Application Form for Certificate of Occupancy - CITY OF HALTOM CITY, Texas

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APPLICATION
CERTIFICATE OF OCCUPANCY
$50.00 FEE (non-refundable)
CITY OF HALTOM CITY, TEXAS, 5024 BROADWAY AVE., HALTOM CITY, TEXAS 76117
Telephone - 817-222-7730
FAX - 817-222-7739
*** C/O APPLICATION FEE IS NON-REFUNDABLE***
DATE __________________ NAME OF BUSINESS _____________________________________________________
HALTOM CITY PROPERTYADDRESS ______________________________________________________________
BUSINESS PHONE #_______________________ CONTENTS (office, warehouse, etc.) ______________________
OCCUPANCY (type of business) _____________________________________________________________________
BUSINESS OWNER NAME____________________________________EMAIL:_____________________________
BUSINESS OWNER’S HOME ADDRESS _____________________________________________________________
BUSINESS OWNER’S PHONE # (after hours) ____________________ # OF EMPLOYEES ON SITE ________
DRIVER’S LICENSE NO. ________________________SALES TAX or FEDERAL ID NO____________________
PROPERTY OWNER NAME ________________________________ PHONE # ____________________________
PROPERTY OWNER ADDRESS ___________________________________________________________
--------------------------PLEASE ANSWER ALL OF THE FOLLOWING QUESTIONS--------------------------
--------New Business __ Relocation from other HC Location __ Change of Ownership ____ Add. Space ____
How many square feet will be in the building or lease space? ________________________________________
Are you enlarging an existing tenant space by combining suites? __________
Yes _____
No ___
If yes, list the spaces combined: _
Will you store, use, dispense or mix flammable or combustible liquids for purposes
other than maintenance or operation of equipment in excess of 10 gallons?
Yes ___
No ___
If yes, specify the type of product and maximum quantities (use separate sheet if
Necessary): ____________________________________________________________
Will there be any spray painting on the premises?
Yes ___
No ___
Will you handle or use any hazardous or toxic chemicals such as, but not limited to,
oxidizers, corrosive liquids, poisonous gases or radioactive materials?
Yes ___
No ___
If yes, specify the type and maximum quantities (use separate sheet if necessary): ____
______________________________________________________________________
Will a principal use of the building or tenant space be used for storage?
Yes ___
No ___
If yes, What percentage? ____ List the materials to be stored:
_______________________________________________________________
How high will the materials be stored? _________
Will the materials be stored in racks? _________
Yes
No
Will the building be equipped with any of the following fire protection equipment:
Yes ___
No ___
____ automatic fire sprinkler ___ automatic fire alarm or smoke detectors ___standpipe system
Will food or beverages be manufactured, packaged, stored, distributed, sold or prepared
in any manner other than vending machines?
Yes ___
No ___
Will a swimming pool be located on the premises?
Yes ___
No ___
Will a septic tank be used on the premises?
Yes ___
No ___
Will a grease trap or sand trap be used on the premises?
Yes ___
No ___
Will any goods, merchandise and/or raw materials be displayed or stored outdoors?
Yes ___
No ___
Will you be performing any of the following processes on the premises (if yes, circle
Yes ___
No __
the activities that apply):
manufacturing
treating
formulation/mixing/processing
vehicle washing
welding
Will any liquid waste or sludge be generated which will not be disposed of in the
sewer system?
Yes ___
No ___
Will any form of waste water pre-treatment be utilized at this facility?
Yes ___
No ___
If yes, briefly describe on an attached sheet.
Will combustible dust be generated?
