a.m. Page 1 of 3 00O09poK1D=1�j�: �rn C7 - x e � W 8. W m nDAnaa39—s I �z?. 0.Y)GERD O U F r 1 1 O tl31V1tl -�s Q2'- 3 a QLYa% ¢ so X ... GDss•We10PE'- � pp �" � AV V Cfeygpve. � l S mO^ ONN093019 �•C.� r = r xD-M31P 303 SA" O i 0� tt ^ 3 Down D10.0 W P Sa,.yP g3 6�W Gry i i,,L p �fi trossgv,•$.3,O.x+3pS3P' E m �Vryti e 3 e Jpm6W ti4P Yy 0. « .x�-;$ Kates ¢ O�i�♦ �f Ix5�r HS ZW gr.,rye J pO o O� a`'a L't PEE I � QJi yZa 01)6'WP" ¢N �mll - = i Qoar � F im a5 1 x a a, e m" 3 fWC Z 5= 1 o . a Y W \���Oy,0PNK31 ix NV49 ?m°�Q ¢ - 3 O '-s a i _e fOMMEOEE'� O m � � J • 1 z ^ ° I - bmw ybn m k � I m a j J S ym� 5 aS mi I CERTIFICATE OF OCCUPANCY WORKORDER PERMIT #f7- -l 7 / q ADDRESS OF INSPECTION: l k l43 1 ancnf skr 1(�Jr --4= aQ I DATE OF INSPECTION: �il�G a,�?l�/ TIME OF INSPECTION: a UO�/YL NAME OF BUSINESS: �GX ZG,tt V-Q Ll }P1 ht"55 TYPE OF BUSINESS: USE OF BUILDING AND/OR PREMISES: G REASON FOR APPLYING: ou) CONTACT PERSON: LbM&1Y zim TELEPHONE NUMBER: COMMENTSNIOLATIONS: **TO BE FILLED OUT BY BUILDING OFFICIAL** ZONING DISTRICT OF INSPECTION LOCATION: TYPE OF BUILDING: 'I' FZC �l /f k GROUP AND DIVISION: ?-> ZONING RESTRICTIONS: 0_'ORMSOSCOINI'ORMAI'IOMWORFORUI-R I2H0 04 Ra,.1.19C^0 ma) N •�' w CIE o N Q O CL a10Ec o c i o.c o CD F.'. 7 j U.n o Lo o -0oa Co LO ' Na > o o , c w Q n m �o0 0 m ' w ID .� mac a a) o ate ' u - o m o m a V c0o a` wv (D 0- 3 o c o w , Z C�L o -��✓ . i 0 Q (D7; sq ca c m oQij '`» � I •> > 006 y x d a) 0)."0 C7 7 0 1 2 a CDo OLL U a' r N ❑ 3 (9 0 t7 0 ° m �l U ow a <� QrZE`o 8 w + 0628 a Ta i U ncc a) ,. -o-0=o m W rnm U TO r ENN J Q) w Y E w.N c w Z E a U `l to m Q U OUmw d Q C) m — U mm c r OsCU N y X a)'> U 7 2 m H C a a) (a O.0.o m m U O m O 40-- N d + > m N J k C C U"t C) C N Cl) "�' y C V u)O«a d x (0 .3 m m O U N G r \{{ OIL