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Home My WebLink AboutCLE201800210 Application 2018-10-04'77"OVEC County Application for Zoning Clearance CLE # G I{7�;jhl PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check # i Date: Receipt # Staff:.) PARCEL INFORMATION Oil FO Tax Map and Parcel: 07800-00-00-83P0 Existing Zoning PD-MC Parcel Owner: PJP Building Two LC Parcel Address: 630 Peter Jefferson Pkwy, Ste 130 City Charlottesville State VA Zip 22911 (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Andrew Chambers, MD Address : 630 Peter Jefferson Pkwy, Ste 130 City Charlottesville State VA Zip 22911 Office Phone: 4( 34) 328-8787 Cell # 434-242-1959 Fax # 434-328-8765 E-mail andrew@chambersmd.com APPLICANT INFORMATION Check any that apply: Change of ownership X Change of use Change of name New business Business Name/Type: Blue Ridge Telepsychiatry PLC Previous Business on this site Charlottesville Psychiatric Medicine PLC Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and any additional information that you can provide: Proposal to intensify use by adding part-time telemedicine services of new company Blue Ridge Telepsychiatry PLC to existing on - site services of Charlottesville Psychiatric Medicine PLC. Both companies are single member PLLCs of Andrew Chambers. *This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning Clearance will be required. I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature INA Printed Andrew J. Chambers, MD APPROVAL INFORMATION [ ] Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117. [ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan. [ ] This site complies with the site plan as of this date. Notes: Building Official L� Date Zoning Official Date oJ1 Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised 11/02/2015 Page 2 of 3 Intake to complete the following: Is / Is us m LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y /� Wi ere be food preparation? If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on private wel or public water? If private well, provide Hea apartment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applie Is parcel on septic o ublic sewer Y /CN) Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y ! Will ere be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoninu to complete the following: Reviewer to complete the following: Square footage of Use: —7S69 Y / N Mlle Permitted as: CS Under Section: Supplementary regulations section: Parking formula: Required spaces: i Y / Items to be verified in the field: Inspector : Date: Vi I s: Y/N kI ist: Proffers: Y/N If so, List: ry�y 2t�`ll 1 —15 Va a e: Y If so, List: SP's: Y/N If so, List: —7 Clearances: 7^ �� SDP's Revised 11/1/2015 Page 3 of 3 CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the owner. I certify that notice of the application, Application for Zoning Clearance [County application name and number] was provided to PJP Building Two LC [name(s) of the record owners of the parcel] and Parcel Number 07800-00--00-03F0 manner identified below: Hand delivering a copy of the application to the owner of record of Tax Map by delivering a copy of the application in the [Name of the record owner if the record owner is a person; if the owner of record is an entity, identify the recipient of the record and the recipient's title or office for that entity] on Date Mailing a copy of the application to Olivia Woodberry, Asst. Prop. Mngr., Brandywine Realty Trust [Name of the record owner if the record owner is a person; if the owner of record is an entity, identify the recipient of the record and the recipient's title or office forthatentity] , orC on Z 6Y to the following address: Date 300 Arboretum Place, Ste 330, Richmond, VA 23236 [address; written notice mailed to the owner at the last known address of the owner as shown on the current real estate tax assessment books or current real estate tax assessment records satisfies this requirement]. Signature of Applica Andrew J. Chambers, MD Print Appl' ant N7z- ,2 A 61 Date Application for Zoning Clearance CLE # viU1 ,9 httU PLEASE REVIEW ALL 3 SHEETS OFFICE US ONLY Check # �'t 5 Date: Receipt # Staff: PARCEL INFORMATION Tax Map and Parcel: 07800-00-00-03FO Existing Zoning PD-MC Parcel Owner: PJP Building Two LC Parcel Address: 630 Peter Jefferson Pkwy, Ste 130 City Charlottesville State VA Zip 22911 (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Andrew Chambers, MD Address: 1604 Cambridge Circle City Charlottesville State VA Zip 22903 Office Phone: (__) Cell # 434-242-1959 Fax # Ismail achambers@cvillepsychmed.corrl APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name X New business Business Namefrype: Charlottesville Psychiatric Medicine PLC Previous Business on this site Brandywine Realty Trust Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and any additional information that you can provide: S d Lo PkT_Vlt-7T - }PKACT!CC . /5,ii/C"J�4 6r-rrco O CT AAID &NE4A 1 T V , _re.NA& This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning Clearance will be required. I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature ,� ,Ub Printed Andrew J_ Chambers, MD APPROVAL INFORMATION Approved as proposed [ ] Approved with conditions [ ) Denied [ ] Baclflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, x1IT [ ] No physical site inspection has been done for this clearance_ Therefore, it is not a determination of compliance with the existing site plan- [ ] This site complies with the site plan as of this date. Notes: Building Official Date c Zoning Official Date ;?—h—, Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised 11 /02/2015 Page 2 of 3 O) Cxi (� O ab �t2l C-9 ow.1 0tJC� cOCtq.1 F- W 0 00 8 lrrr ATM CHARLOTTESVILLE•PSYCHIATRIC•MEDICINE ANDREW CHAMBERS, MD Ph (434) 328-8787 630 Peter Jefferson Pkwy, Ste 130 Fax (434) 328-8765 Charlottesville, VA 22911 cvillepsychmed.com September 20, 2018 County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Re: Application for Zoning Clearance To Whom it May Concern: Attached please see my application for zoning clearance, requesting to intensify the use of parcel 07800-00-00-03F0. I previously received zoning clearance to conduct a solo private practice psychiatry office through a single -member professional limited liability company called "Charlottesville Psychiatric Medicine PLC," per CLE # 2017-52. also now plan to provide part-time telemedicine services from this office for online appointments with clients through an additional single -member professional limited liability company called "Blue Ridge Telepsychiatry PLC." I am applying for clearance to add this additional service to the parcel, so I can apply for a business license for the additional company. This does not involve any additional burden to the parcel with respect to personnel, parking, or client traffic. Please let me know if you need any other information. RECENED Sincerely, COMMUNITY DEVELOpMENT Andrew Chambers, MD