Yes ___
No
SIGNATURE OF APPLICANT: ____________________________________________ DATE:
__________________
APPLICATION
CERTIFICATE OF OCCUPANCY
$50.00 FEE (non-refundable)
CITY OF HALTOM CITY, TEXAS, 5024 BROADWAY AVE., HALTOM CITY, TEXAS 76117
Telephone - 817-222-7730
FAX - 817-222-7739
*** C/O APPLICATION FEE IS NON-REFUNDABLE***
DATE __________________ NAME OF BUSINESS _____________________________________________________
HALTOM CITY PROPERTYADDRESS ______________________________________________________________
BUSINESS PHONE #_______________________ CONTENTS (office, warehouse, etc.) ______________________
OCCUPANCY (type of business) _____________________________________________________________________
BUSINESS OWNER NAME____________________________________EMAIL:_____________________________
BUSINESS OWNER’S HOME ADDRESS _____________________________________________________________
BUSINESS OWNER’S PHONE # (after hours) ____________________ # OF EMPLOYEES ON SITE ________
DRIVER’S LICENSE NO. ________________________SALES TAX or FEDERAL ID NO____________________
PROPERTY OWNER NAME ________________________________ PHONE # ____________________________
PROPERTY OWNER ADDRESS ___________________________________________________________
--------------------------PLEASE ANSWER ALL OF THE FOLLOWING QUESTIONS--------------------------
--------New Business __ Relocation from other HC Location __ Change of Ownership ____ Add. Space ____
How many square feet will be in the building or lease space? ________________________________________
Are you enlarging an existing tenant space by combining suites? __________
Yes _____
No ___
If yes, list the spaces combined: _
Will you store, use, dispense or mix flammable or combustible liquids for purposes
other than maintenance or operation of equipment in excess of 10 gallons?
Yes ___
No ___
If yes, specify the type of product and maximum quantities (use separate sheet if
Necessary): ____________________________________________________________
Will there be any spray painting on the premises?
Yes ___
No ___
Will you handle or use any hazardous or toxic chemicals such as, but not limited to,
oxidizers, corrosive liquids, poisonous gases or radioactive materials?
Yes ___
No ___
If yes, specify the type and maximum quantities (use separate sheet if necessary): ____
______________________________________________________________________
Will a principal use of the building or tenant space be used for storage?
Yes ___
No ___
If yes, What percentage? ____ List the materials to be stored:
_______________________________________________________________
How high will the materials be stored? _________
Will the materials be stored in racks? _________
Yes
No
Will the building be equipped with any of the following fire protection equipment:
Yes ___
No ___
____ automatic fire sprinkler ___ automatic fire alarm or smoke detectors ___standpipe system
Will food or beverages be manufactured, packaged, stored, distributed, sold or prepared
in any manner other than vending machines?
Yes ___
No ___
Will a swimming pool be located on the premises?
Yes ___
No ___
Will a septic tank be used on the premises?
Yes ___
No ___
Will a grease trap or sand trap be used on the premises?
Yes ___
No ___
Will any goods, merchandise and/or raw materials be displayed or stored outdoors?
Yes ___
No ___
Will you be performing any of the following processes on the premises (if yes, circle
Yes ___
No __
the activities that apply):
manufacturing
treating
formulation/mixing/processing
vehicle washing
welding
Will any liquid waste or sludge be generated which will not be disposed of in the
sewer system?
Yes ___
No ___
Will any form of waste water pre-treatment be utilized at this facility?
Yes ___
No ___
If yes, briefly describe on an attached sheet.
Will combustible dust be generated?
Yes ___
No
SIGNATURE OF APPLICANT: ____________________________________________ DATE:
__________________
MUST PROVIDE COPY OF OCCUPANT’S DRIVER’S LICENSE I.D.
CERTIFICATE OF OCCUPANCY
ZONING REQUIREMENTS
PAVED PARKING AREAS: Section 31 A. – All land uses must provide paved parking areas at the time of
the issuance of the certificate of occupancy. This includes visibly striped parking spaces and fire lanes. One
parking space shall be specifically designed, located and reserved for the use by the handicapped.
DUMPSTER OR TRASH RECEPTABLE: Section 32.B3. – Except for one and two family dwellings,
garbage storage areas shall be visually screened by a six-foot (6’) high solid fence on all sides and shall be
located at the rear of the facility.
SOLID WASTE / TRASH REMOVAL: Section 42-9a (City Code) – Every owner, tenant or lessee of a
building used for business, commercial or industrial purposes shall arrange for the removal of garbage and
refuse from the premise.
TENANTS MUST SUBMIT A LETTER OF INTENT UPON REQUEST BY STAFF
IMPORTANT:
IT IS THE RESPONSIBILITY OF EVERY OWNER, TENANT OR LESSEE OF A
BUILDING USED FOR COMMERCIAL OR INDUSTRIAL PURPOSES TO ARRANGE
FOR COMMERCIAL REFUSE SERVICE AND PROVIDE FOR ALL THE ABOVE-
LISTED
CRITERIA AT THE TIME OF ISSUANCE OF A CERTIFICATE OF OCCUPANMCY.
