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HomeMy WebLinkAboutWPO201500045 Bond WPO VSMP 2016-11-14 Internal Use Oni.I f /(1 4t �v �� 1 �l/�/ '(� r/Jl A ! I. 212:: pF"'t _ I^r //^,QpD V c REQUEST TO ESTABLISH A BOND /] APPROVED PLAN#WP0201500045 (�' �—J PROJECT NAME: Berkeley Water Main Replacement Project(2014-05) (As listed on the approved plan) All parcels in the project,including any off-site work if easements are not provided,and current owners. Use a separate sheet if more owners are required. Owner and tax map information must be correct,and plans must be approved prior to bond estimates being prepared. - TAX MAPs/PARCELs: 61M-10-4 OWNER'S NAME: Eva Alvarez SIGNATURE: date: TAX MAPs/PARCELs: 61 M-1-10 OWNER'S NAME: Francis L. and Gladys W.Cambell SIGNATURE: date: —TAX MAPs/PARCELs: 61 M-2-7 OWNER'S NAME: Frederick T. Hartling SIGNATURE: date: TAX MAPs/PARCELs: OWNER'S NAME: SIGNATURE: date: —TAX MAPs/PARCELs: 61 M-2-10 OWNER'S NAME: Karl Hohenstein and Donna C.Frye SIGNATURE: date: NOTE: If ownership of the property is in the name of any type of legal entity or organization including, but not limited to the name of corporation, partnership, limited liability company, trust, association,etc.,documents acceptable to the County must be submitted certifying that the person signing above has the authority to do so. The requested estimates are; ® VESCP Erosion&Sediment Control per Water Protection Ordinance section 17-207; $0 fee ® VSMP Erosion and Sediment Control,Stormwater Management and Mitigation per Water Protection Ordinance section 17-208;$250 fee required ❑ Subdivision(roads,drainage, etc.)per Subdivision Ordinance section 14-435; &Water& Sewer per Subdivision Ordinance section 14-435;$250 fee required A bond estimate will be prepared by the plan reviewer.The estimate must be sent to the owner. Please provide contact information. EMAIL: mvieira@serviceauthority.org OR REGULAR MAIL ADDRESS: Michael Vielra 168 Spotnap Rd.,Charlottesville,VA 22911 Revised 6/202014 V 4 Internal Use Only oF A Date Received: Fee Paid: Received by: _Intake: Forward to Management Analyst l©' REQUEST TO ESTABLISH A BOND APPROVED PLAN#WP0201500045 PROJECT NAME: Berkeley Water Main Replacement Project(2014-05) (As listed on the approved plan) All parcels in the project, including any off-site work if easements are not provided,and current owners. Use a separate sheet if more owners are required.Owner and tax map information must be correct,and plans must be approved prior to bond estimates being prepared. - TAX MAPs/PARCELs: 61M-2-16 OWNER'S NAME: Cathrine Miranda and John Miranda, Sr. SIGNATURE: date: �r TAX MAPs/PARCELs: 61M-8-3 OWNER'S NAME: Alice M. Micklem SIGNATURE: date: . TAX MAPs/PARCELs: 61 M-8-8 OWNER'S NAME: Malcolm L.Taylor,Jr. SIGNATURE: date: -TAX MAPs/PARCELs: 61 M-12-1 E2 OWNER'S NAME: DEMREP, L.L.C. SIGNATURE: date: TAX MAPs/PARCELs: 61M-6-2 OWNER'S NAME: Ruth Parsons SIGNATURE: date: NOTE: If ownership of the property is in the name of any type of legal entity or organization including, but not limited to the name of corporation, partnership, limited liability company, trust, association,etc., documents acceptable to the County must be submitted certifying that the person signing above has the authority to do so. The requested estimates are; • VESCP Erosion&Sediment Control per Water Protection Ordinance section 17-207;$0 fee ® VSMP Erosion and Sediment Control,Stormwater Management and Mitigation per Water Protection Ordinance section 17-208;$250 fee required ❑ Subdivision(roads,drainage,etc.)per Subdivision Ordinance section 14-435; &Water&Sewer per Subdivision Ordinance section 14-435;$250 fee required A bond estimate will be prepared by the plan reviewer.The estimate must be sent to the owner. Please provide contact information. EMAIL: mvieira@serviceauthority.org OR REGULAR MAIL ADDRESS: Michael Vieira 168 Spotnap Rd.,Charlottesville,VA 22911 Revised 6/20/2014 LC ,D S • Interval Use Only F A Date Received: Fee Paid: Received by: rY`' ©ice Intake: Forward to Management Analyst 0 REQUEST TO ESTABLISH A BOND • 'APPROVED PLAN#WP0201500045 PROJECT NAME: Berkeley Water Main Replacement Project(2014-05) (As listed on the approved plan) All parcels in the project,including any off-site work if easements are not provided,and current owners. Use a separate sheet if more owners are required. Owner and tax map information must be correct,and plans must be approved prior to bond estimates being prepared. - TAX MAPs/PARCELs: 61 M-13-2F OWNER'S NAME: Berkmar Crossing Building "F2"Condo As SIGNATURE: date: TAX MAPs/PARCELs: 61M-11-13 OWNER'S NAME: Richard W. Galione SIGNATURE: date: TAX MAPs/PARCELs: 61M-11-14 OWNER'S NAME: Bedri Raci SIGNATURE: date: -TAX MAPs/PARCELs: 61 M-1-16 OWNER'S NAME: Charles S. and Mary B.Yancey SIGNATURE: date: TAX MAPS/PARCELs: 61X2-2 OWNER'S NAME: Four Seasons Townhouse Assoc., INC. SIGNATURE: date: • NOTE: If