HomeMy WebLinkAboutCLE202000055 Application 2020-03-19by the Albemarle County
k Community Developme!t Department QV t4
IcZv . 114 rq Albemarle County
p- Community Development
1 Z o n b-c+e�-n� p I i c a t i o n ti 401 McIntire Rd. North Wing
ChaAoltesville. VA 22902
Phone 434.298.5832
FOR OFFICE USE ONLY Clearance NumberG:e��
Fee Amount: $ 54 Date Paid: 3 22(2-J By: 1
Receipt #:-7O612_q (-7-7 V c(;j Check #: (G_ By:
Applicant - Fill out the entire page below
And return to Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902
Name:
Sentara Healthcare
E-Mail Address:
kgabel@lantzcc.com
Mailing Address:
500 Martha Jefferson Drive, Suite 200,
Phone #:
540-271-5024
Tax Map and Parcel
number and/or Address
of the Business:
500 Martha Jefferson Drive,
Charlottesville, VA
Zoning:
Staff will fill out ifunknown
i
Parcel Owner:
Sentara Healthcare
Owners Address: 111803
Jefferson Ave, Suite 200 Newport News, VA
Check any that apply:
New Business D Change of Use Change of Ownership E] Change of NameNXtI�
Business Name:
Sentara Martha Jefferson Hospital
Description of Business:
Describe the business including use, number of employees, number of shifts, availability of parking, and any additional info.
Hospital, 1600 employees
Previous Business on Site:
None
Floor Plan:
Please attach either an architectural drawing or a sketch of the proposed business indicating the location of uses, the
uses of rooms, the total square footage of the use, and any additional information.
Total Square Footage Used
for the Business:
Area of renovation within the hospital is 410sf.
Is the Parcel Zoned LI, HI, or PDIP?
❑ Yes A No If yes, fill out a Certified Engineer's Report fCER1
Will there be food preparation?
U Yes 141 No If yes, provide Virginia Department of Health approval
Is the Parcel on public water or private well?
4 public Private If on private well, provide Virginia Department of Health approval
Is the Parcel on public sewer or septic?
Public Septic If on septic, provide Virginia Department of Health approval
Will you be putting up any new signage?
Yes ® No If yes, obtain appropriate sign permit and list permit # below
Will there be new construction or renovations?
A] Yes D No If yes, obtain appropriate building permit and list permit # below
Please list any applicable Building Permit #s:
1?J 20.2c —ocI4 12 -A(
Zoning Clearance review cannot begin until the application above is complete and all applicable forms and fees are submitted.
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. 1
Signature Printed /rwe 1.1 (;�2` Di rie LPNtJ l!</GI
Date e� �"� '�/► /�
For Albemarle County Staff Review Only
i
Proposed Use++; °�+
Permitted
Yes ❑ No
Permitted by Sec(ion
Z A
Suppletnerita y Regulations
---
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AIhpllcablef�Specia( Use,'Permit (SP)
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Appliable Reorltriq$ (ZMA} °=
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Applic$bi'p Site P(ar�s (SDP}
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P'a'rlingz�,''
If there is an approved site plaA associated with the parcel, the parking requirements will be defined by the SDP, Some
parking requirements are determined by a ZMA or by an approved Code of Development.
P�rrngormula ,ri Yf,
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pefined by,
[aSite Plan ❑Zoning Ordinance ❑ CoD
_]Existing
Total Square Footage pf the
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Required numberlaf parI spaces,!,
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Associated Clearances''
0 4 O , 311 -3 e
7
Violations.
Is a site inspection necessary?„ . ,, '
❑Yes No
Site Inspection. on. (date}
To;.Cortfirm ";^
Notes:
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Condttions of Approval
Additional conditions of approval apply to Fireworks and Christmas TreesD✓�kt k9
Approval Information
Q]/Approved as proposed ❑ Approved with conditions
❑ Denied
❑ Backflow prevention device and/or current test data needed for this site. Contact ACSA, 434.977.4511 ext. 117
❑ 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.
Condttions x ' �-
Additronal Notes r
Building Official
Date
�2
Zoning Official
Date ✓�( /
Other Official
Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Phone: 434.296.5832 Fax: 434.972.4126 4
� pC rife
�h'x Albemarle County
Z ®n i n Clearance A p p l i c a t i ®n O r`}} r Community Development
l— _. ' m 401 MGntlre Rd, North Wing
?=1�7, Charlottesville, VA 22902
� .17IRCIN�_ Phone 434.295.5832
Applicant - If you are not the land owner, please fill out the entire page below confirming that you have either
informed or are going to inform the owner of your zoning clearance application.
• • •
I certify that I will provide (or have provided) notice of this clearance application,
Martha Jefferson Hospital Gt r Z,�,) -55
clearance number provided by Staff or business name
to Sentara Healthcare the owner
Name of landowner on record
of Tax Map and Parcel Number 500 Martha Jefferson Drive by either delivering a
TMP number of property
copy of the application to them in person or by sending them a copy of the application by
mail. (Please check one of the following below)
Ci Hand delivering a copy of the application to the owner identified above on
Date 15/20
[] Mailing a copy of the application to the owner identified above on
Date
to the following address:
(Written notice to the owner and last known address on our record books will satisfy this
requirement. Please see staff for help determining this information if needed)
Signature of Applicant
Applicant Name Printed revctj aA-VZL_ - (btmc v �ws{s✓, �.,J (�(�-� L44
Date a 11�1_8 /2-40 Co�s°(vvc�7o� 60.
3