Assured Self-CS031106T H E ~ C I T V O F
COPPELL •
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APPLICATION FOR: CERTIFICATE OF OCCUPANCY OR
BUILDING FINAL (iJNOCCUPIED BUILDING)
Application for Certificate is made to the Building Official of Coppell, Tezas, for Certificate of Occupancy,
authorizing the use of vacant land or building at:
Address of use: ~ ~ , h' ~i-'L7-L«~ Suite No.:
Business name of occupanthenant: ~ if~n'[~ ~~ /~ ~~oi7
Building to be used as: ~rl ~ ~ ~~-~~~Z Square feet: ~~ Cx'~ C~
Previous use: ~'//'~~/~r
Occupantkenant name: ~SSuF~'-C ~~~~ .~~'~ Telephone: 7~ ~Z ~3C?-~C7-~
Mailing address:~~i~~l~s~-t 1~iL.--City: ~h ~'G'~~ StateT_~Zip: ~~
Plellse Check: ^ New Tenant ^ Same Business Owner, New Name
^ Clean and Show ^ Shell Building (No occupancy)
^ Expanding lease space ^ Same Business Name, New Owner
I hereby certify that plans have been reviewed and the building will be inspected by a certified energy code
inspector in accordance with State Law. Plan review and inspection documentation shall be made available
to the Building Inspection Department (required for new buildings and additions).
I hereby certify that plans have been submitted to the Texas Department of Licensing and Regulation for
Accessibility Review. Control Number:~Rt~"/~.~ (Not required for 1 & 2 family dwellings).
s
~~FOR DEMOLITIONS, ADDIITONS AND/OR ALTERATION TO COMIvIEItCIAL AND PUBLIC BUII.DINGS'•
^ I hereby certify that an asbestos survey has been conducted for this structure in accordance with the
regulatory requirements of the Texas Department of Health.
I hereby certify that the foregoing is corcect to the best of my knowledge and all work will be performed
according to the documents approved by the Building Inspections Department and in compliance with the City
of Coppell Ordinance regulating construction. It is understood that the issuance of a Certificate of Occupancy
does not grant or authorize any violation of any code or ordinance of the City of Coppell. I FURTHERMORE
UNDERSTAND THAT PLANS AND SPECIFICATIONS ARE NOT REVIEWED FOR HANDICAPPED
ACCESSIBILITY BY THE CITY, AND THAT THE DESIGN PROFESSIONAUOWNER IS
RESPONSIBLE FOR OBTAINING SUCH APPROVAL FROM THE APPROPRIATE STATE AND/OR
FEDERAL
Printed na
Signature
(Please complete checklist on reverse side)
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Check?%st (or Ce ~rcate o(Occuaancv:
1. Are you enlarging an existing tenant space by combining suites, or portions of suites? Yes No
List lease spaces being combined ~~
2. Will you store, use, dispense or mix flammable or combustible liquids for purposes other than Yes ~ No/
maintenance for operation of equipment? If so, specify the type of product and the projected ~~
quantifies:
3. Will there be anY sPmY P~nanB on premises? Yes No
4. Will you handle or use any hazardous or toxic chemicals such as, but not limited to, oxidizers, Yes o
wrosive liquids, poisonous gases and radioactive materials? If so, specify the type and
projected quantities:
5. Will the principle use of the building or tenant space be used for storage? ( Yes j No
a. if yes, what materials will be stored? > ~ ~/~ ~~
b. What percentage will be used for storage? ~ O~
c. How high will materials be stacked? '
d. Will the materials be stored in racks? ^ Yes o
6. Will the building be equipped with a Sre sprinkler system or a standpipe system? Yes No
7. Will food or beverages be manufactured, Packaged, stored, distributed, sold or prepared in any Yes No
manner other than vending machines?
8. Will alcoholic beverages be sold for consumption on the premises? Yes No
9. Will any goods, merchandise, or raw materials be stored or displayed outdoors? Yes o
10. Will used goods be sold on the premisesT Yes o
11. Will you be performing any of the following processes on the premises? If so, please indicate: Yes No
^ Manufacturing ^ Treating ^ FormulatiomTvlixing~Processing
^ Vehicle Washing ^ Welding
12. Will any liquid waste or sludge be generated which is not disposed of in the sewer system? Yes N
13. Will any form of wastewater prrrtreatment be utilized at this facility? If yes, please describe Yes No
here:
Please mail the comaleted Certificate of Occuaancy to:
^ Tenant's address, as listed on the front side of this form.
^ A different address, as follows:
^ Contractor will pickup
Please return this form to: Building Inspections Dept., 500 Southwestern Blvd., Coppell, TX 75019.