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HomeMy WebLinkAboutCLE201900079 Application 2019-05-03APPROVED by the Albemarle County Community Development Department Ilntca 5—'3-14 Application for Zoning Clekrance---'', _, CLE # aC�VQ - _ PLEASE REVIEW ALL 3 SHEETS OFFICE SE O Y Check # Date: 1 �{ Receipt # 'i Staff: PARCEL INFORMATION () ���/ Tax Map and Parcel: I VV Oi�o(� OK 0 J-0Q Existing Zoning �` Parcel Owner: ! 1 f C HU) Parcel Address: n IIE S�Mm)Ui TO—L, City l FWI05-t!'{if State VA Zip 2220/ (include suite or floor) PRIMARY CONTACT TT Who 1A10 �✓�Q�`� should we call/write concerning this project? i Address : 112/0 1410 y /fury City /fL 40 /E State y4 - Zip I 0 Office Phone: Cell # Fax # E-mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: _456A5064S OF GAA( ,r ALL Previous Business on this site cit'-wt o r5yill e f ovieR E0 a l R AA-­V 7_ 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: T/0. Si9/,0 W%doe-0 *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 t of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signa Printed�lffl�/ APP�cOVAL INFORMATION [ pproved 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. f'� Notes: li'Cv' q L,L 1 6a_!4 Building Official Date Zoning Official Date Other Official fr_ k-t5a< M L+c��(' Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised 1 ]/1/2015 Page 2 of 3 Intake to complete the following: Y /(9 Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y / 2ere Will 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 well or u�artmenit If private well, provide Healt form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that ap Ii Is parcel on septic o public sewer? Y� N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y / Wilere/be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: 17 Square footage of Use: / O© Y/N ermitted as: 5ece se" (SQt� � � Under Section: ,�fr 4_Q t 1" rL c4L �e_ Supplementary regulations section: Parking formula: n Required spaces: Y/N Items to be verified in the field: Violations: /Y)N Afso, List: Proff Y/ If so" -fist: 201( - 1y?, 2©I(- 3n , L©l(, IDg 2®tl' 3 3,c 2col;- 60 VID 2p1(-12 Y*riance: Y/N If so, List: , %r7S-z�( N pfs! List: 200 31, 2015 3( Clearances: 26, Z-[9. Zara-97,?©tg-Ol SDP's 2012-23y,' 2or7-IDS ,tot,2ot?-1�z� c, 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, was provided to [County application name and number] [name(s) of the record owners of the parcel] and Parcel Number 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 ij ,arc'/L % 7� 201 Date Mailing a copy of the application to [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 to the following address: [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]. /ignlalt4ure/of Applicant Jo7e 1li�) _ Print Applicant Name i`-8 Date LEASE AGREEMENT This agreement of Land Lease is made this day of A0,-1L .201q between th L3 i (� i 1 E �,' ,(LESSOR) and �3 C h c!rc.'_`� n i i ►�c:Frt I- t C ,(LESSEE) for the Property described as an area at the front of I I G S SL', C L4, -Ti- P, i L_ , more specifically Described on the attached site plan. LESSOR and LESSEE agree that for and in consideration of the sum of ii,t:c 1'N r:•� -fort- ko OzS;b ?`76) Paid by check to the LESSOR at the signing of this document or prior to the commencement date of said Lease, LESSEE may land lease the site indicated on Exhibit A here to during the period of Cho r1ley 7 is zoo LESSEE agrees to obtain the necessary permits from L).L i q PA- A i.,3r' for the Purpose of selling VA . /tPl'2ct,> Fi �wcx during this period. ^ LESSEE agrees to provide a certificate of insurance to the LESSOR providing coverage during the above dates, naming (2L, i ,j E A' as additionally insured. LESSEE agrees to remove all stands, merchandise and refuse from the leased area by And shall restore the area to the same condition it was before the lease began. In addition, LESSEE agrees to hold and owners harmless of any and all accidents; etc. LESSEE will be responsible for all activities on leased premises related to their business operations. LESSOR: SIGNED: WITNESS: DATE: LESSEE:_ _ )A., , 4: L 6. 