How building permits work for a medical or dental office in Dallas–Fort Worth

A medical or dental office cannot open until the city says it can. Between the first floor plan and that day there is a building permit, a state accessibility review, a fire review, a set of inspections, and a certificate of occupancy. Some practices have a state health review as well. This guide explains how the pieces fit, so you can plan your lease dates, equipment order, and opening around them.

Who submits for the permit

On most of our projects, we submit the application and drawings to the city. On some projects the architect does. Either way, one party should own the submittal and track it, and you should know who that is.

In a leased suite, the landlord's approval of the drawings usually comes first. It is a lease step, not a city step, but it sits on the same path.

What goes in the application

Each city publishes its own checklist. For an interior build-out, a typical package includes:

• The permit application, with the contractor's city registration
• Architectural drawings to scale, showing the existing space and the new work
• Mechanical, electrical, and plumbing drawings, sealed by an engineer where required
• An energy code compliance document
• The state accessibility registration number (see below)
• For a renovation, evidence of an asbestos survey of the area being altered, or a certification from an architect or engineer. Texas law does not let a city issue a renovation or demolition permit for a commercial building without one.

A new building needs more, and earlier. Platting, zoning, and site plan approvals come before the building permit, and the package adds civil, structural, and landscape drawings. Our guide to site approvals in DFW cities walks through those steps.

Plan review and review cycles

After the city accepts the application, its reviewers read the drawings. Building, mechanical, electrical, plumbing, fire, and zoning reviewers may each issue comments. The architect and engineers answer the comments and resubmit. That is one cycle. A complete set may be approved in one cycle. An incomplete one can take several.

Review times differ by city and by season, and they change. Ask the city for its current turnaround when you start. Some cities offer alternatives. Fort Worth's permit application, for example, has a place to name a third-party company for plan review and inspections.

Each city adopts its own code editions and amendments, so the same drawings can get different comments in Dallas, Fort Worth, and a suburb.

The state accessibility review

Texas runs its own accessibility program, separate from the city. A project with an estimated construction cost of $50,000 or more must be registered with the Texas Department of Licensing and Regulation (TDLR). A registered accessibility specialist reviews the drawings against the Texas Accessibility Standards (TAS) and inspects the finished space.

The design professional must send the drawings for review within 20 business days after issuing them. State law makes the building owner responsible for compliance, though the owner can name an agent to handle it. Cities tie the two processes together: the Dallas and Fort Worth permit forms both ask for the TDLR project number.

Health-related reviews

Most medical and dental offices have no state health agency plan review. Three situations are different.

• X-ray equipment. X-ray machines are registered with the Texas Department of State Health Services. The registration is the practice's, not the contractor's, and it is not part of the building permit.
• Surgery centers. A licensed ambulatory surgical center goes through the Architectural Review Unit at the Texas Health and Human Services Commission (HHSC). Construction cannot begin until the unit approves it in writing, and patients cannot use the space until it passes the unit's final inspection. See ASC construction and licensing steps in Texas.
• Hospitals. Licensed hospitals and freestanding emergency centers go through the same HHSC unit.

Fire review

The fire marshal's office reviews exits, fire-rated walls, the fire alarm, and the sprinkler system. Sprinkler and alarm changes usually go in as their own submittals from fire protection contractors licensed through the State Fire Marshal's Office. Moving walls in a sprinklered suite usually means moving sprinkler heads, so expect this step.

Inspections and the certificate of occupancy

During construction, city inspectors check the work in stages before it is covered: framing, the plumbing, electrical, and mechanical rough-ins, the space above the ceiling, and then the finals. The fire marshal and the accessibility specialist make their own visits. S&I schedules the city, fire, and state accessibility inspections, and our superintendent or the trade partner meets the inspector.

The last step is the certificate of occupancy (CO). Fort Worth states the rule plainly: any building used or occupied in the city must have one, and it is issued after all final inspections are approved. Plan furniture, equipment installation, staff training, and your first patient day around the CO.

Why the schedule starts with permits

A contractor controls construction. Landlord approval, city review, and state review are in other hands, and they come first. A schedule that begins on the day construction starts leaves out most of the risk.

S&I often schedules design, permitting, and construction together from the first concept. Your lease dates, rent start, and equipment deliveries can then be set against the approvals.

What you can do to speed it up

• Check the use before you sign. Confirm that the zoning and the building allow a medical or dental use. See what to ask before signing a lease.
• Choose equipment early. X-ray units, sterilizers, and compressors drive the plumbing, power, and wall drawings.
• Submit complete drawings. A partial set costs more time in review than it saves.
• Order the asbestos survey early on a renovation.
• Answer comments quickly, and start the landlord's approval at the same time.
• Hold the plan steady. A layout change after submittal can send the drawings back through review.

By specialty and city

For what each kind of space involves, see our dental, medical, surgery center, radiology, optical, and veterinary construction pages. Our city pages show nearby projects:

• Dental: Arlington, Colleyville and Grapevine, Dallas, Fort Worth, Frisco, Keller, Mansfield, Plano, Southlake, Trophy Club
• Medical: Dallas, Fort Worth, Mansfield, Southlake
• Optical: Colleyville, Fort Worth, Southlake
• Veterinary: Arlington, Dallas, Bedford and North Richland Hills

If you are weighing a space, we will walk it with you before you sign, and a first budget is at no charge. Tell us about your project.

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