HomeMy WebLinkAboutWPO201900066 Application 2019-11-25Y S S J�
Virginia Stormwater Management Program (VSMP)
Application for Albemarle County,
t'7rt("5`l�a
Project Name: Beaver Creek Medical Office Building
(The name should he the same as it appeaf-s 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: (to be provided by the Countyfor nely applications)
The following are required elements of 'n"7 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. 1 hereby grant the County of Albemarle the righ�to enter �}pon the proper y 7required to ensure
compliance with the approved plans and permits. i j
06000-00-00-03800 West End Shops - West
Tax Map & Parcel Print Naive of Owner
Tax Map & Parcel Print Name of Owner
Tax Map & Pat -eel Print Name of Ovaier
Tax Map & Parcel Print Name of Owner
Contact Information for the Owner(s) to receive correspondence.
Print NameWest End Shops - West LLC
Address 2246 ly/ Road, Suite 5
CityCharlottesville
Daytime Phone (
E-mail
Owner
Signature of Owner
Signature of Owner
ignature of Owner
�
Date [
Date
Date
Date
,VA Zip 22903
Revised 07/24/18 Page 1 of 2
W1 B. All Fees [Code section 17-208]
For new or modified plans; Total acres proposed to be disturbed 1.51
Acres to be
Total Fee
Fee Due with this
Fee with Transfer or
disturbed
Application
modification of permit
Less than 1
$290
$145
$20
1 and less than S
$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
$6,100
$3,050
$450
100
!00 and mare
$9,600
$4,800
$700
For (minor) amendments to an approved plan; $200 per review
Variances; $150
Mitigation Plan; $150
la C. Registration Statement on the official DEQ form.
m D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402.
la E. Stormwater Management Plan satisfying the requirements of code section 17-403.
W F. Pollution Prevention Plan satisfying the requirements of code section 17-404.
PJ 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.
❑ 1. 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_ofall 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)
PrintNameJohn Thier (Turner Enterprises)
Address 250 West Main Street, Suite 201
city_ harlattesville
VA Zip 22902
Daytime Phone {434 1 533-0788 E-mail John@turner-enterprises.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?
Revised 07/24(18 Page 2 of 2