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HomeMy WebLinkAboutCLE201900167 Action Letter 2019-08-09yt=Pf 0VF-LJ ty the —Albemarle County Community Development Department Application for Zoning Clearance �_�"'may. F— CLE # �?Z� 6 — I (0 -1 J� ]- PLEASE REVIEW ALL 3 SHEETS OFFICE USE ONLY Check #-S Date: Receipt # Staff: PARCEL INFORMATION S Tax Map and Parcel{ LU, I b f � 6 1, a f-� 7 V Existing Zoning Parcel Owner: I�-1 & S (� Parcel Address: ( City State NJ /1, _ Zip��� (include suite or floor) PRIMARY CONTACT y p (� Who should / ��V we call/write concerning this p1.11akmt 5q Address: I IJ�� tt !. harloII Ok State ✓ Zip`11l ) 654 - 94W (540)Jf9 I�fi an ` Un f �� l C fP�I Office Phone: Cell # Fax # �Q • ! O111 E-mail U APPLICANT INFORM TION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type:Jlnl(,{lra Tamil v Min .rir of hIbmarlt J uarP Ph lfl am Previous Business on this site!1 Ibrmarlt Aq Ja rt ! omi)v a (u 1r Describe the proposed business including use, number of emplo ees, number of shi is available par ing space), number of vehicles, and an info a ; trn ,`� xI additio al nation that you an provide: I rj, Q fj— �WURJ a0 1 1 1110 *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,/h�e/¢est ooffMy kno ledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature 6 "'e 'l.�f Printed APPROVAL INFORMATION ;Approved as proposed [ ] Approved with conditions [ ] Denied [ ) Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, x1 17. [ ] 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 Zoning Official Date 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 1 1/1/2015 Page 2 of 3 Intake to complete the following: Is /( Is us LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified Y / Will 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 well or( r ublic water If private well, provide Health epartment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic or ublic sewer. Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y / N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: Square footage of Use: 4-5 DO Y N ermitted as: �l,�s, ) II ir�U��� I►1�� iGGI) d e��a (� antl p � t► ca 1 l Under Section: _? r'7 . —� 2-3 Z, I Supplementary regulations section: N/(4 Parking formula: 5. S/ 1000 s Ak- P Ik -) Required spaces:OCN 2 S Y/N Item o be verified in the field: over eaf/E= f , e-UT Inspector: Notes: Date: Viol�kons: Y /j(NJ If so, ist: Proffers: Y / If so, ist: r►ance: Y YN so, List: SP's- Y //N� If so, ist: Clearances: r✓+! W05 36 lbe�a�tc s . SDP's 11Zo©(o coc) ��fj� use ev �a r Revised 11/I/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 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]. A,0-1 W#& Signature of Applicant A rl a, i t Sol) f Print Alicant Name ,pq Date Kevin McCollum From: ARIELLE N SOLIE <ANSOLIEI@sentara.com> Sent: Thursday, August 08, 2019 10:33 AM To: Kevin McCollum; PATRICE R SIMPSON Subject: Floor Plan and Estimated Square Footage for Albemarle Square Attachments: Floor Plan.pdf, 422 Albemarle Sq Plans.pdf Importance: High Hello again, Patrice is amazing and has come through with the information we needed. Attached are the floor plans. The estimated square footage is 4500 square feet. Is there anything else you require in order to process this request? Thank you for your attention to this matter. .AYZBIk Arielle Solie Practice Manager II Physician Services Administration S F. N TA 11 A From: ARIELLE N SOLIE Sent: Thursday, August 8, 2019 10:16 AM To: 'Kevin McCollum' <kmccollum@albemarle.org>; PATRICE R SIMPSON <PRSIMPSI@sentara.com> Subject: RE: Zoning Clearance Sentara Family Medicine at Albemarle Square Importance: High Good morning, Thank you for your email. I am including the Practice Manager for this location, Patrice Simpson, so that she can provide the following documents: • Floor plan • Estimate square footage of the practice There will be no new construction. Patrice, please reply to this email with the attached documents — I understand that floor plans are often quite large, so if we are unable to scan, I can run this by the county office building if that is acceptable, Kevin. 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Z �m 26 ° o0 0 LL z = Kim m 0 Z W J IL U fv u ii 4 n N i v J Z LU Z v7 W J J W W W U CL U QL /^ J l.J J re Q Revised Air Balance - 2/7/07 ACAC Doctor's Office Unit #422 4/8/2005 1/8' _ lion AlbemQrle Heating & Air M1 Note: The alterations and improvements herein p vroposed to be made by Tenant are approved for coaskuction ro on the essed condition that at the expiration or earlier eicpr termination of the Lease, Tenant shall promptly remove said improvements and alterations, repair any damage arising in the process, and reinstall the improvements that had been previously made by Landlord to retail vanilla box atom ,M, reshaoms, and cett! lights, all installed and hooked up Qperly, to code, end in good working TENANT:1`1-— Q/ rat_ i Approved B . Date✓ t� % LANDLORD: RIO ASSOCIATES LIMITED PARTNERSFRP Approved By: Dumbarton Prop es, ., its 33Auut�tho;ed rEs t Date: _.�/l74,-;z