City Of Haltom City Certificate Of Occupancy
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4APPLICATION
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:
__________________
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Parent category: Business