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HomeMy WebLinkAboutCLE202000087 Application 2020-06-03O� r,� Albemarle County Community Development y � Zoning Clearance Application 401 Rd, North Wing Charlottesville, VA 22902 .tsz �x �RCyrlit" Phone 434.296.5832 FOR OFFICE USE ONLY Clearance Number: %do Fee Amount: $ 54 Date Paid: jc;Ujd6Z By: S(�ct_ � &LC by the A4bemar4e Receipt #: I D 1 I ( check #: �134 By: J�>ammunity Yelp _ nt Department Applicant - Fill out the entire page below Date File _ And return to Community Development 401 McIntire Rd, North Wing, Charlottesville, 902 _. Name: S^E�� OFCFiAc I^�C Ia SIMO. E-Mail Address:o2���•� Mailing Address: t�046 ow Mosby riwau PIE VA. 20105- Phone#: (I7Q3)9,27-a7/? Tax Map and Parcel number and/or Address of the Business: 0(t�, I woo;L Of 00® 100 Zoning: Staff will fill out if unknown I Parcel Owner; C l j 1 C I-i �/� Owner's Address: �Sjp,(T�gL ('Wik tvl3 (�f Check any that apply: New Business Change of Use Change of Ownership D Change of Name Business Name: _ , H",6E . 1, LC keTA I L f h26(,4,OQ S Description of Business: Describe the business including use, number of employees, number of shifts, availability of parking, and any additional info. 1 E keTA I L 45 PILL OF A - ,eft*10 F1 &Uk) 'Q,< S o U 5 i.U(b A 8 X q6 ALf-5 Qr0TArM_-C FP-Orr-7 5)&)rC- Z - XVL Z-OZ(-) 56fnt-56i Previous Business on Site: C-HFtkL0T6VA 1 E_ owie e. 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: 320 5 Q F—(, Is the Parcel Zoned LI!, HI, or PDIP? Yes No If yes, fill out a Certified Engineer's Report (CER) Will there be food preparation? Yes No If yes, provide Virginia Department of Health approval Is the Parcel on public water or private well? 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? Yes MNo If yes, obtain appropriate building permit and list permit # below Please list any applicable Building Permit #s: 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. Signature Printed _01S1VY,1'c4 6, 151-f-f0"J1L Date 'S 5- zo 2 BE For Albemarle County Staff Review Only Proposed Use. �u(^1 I t'// i Permitted: es ❑ No Permitted by Section: .7fq5 5� (ac. kppkjj. Supplementary moons: �— Applicable Speck Use Permit (SPY Applicable Rezonings RNiA): ..— Applicable Site Plants (SDP): I q G t-H Parking: If there is an approved site plan associated with the parcel, the parking requirements will be defined by the SDP. Some parking requirements are determined by a ZMA or by an a oved Code of Development. Parting Formula: �� Defined by; ite Plan ❑ Zoning Ordinance ❑ Col) []Existing Total Square Footage of the Use: •Z Ze 5 GQc pft "�t�E Required number of parking spaces: Associated Clearances: C 1? - 7 Q1 Variances: Violations: Is a site inspection necessary?: ❑ Yes No Site Inspection on (die): To Confirm: Notes: Conditions of Approval: Additional conditions of approval apply to Fireworks and Christmas Trees Approval Information ❑ 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. Conditions: Additional Notes: Building Official Date Z� Zoning Official_<;��Wr Date "— 26) Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Phone: 434.296.5832 Fax: 434.972.4126 of F1. Albemarle County Zoning Clearance Application 40 R°evebprient ^ Charlottesville, VA 22902 �jlytR Phone 434.296.5832 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. CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER I certify that I will provide (or have provided) notice of this clearance application, clearance number provided by Staff or business name to C-=3 L> l C i•tc-/') Name of landowner on the owner of Tax Map and Parcel Number 0& 1 WM)- QAOD-206 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) 4K Hand delivering a copy of the application to the owner identified above on Date Qy,"-,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 l Applicant Name Printed 'Dow&L Date .5 = 05 ZC2 3 LEASE AGREEMENT This agreement of Land Lease is made this of•�/�� C� between -,i-fi C141k! ,(LESSOR) and 5 (F )69E a ►.LC. ,(LESSEE) for the Property described as an area at the front of 1 I Q!� Se.'�'1 iMOCC T�A 1 L ,more specifically Described on the attached site plan. LESSOR and LESSEE agree that for and in consideration of the sum ofTuXy TAO!mA-Fib 4WD ( 2,Soa°7*9 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 AI i TWU #1d:5- 2020. LESSEE agrees to obtain the necessary permits from oo-: 'y of &6E c for the purpose of selling j/A . APBOoUf D F I.Q E uXoeKL, during this period. LESSEE agrees to provide a certificate of insurance to the LESSOR providing coverage during the above dates, naming Gj )3 ( m ,,1 as additionally insured. LESSEE agrees to remove all stands, merchandise and refuse from the leased area by 1 a 20Zo And shall restore the area to the same condition it was before the lease began. In addition, LESSEE agrees to hold Go; Gi&"U and owners harmless of any and all accidents; etc. LESSEE will be responsible for all activities on leased premises related to their business operations. Given the unprecedented and unpredictable health situation of the coronavirus, if the country is mandated to not allow product into the United States and we cannot move forward with the Fireworks season, Lessor agrees to release Lessee of all financial liability for the current year(2020). LESSOR: GQs 46AJ SIGNED WITNESS:_ ____ DATE: y-O/-20 LESSEE: J)&kjq _i- (;-,. t)iA4oa» SIGNE WITNESS: } DATE: `lam/'ze A�ORO� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 2/3/2020 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 CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Britton -Gallagher and Associates, Inc- One Cleveland Center, Floor 30 1375 East 9th Street NAME: PHONE 216 658 7100 Noll: 216�58 7101 E-MAILEM, ADDREss: info britton alla her.com Cleveland OH 44114 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Everest Indemnity Insurance Co. 10851 INSURED 18166 Fireworks Over America of South Carolina, Inc. INSURER B : 916 Rosewood Drive INSURER C : INSURER D : Columbia SC 29201 INSURER E INSURER F COVERAGES CERTIFICATE NUMRER- 19n96RsAA1 RFVIRrnfa fall 111U1L2co• 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRR TYPE OF INSURANCE � SUBR POLICY NUMBER POLICY EFF IPOLICY ID Y EXP LIMITS A GENERAL LIABILITY SIBGL00655-191 12/12019 12/1/2020 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILFTY CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one Pew) $ X $2500 Deductible PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMWOP AGG $ 2,000,000 X POLICY PRO X LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA L1AB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) It yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. Stand Owner, Property Owner and Others listed below are named additional insured's. Property Owner: Gui Chen as well as Seasons of Change, LLC/Dan Simone Location: 195 Seminole Trail, Charlottesville, VA 22901 {. =r% 1 11-I Vfl 1 C rl V L►JCR UANUhLLA I IUN Seasons of Change/Dan Simone 4063 Johns Mosby Hwy Aldie VA 20105 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. 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