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Home My WebLink AboutCLE201900199 Application 2019-08-27O�2SSA bG�s'S�-7 6� V Application for Zonin Clearan e=�p4"p CLE # G — - 7� -�, is `�RGIN�P OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check # G Date: Receipt # Staff: PARCEL INFORMATION Tax Map and Parcel: 061 WO-03-00-019AO Existing Zoning NMD Parcel Owner: OCT STONEFIELD PROPERTY OWNER LLC Parcel Address: 2055 Bond Street Suite 180 City Charlottesville State VA Zip 22901 (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Maurice Kelly Address : 2055 Bond Street Suite 180 City Charlottesville State VA Zip 22901 Office Phone: (434) 2848874 Cell # 2023453534 Fax # E-mail maurice@fastfine.pizza APPLICANT INFORMATION Check any that apply: Change of ownership Change of use X hange of name New business Business Name/Type: Matchbox Previous Business on this site MidiCi 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: Full Rosta-r;;nt T� G Shifts (A%!/PM) front street on Bond Street, aAd lots throughout the park'Ag park'Ag (Zhnnc nt Ctnnefiolri Annrnvimotel'I`2�. omnlniiooc �niill ho nn et-+ff *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 Printed Maurice Kelly AP ROVAL INFORMATION [vf 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 Date Zoning Official Date 1 Other Officialyo It 4' rr� 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 (�ZaG�—o2GoS-S Intake to complete the following: Is Yin LI, HI or PDIP zoning? Engineer's Report (CER) packet. If so, give applicant a Certified Y/ N Will there 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 lic water9 If private well, provide eal ment form. Zoning review can not be 'n until we receive approval from Health Dept. FAX DATE Circle the one that applies Is parcel on septic o ublic se Reviewer to complete the following: Square footage of Use: 34 TO i,S Y N 1 ermitted as: eC` Al-3 Gt� vkl0ie4 Under Section: �reN La✓�tyL no t Oi Supplementary regulations section: Parking formula: L!i ` s�o� eE 1 r- ld �110,4e Required spaces: Y/N Items to be verified in the field: Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # OU t c-07 0 5 Inspector Y / N Notes: Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: iolations: Y/N J,Aso, List: ZLlo: l �l7- 2,3�, - � 3, Zyl6- !`� 1, Proffers: Y/N If so, List: -z' -- 20 1-I"I!/ 2-0I(-2-2-6, ZeV -7 1= IO:Zo4S-KS.'2o�. ZaIL-(2 201l - 2Ao8-03 Z oo t - 7 Mn�ice: Lst: Z2 cz—aG,�� C � 's: / N If so, List: Zo(6 -Z6 Gce, Clearances: 20l-7-106 C f-c�cQ�c�� SDP's Zvcq-'v5 C v`�e►.• s f Its Zo - 3 2 L 121 kr7XV'G)20 0 oo wt, Revised 1 I/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, Matchbox, CLE2019- l G 9T [County application name and number] was provided to Maurice Kelly the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number 061 WO-03-00-019A0 manner identified below. 0 Hand delivering a copy of the application to 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]. Signature of Applicant Maurice Kelly Print Applicant Name 08/22/19 Date Food Establishment Inspection Report Albemarle County Health Department 1138 Rose Hill Drive , Charlottesville , VA 22903 (434) 972-6219 Risk/Intervention Obs. Out of Compliance: 2 Date: 25-Jan-201 Repeat RiskAntervention Obs. Out of Compliance: 0 Time In: 03:15:00 P Good Retail Practices Obs. Out of Compliance: 0 Time Out: 04:15:00 PIV Establishment Midici - The Neapolitan Pizza Company Address 2055 Bond Street Suite 180 Charlottesville, VA 22901 Telephone (202 ) 345-3534 Person In Charge Maurice [x] Certified Manager #14305333 27-Oct-2021 Permit Holder Connect People, Inc. EHS Casandra Styles Purpose of Inspection Routine Est. Type Full Service Restaurant Priority Level Risk Category 2 Smoking Status Smoke Free Title 15.2-2825 Virginia Indoor Clean Air Act. In I Compliance with legislation. FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS Risk Factorsare improper practices or procedures identified as the most prevalent contributing factors of foodborne illness or injury. Public Health intervention are control measures to prevent foodborne illness or injury. Supervision