Custodial Care Facility Attachment – Dallas, TX

The Custodial Care Facility Attachment is the City of Dallas Development Services Department form on which an applicant attests to the conditions and facts of the business model when applying for a permit to convert a dwelling to a custodial care facility. It travels with that permit application.

The form quotes the definition of "Custodial Care" from the 2015 Edition of the International Building Code: assistance with day-to-day living tasks such as cooking, taking medication, bathing and using toilet facilities, including care for occupants who evacuate at a slower rate or have mental and psychiatric complications. The code also sets life safety requirements for a "Custodial Care Facility" (Section 420, on the page attached to the form).

The form explains why it exists. A permit is required to convert a dwelling to a custodial care facility, and that change in use may trigger a fire sprinkler requirement and other life safety requirements. The code requirements apply going forward to any new or newly expanded facility.

On the form you check one option for the number of residents receiving care and one for their exiting capability, identify the location and the BU permit number under which the use was first established, and sign as tenant or owner.

An applicant for a permit to convert a dwelling to a custodial care facility must complete and sign this form with the conversion permit application. The signer is the tenant or owner, whose printed name, signature and date appear in the Acknowledgement block.

The form also speaks to operators who already run a facility. Its code requirements are prospective: they apply to a new facility or a newly expanded one. A change in the character of the use, such as a different number of residents or different capabilities of the residents, may trigger the building code requirements, require a new permit and require compliance with building and fire code requirements.

The form names no other filer and does not say that anyone may sign for the tenant or owner. It is not a permit and does not replace the permit application it accompanies.

Submit the form at the same time as the permit application to convert a dwelling to a custodial care facility: the form says it must be executed with any conversion permit application. No separate due date is printed on it.

Timing can come up again later. If the number of residents or their capabilities change after the facility is established, the form warns that the change may trigger building code requirements and require a new permit. The facility must then comply with the currently adopted code if the number of patients increases or more residents are incapable of self-preservation.

The form is submitted together with the permit application to convert a dwelling to a custodial care facility; it has no separate filing channel of its own.

The form prints the contact details of the Development Services Department: 320 E Jefferson Blvd, Dallas TX 75203, telephone (214) 948-4480. It does not say whether the permit application is filed in person, by mail or online, so follow the City of Dallas instructions for the permit application itself or call the department at that number.

Before you send it, have the BU permit number under which the use was first established, because the certification asks for it along with the suite and address of the BU application. The form also refers to a DADS application that lists the residents to be housed; the boxes you check should match it. FillingPDF lets you fill out and download the PDF; submission follows the City of Dallas channels.