HomeMy WebLinkAboutWPO201800029 Application WPO VSMP 2018-04-24` Virginia Stormwater Management Program (VSMP)
Application for Albemarle County
Project Name: The Center at Belvedere
(The name should be the same as it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No ❑
Is this a revision or resubmission for review? Yes ❑ No ❑
County File Number: WP0201800029 (to be provided by the County. for new applications)
The following are required elements of new applications (from code section 17-401]. For revisions or
amendments, please indicate which items are being amended. Signatures must be provided for any
submission.
❑ A. Signature of the Owner for each parcel: (Required with every submission or revision, NOT TO BE
SIGNED BY AN AGENT OR CONSULTANT)
By signing this application as the owner, I hereby certify that all requirements of these plans and permits will be
complied with, and I have the authority to authorize the land disturbing activities and development on the subject
property. I hereby grant the County of Albemarle the right to enter upon the property as required to ensure
compliance with the approved plans and permits.
61-154 Senior Center Incorporated
Tax Map & Parcel Print Name of Owner Signature of Owner Date
Tax Map & Parcel Print Name of Owner
Tax Map & Parcel Print Name of Owner
Tax Map & Parcel Print Name of Owner
Contact information for the Owner(s) to receive correspondence:
Signature of Owner
Signature of Owner
Signature of Owner
Print Name Senior Center Incorporated attn: Peter Thompson
Address 1180 Pepsi PL.
City Charlottesville
Daytime Phone ( 434) 974-7756 E-mail peter@seniorcenterinc.org
Date
Date
Date
VA 7i„ 22901
Revised 07/24/18 Page 1 of 2
❑ B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed 5.76 AC
Acres to be
disturbed
Total Fee
Fee Due with this
Application
Fee with Transfer or
modification of permit
Less than 1
$290
$145
$20
1 and less than 5
$2,700
$1,350
$200
5 and less than 10
$3,400
$1,700
$250
10 and less than 50
$4,500
$2,250
$300
50 and less than
100
$6,100
$3,050
$450
100 and more
$9,600 1
$4,800
$700
For (minor) amendments to an approved plan; $200 per review
Variances; $150
Mitigation Plan; $150
❑ C. Registration Statement on the official DEQ form.
❑ D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403.
❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405.
❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies of all plans and any supporting documents. Professional seals must have original
signatures.
Additional information if not provided on plans and documents:
Name of a Contact Person for correspondence (usually the plan preparer, consultant or agent)
Print Name Timmons Group attn: Craig Kotarski
Address 608 Preston Ave STE 200
City Charlottesville State VA Zip 22903
Daytime Phone (A34) 327-1688 E-mail craig.kotarski@timmons.com
*When applications and plans are reviewed, but not approved, and a response to comments is -not received within 6 months
from the date of county comments, the application will be deemed withdrawn. Applications without valid owner's
signatures will not be considered valid.
FOR OFFICE USE ONLY WPO #
Fee Amount $ Date Paid By who? Receipt # Ck# By:
Revised 07/24/18 Page 2 of 2
Albemarle Coity
Planning Application
Community Development Department
:4c1 nti re Road Charl ottesvi Il e. VA 72902-4596
1t0ice: 434} 296-5832 Fax :(434) 972-4125
TMPJ 06100-00-00-15400 Owner(s): SENIOR CENTER INCORPORATED
Application # W -i -P62-01800029 I
Legal Description BELVEDERE PARCEL I
f
Magisterial Dist Rio Land Use Primary Open
Current AFD !Not in A/F Dtxstrki Current Zoning Primary Neighborhood Model District
►PPLICATION INFORMATION
Street Address Entered By
Application Type Water Protection Ordinances _ _ + Jennifer Smich
Project THE CENTER AT BELVEDERE - VSMP
Received Date 04/23/1$ Received Date Final Submittal Date Total Fees 1700
Closing File Date Submittal Date Final Total Paid 1700
Revision Number
Comments
Legal Ad
B
Stormwater Management/BMP Plan iO4/23/18
..................