5 i kA 6.,Ub SIGNE�,�,,,�i_ WITNESS: DATE: CERTIFICATE OF LIABILITY INSURANCE 2I820, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CE ITIFUCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING IIMRER(S� AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMIPORTANT: N the certificate holder Is an ADDITIONAL DISUIRED, the poWies) must be mWoraed. If SUBROGATION IS WAIVED, s &)w to the terms and conditions of the policy, cerhun policies may require an endorsement. A statement on this cerfificgite does not confer rights to the certificate holder In fieu of such s . PRODUCER Britton -Gallagher and Associates, Inc. One Cleveland Center, Floor 30 1375 East 9th Street Cleveland OH 44114 CONTACT PHONE FAX ADS INSURERM AFFatDeo VE NAIC 0 VISUIIER A Everest Indemnity Insurance Co- 1 1 INSURED 18166 Fireworks Over America of South Carolina, Inc. 916 Rosewood Drive Columbia SC 29201 MaI�w�AM 04SURER B : INSURER c INSURER D. INSURER E - RLStRiER F : ,i1V1W a.cn r rrn r � Mk) "' 9I71CC7 JC THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIE& LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAR) CLAIMS. LTR TYPE OF 64SURAMCE POLICY NUMBERP WJCY POLICY EXP LIMITS GENERAL LIABILITY S18GLOO655-181 12/1/2018 12/1i2019 EACH OCCURRENCE $1,000,000 DAMAGETO Fa E C40MMERCIALG LIABILITY LED EXP am person) $ CLAIMS -MADE OCCUR $2500 Dedle PERSONAL a D,ruRY a10x>o GENEtALAGGA $20,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $2,000 000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY ANY AUTO aocid BODILY Y I I R2Y (Per Pam) $ ALLONMED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS HIRED AUTOS �-0�ED AUTOS PROPERTY DAMAGE $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAR CLAIMS -MADE DLL I I RETENTION S $ COIATHRd AND 1MIPLOYER5' LIABILITY Y / N WC STATL� OTH- EL EACH ACCIDENT $ ANY PROPRIETORIPARTNERIEXEcunvE OFFICERAMEMBER EXCLUDED? E-1 NIA EL DISEASE - EA CLOY $ Y � yyaess,, dasaibe ts.der EL DISEASE - POLICY LIMIT $ tH SCRIT'7ION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / 1lEHICLES (Aitedi ACORD 101, Ad&fionW Reawdcs ScInKkde, if mole space is required) Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement_ Stand Owner, Owner and Otters listed below are named additional insureds. Property Owner Gw Chen as well as Seasons of Change, LLC/Dan Simone Location: 1195 Seminole Trail, Charlottesville, VA 22901 Seasons of ChangefDan Simone 40463 John Mosby Hwy Aldie VA 20105 StK)U .D ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2DIWN) ® iMRKE ITU AGUMV CORPORATION. All rights reserved. The ACORD name and kmo are registered marks of ACORD Certificate of Flame Resistance REGISTERED FABRIC ISSUED BY Date of Manuhw:hm NUMBER JOHNSON OUTDOORS INC. BINGHAMTON, NEW YORK 13902 JAN 2004 F-140.01 Manufacturers of the Finest Tent Products Descnbed Herein This is to certify that the products herein have been manufactured from material inherently flame retardant as here after specified by the material supplier. NAME: GIBSON RENTALS CITY: BARBOURSVILLE STATE: VA certtflcation is hereby made that: The arbdes described on this certificate have been marwfach+red with an approved flame retardant chemical in compliance with California State Fire Marshal Code, NFPA-701•, Underwriters Laboratory of Canada, and have been tested in accordance with the Federal Test Mediod Speafimbons and meet or exceed the Military Flame Specifications d MIL-C 4300GG. j Type, color and weight of material: 14 OZ Vinyl WHITE BLOCKOUT I LOescription of [tern certified: 2OX40 ELITE PARTY CANOPY I Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric Snyder Manufacturing, Inc. TENT DEPARTMENT. 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