Protection from Contamination continued 1 In Person in charge present, demonstrates knowledge & performs duties 16 In Food -contact surfaces: cleaned & sanitized 17 In Proper disposition of returned, previously served, I reconditioned & unsafe food 2 In Certified Food Protection Manager Em to ee Health Time lTem erature Control for Safety 3 In Mana ement awareness policyresent 18 N/O ProDer cookingtime & temperatures 4 In Proper use of re ortin restriction & exclusion 19 N/O Proper reheatingprocedures for hot holding 5 In Procedures for res ondin to vomitin & diarrhea) events 20 NIO Proper cooling time & temperatures Good H ienic Practices 21 In Proper hot holdingtemperatures 6 In ?Proor!!! eatin testing,drinking, or tobacco use 22 Out Proper cold holding temperatures 7 In I No discharge from eyes nose and mouth 23 In Proper date marking & disposition Preve tinq Contamination b Hands 24 N/A Time as a public health control: procedures & records 8 In Hands clean & Property washed Consumer Advisory 9 In No bare hand contact with RTE foods or approved alternate methodproperty ro ertfollowed 25 N/A Consumer advisoryprovided for raw or undercooked foods Hi hl Susce tible Populations 10 Out Ade uate handwashin facilities supplied & accessible 26 N/A Pasteurized foods used prohibited foods not offered Approved Source Food/Color Additives and Toxic Substances 11 In Food obtained from a roved source 27 NIA Food additives: approved & properly used 12 N/O Food received at proper temperature 28 In Toxic substances Property identified stored &used 13 In Food in ood condition safe & unadultered Conformance with Approved Procedures 14 N/A Required records available: shellfish stock tags, parasite destruction 29 N/A Compliance with variances specialized process & HACCP Ian Protection from Contamination 5 Foode o GOOD RETAIL PRACTICES Safe Food and Water Pro er Use of Utensils 3o Pasteurized eggs used where required 43 In -use utensils: properly stored 31 Water & ice from approved source 44 Utensils equipment & linens: Property stored dried & handled 32 variance obtained forspecialized processing methods 45 Sin le -use & single -service articles: property stored & used Food Temperature Control 46 1 1 Gloves used property 33 Proper cooling methods used adequate equipment for temperature control Utensils Equipment and Vending 34 Plant food properly cooked for hot holding 47 Food & non-food contact surfaces cleanable, properly designed, constructed, & used 35 1 1 Approved thawing methods used 36 Thermometers provided & accurate I Warewashina facilities: installed maintained & used7 test strips Food Identification 49 Non-food contact surfaces clean 37 Food Properly labeled original container Physical Features Prevention of Food Contamination 50 Hot & cold water available adequate pressure Insects rodents & animals not resent 51 Plumbinginstalled ro er backflow devices Contamination revenled durin food re aration stora e & dis la 52 Sewa e & waste water ro ert dis osed Personal cleanliness53 Toilet facilities: ro ed constructed su lied & cleaned L'3 Wi in cloths: ro ert used & stored 54 Garba e & refuse ro ertdis osed facilities maintained Washing fruits & vegetables 55 Physical facilities installed maintained & clean 56 Adequate ventilation & Ii htin : desi nated areas used IN = in compliance OUT = not in compliance N/O = not observed N/A = not applicable Midici - The Neapolitan Pizza Company (Inspection Date: 01/25/2019) Page 1 of 2 TEMPERATURE OBSERVATIONS E ui ment Temperatures Description Temperature OF Prep unitsX3 One door lowboy one door lowboy Two door lowboy One door freezer Reach in freezer WIC Food Temperatures Description Type Temperature IF WIC small mozerella balls Cooling 46 pesto Cold Holding 40 sliced tomatoes Cold Holding 41 Front assemby lines ground beef Cold Holding 40 sliced cherry tomatoes Cold Holding 41 One door lowboy pesto Cold Holding 55 dressing Cold Holding 58 pesto Cold Holding 42 Leafy greens arugula Cold Holding 52 Steam table sauce Hot Holding 159 Midici — The Neapolitan Pizza Company (Inspection Date: 01/25/2019) Page 2 of 2