Eration 'and Sediment Control Plan 64/23/18'
CONTACT
xxactt ype I Name Adare6s I Ci State Zip I Phone I ftoneCell
G'w i SENIOR CENTER INCORPORATED ;1160 PEPSI PL i CH aRLOTTESVILL 22901 i
... ......... ................ ..................................................................
,.:.:: Q:. -
............................, ..... .............................................
r1mary t stat : HERB WHITE 3040 AVEMORE S DARE PLACE CH,ARLOTTSVILL :22911 4349842700
..
.................................. ......................:........
Mica nt ! PETER THOMPSON -SENIOR CENTER. INC 491 HILLSDALE DRIVE CHARLOTTESVILL 2290.. ...1 4349747756 _
Signature of Contractor or Authorized Agent Date
IM
Virginia Stormwater Management Program (VSMP)
Application for Albemarle County
Project Name: The Center At Belvedere
(The name shoidd be the same as it appears on plans)
Is this an amendment to an approved plan? Yes ❑ No
Is this a revision or resubmission for review? Yes ❑ No
M
County File Number: (to be provided by the County for new applications)
r.;
The following are required elements of new applications [from code section 17-401]. For revisions or
amendments, please indicate which items are being amended. Signatures must be provided for any
submission.
® A. Signature of the Property Owner for each parcel: (Required with every submission or revision, NOT
TO BE SIGNED BY AN AGENT OR CONSULTANT)
By signing this application as the owner, I hereby certify that all requirements of these plans and permits will be
complied with, and I have the authority to authorize the land disturbing activities and development on the subject
property. I hereby grant the County of Albemarle the right to enter upon the property as required to ensure
compliance with the approved plans and permits.
TMP 61-154 .2— r� i.�,,. > le-
Tax
e t..��
Tax Map & Parcel Print Name of Property Owner Signature of Owner Date
Tax Map & Parcel
Print Name of Property Owner
Signature of Owner Date
Tax Map & Parcel
Print Name of Property Owner
Signature of Owner Date
Tax Map & Parcel
Print Name of Property Owner
Signature of Owner Date
Contact Information for the Owner(s) to receive correspondence:
Print Name Senior Center, Inc., C.O. Peter Thompson, Executive Director
Address 1 t8&f%psi-face 4R 1 kk jlks c)4 t p 1! -t;
City Charlottesville
State VA Zip 22901
Daytime Phone (_A31) C-74-7756 E-mail peter@seniorcenterinc.org
7/1/14, Revised: 7/10/14, I/7t14' Page 1 of
® B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed 7.11
Acres to be
disturbed
Total Fee
Fee Due with this
Application
Fee with Transfer or
modification of permit
Less than 1
$290
$145
$20
1 and less than 5
$2,700
$,135(0
$200
5 and less than 10
$3,400
1 $1,700
$250
10 and less than 50
$4,500
$2,250
$300
50 and less than 100
$6,100
$3,050
$450
100 and more
$9,600
$4,800
$700
For (minor) amendments to an approved plan; $200 per review
Variances; $150 (per request)
Mitigation Plan; $150
❑ C. Registration Statement on the official DEQ form.
0 D. Erosion and Sediment Control Plan satisfying the requirements of code section 17402.
10 E. Stormwater Management Plan satisfying the requirements of code section 17403.
❑ F. Pollution Prevention Plan satisfying the requirements of code section 17404.
❑ G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17405.
❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of
stream buffers.
❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408.
❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the
requirements of code section 17-422.
Provide 2 copies of all plans and any supporting documents. Professional seals must have original
signatures.
Additional information if not provided on plans and documents:
Name of a Contact Person for correspondence (usually the plan preparer, consultant or agent)
Print Name Herb White
Address 3040 Avemore Square Place
City Charlottesville State VA Zip 22911
Daytime Phone (A34) 984-2700 E-mail hwhite@wwassociates.net
`When applications and plans are reviewed, but not approved, and a response to comments is not received within 6 months
from the date of county comments, the application will be deemed withdrawn. Applications without valid owner's
signatures will not be considered valid.
FOR OFFICE USE ONLY WPO #
Fee Amount $_ Date Pai�y -twlnik Cfkr'R'eceipt # ! t1CkR By:( 15
7/1/14, Revised: 7/10/14, 1/7/14 Page 2 oft