ownership of the property is in the name of any type of legal entity or organization including, but not limited to the name of corporation,partnership, limited liability company, trust, association,etc., documents acceptable to the County must be submitted certifying that the person signing above has the authority to do so. The requested estimates are; • VESCP Erosion&Sediment Control per Water Protection Ordinance section 17-207; SO fee Il VSMP Erosion and Sediment Control,Stormwater Management and Mitigation per Water Protection Ordinance section 17-208;$250 fee required ❑ Subdivision(roads,drainage,etc.)per Subdivision Ordinance section 14-435; &Water&Sewer per Subdivision Ordinance section 14-435;$250 fee required A bond estimate will be prepared by the plan reviewer.The estimate must be sent to the owner. Please provide contact information. EMAIL: mvieira@serviceauthority.org OR REGULAR MAIL ADDRESS: Michael Vieira 168 Spotnap Rd., Charlottesville,VA 22911 Revised 6/20/2014 3 Internal Use Only p4 AL Date Received: Fee Paid: ,$,�'+ ' Received by: r'i�� '-'t �r Intake: Forward to Management Analyst k.1114 SC REQUEST TO ESTABLISH A BOND APPROVED PLAN#WP0201500045 PROJECT NAME: Berkeley Water Main Replacement Project(2014-05) (As listed on the approved plan) All parcels in the project,including any off-site work if easements are not provided, and current owners. Use a separate sheet if more owners are required. Owner and tax map information must be correct, and plans must be approved prior to bond estimates being prepared. TAX MAPs/PARCELs: 61 M-1-5 OWNER'S NAME: Robert L.and Joyce S. Deeds SIGNATURE: date: TAX MAPs/PARCELs: 61M-1-6 OWNER'S NAME: Sue A.Albrecht SIGNATURE: date: - TAX MAPs/PARCELs: 61 M-4-6 OWNER'S NAME: John Wescott Stewart Declaration of Trtt SIGNATURE: date: -TAX MAPs/PARCELs: 61 M-4-9 OWNER'S NAME: Thomas Charles Osina and John Edward Mattison. III SIGNATURE: date: TAX MAPs/PARCELs: 61U-1-11 OWNER'S NAME: Adams and Garth, INC. SIGNATURE: date: NOTE: If ownership of the property is in the name of any type of legal entity or organization including,but not limited to the name of corporation, partnership, limited liability company, trust,association,etc., documents acceptable to the County must be submitted certifying that the person signing above has the authority to do so. The requested estimates are; ® VESCP Erosion&Sediment Control per Water Protection Ordinance section 17-207;$0 fee i VSMP Erosion and Sediment Control,Stormwater Management and Mitigation per Water Protection Ordinance section 17-208;$250 fee required ❑ Subdivision(roads,drainage,etc.)per Subdivision Ordinance section 14-435; &Water&Sewer per Subdivision Ordinance section 14-435;$250 fee required A bond estimate will be prepared by the plan reviewer. The estimate must be sent to the owner. Please provide contact information. EMAIL: mvieira@serviceauthority.org OR REGULAR MAIL ADDRESS: Michael Vieira 168 Spotnap Rd., Charlottesville,VA 22911 Revised 6/20/2014 y6-1 Internal Use Only Date Received: Fee Paid: efA(^T Received :6Y Intake: Forward to Management Analyst tgp ICY!: REQUEST TO ESTABLISH A BOND APPROVED PLAN#WP0201500045 PROJECT NAME: Berkeley Water Main Replacement Project(2014-05) (As listed on the approved plan) All parcels in the project,including any off-site work if easements are not provided,and current owners. Use a separate sheet if more owners are required. Owner and tax map information must be correct,and plans must be approved prior to bond estimates being prepared. TAX MAPs/PARCELs: OWNER'S NAME: SIGNATURE: date: TAX MAPs/PARCELs: 61M-7-1 OWNER'S NAME: Mark L.and Sally F.Jenkins SIGNATURE: date: - TAX MAPs/PARCELs: 61 M-12-1E OWNER'S NAME: Anvince Land Trust SIGNATURE: date: - TAX MAPs/PARCELs: 61 M-2-26 OWNER'S NAME: Helen Meruvia Mendoza SIGNATURE: date: TAX MAPs/PARCELs: 61M-7-11 OWNER'S NAME: Keith L.Smith and Patricia R. Smith SIGNATURE: date: NOTE: If ownership of the property is in the name of any type of legal entity or organization including, but not limited to the name of corporation, partnership, limited liability company, trust, association, etc.,documents acceptable to the County must be submitted certifying that the person signing above has the authority to do so. The requested estimates are; ® VESCP Erosion&Sediment Control per Water Protection Ordinance section 17-207;$0 fee ® VSMP Erosion and Sediment Control,Stormwater Management and Mitigation per Water Protection Ordinance section 17-208;.$250 fee required ❑ Subdivision(roads,drainage, etc.)per Subdivision Ordinance section 14-435; &Water&Sewer per Subdivision Ordinance section 14-435;$250 fee required A bond estimate will be prepared by the plan reviewer.The estimate,must be sent to the owner. Please provide contact information. EMAIL: mvieira@serviceauthority.org ,OR REGULAR MAIL ADDRESS: Michael Vieira 168 Spotnap Rd., Charlottesville,VA 22911 • Revised 6/20/2014 5 V 6