AS OWNER, TENANT OR LESSEE,
I HAVE READ AND UNDERSTAND THE ABOVE-LISTED REQUIREMENTS
_____ OWNER ____ TENNANT ___ LESSEE
SIGNATURE: ________________________
DATE: ___________________
PRINTED NAME OF ABOVE: _-----------------------------------------------------------------------__
CONTACT PHONE NUMBER OF ABOVE: _----------------------------------------------------------
INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
A TAX I.D. IS REQUIRED BEFORE C.O. CAN BE PROCESSED
5525 Broadway Ave, Haltom City, Texas 76117  Phone: (817) 759-8660
Check List √
Final Fire Inspection for Certificate of Occupancy
The Haltom City Fire Marshal’s Office is required to perform a final fire inspection before the
certificate of occupancy is issued. The following is a general list of items that will be inspected,
in order to insure all Life Safety and Fire Codes adopted by the City of Haltom City are met.
This inspection may not be limited to the items listed below, depending upon the occupancy
type. These items must be maintained or in place in order to pass the inspection.
1. All doors, door swings, door closers, door hardware, and force-to-open doors shall be
maintained in proper working order.
2. All means of egress (exits) shall be clear and unobstructed. In a multi-story building with
stairs, all stairs shall be maintained and unobstructed. No storage allowed in stairwells
or under staircases.
3. All emergency lights and exit lighting shall be maintained in working order. These lights
shall operate on normal electrical power and on battery back-up power. Exception:
buildings provided with an emergency back-up generator.
4. If a building is required to have a sprinkler system, a copy of the certification test and
any annual certification letters shall be provided to the Fire Inspector upon request.
5. If the building is required to have a Fire Alarm system, a copy of the certification test
and any annual certification letters shall be provided to the Fire Inspector upon request.
6. If the building is required to have a Hood Suppression system, a state licensed hood
system company shall service the system and supply a certification letter upon request.
The hood, ductwork, fan and filters shall be cleaned and if a cleaning service is used, a
certificate showing date of cleaning shall be maintained on the premises.
7. Smoke and duct detectors shall be maintained in proper working condition, also with
any certification letters made available to the Fire Inspector.
8. All fire extinguishers (5 to 10 lb ABC) shall be maintained by a State of Texas licensed fire
extinguisher company and shall have a current inspection tag signed and dated by the
company.
Haltom City Fire Inspectors do not perform maintenance on fire
extinguishers.
9. In addition to the above mentioned fire extinguishers, if your place of business has a
kitchen, you must also have a “Class K” fire extinguisher.
10. Any storage near electrical panels and/or mechanical equipment shall be no closer than
30 inches from the equipment. Each breaker in the panel box shall be labeled.
11. Storage of any hazardous materials as defined by the Fire Code shall be permitted by
the Haltom City Fire Marshal’s Office and stored properly.
12. Extension cords are allowed on a temporary basis only. Temporary is defined as not
more than 30 days.
13. All interior finishes required by the International Fire Code 2012 shall be maintained.
14. All storage and housekeeping practices shall be in neat order and cleanly maintained.
15. Occupant load signs shall be maintained and clearly visible in the area for which they
apply. (If required)
16. In a tenant space, ceiling tiles shall be removed in a manner suitable for the Fire
Inspector to thoroughly inspect existing tenant demising walls (If not completed at the
80% inspection, the Fire Inspector may request a ladder for better access.)
17. International Fire Code section 506 Key Boxes: All commercial buildings must have a
Knox Box (contact Fire Marshal’s Office for order information or order online by going to
www.knoxbox.com
18. Fire hydrants and Fire Department connections must be free and clear of obstructions
and in proper working order.
19. Address and/or street numbers must be posted and visible also to include suite number
or letters where they may apply. (Minimum of 4 inches)
20. Correct facility information must be provided: name, address, phone number, owner
name, address and phone number. If the address is not provided during the inspection,
the C.O. will not be issued.

Download Application Form for Certificate of Occupancy - CITY OF HALTOM CITY, Texas

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