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Home My WebLink AboutARB202000129 Application 2020-12-03 A 11"0, Community DevelopmentDepartmert \ Albemarle Co ty icIntire Road Charlottesville,VA22902-4596 4,1f,,var—H voice:(434)296-5832 Fax• (434)972-4126 4‘111117 1 Planning Application PARCEL / OWNER INFORMATION IMP 05400-00-00-072A0 Owner(s): SCRUBY, BRIAN G Application# ARB202000129 !PROPERTY INFORMATION --- Legal Description ACREAGE A v Magisterial Dist, White Hall Land Use Primary Forest Current AFD Not in A/F District Current Zoning Primary Rural Areas APPLICATION INFORMATION Street Address Entered By • lerinifaytmftho application Type Architectural Review Board 1121112°p Project VERIZON - SCRUBY PROPERTY TIER III PWSF - DIGITAL Received Date 1 2/03/20 F.e.:ehed Date Final Submittal Date 12/07/20 Total Fees Closing File Date I Submittal Date Final Total Paid Revision Number Comments Legal d SUB APPLICATION(s) Type I Sub Applicatio i Comnrrt Personal Wireless Facility 12/07/20 APPLICANT / CONTACT INFORMATION ContactType Name Address CityState I Zip Phone I PhoneCell C•to-er.,'4;:pairt BRIAN GRAY SCRUBY P,O.BOX 83 GREENWOOD,.VA 22943 540255E030 • Ws:THAN HOLLAND-GDN SITES- 513 STE'A'ART STREET. SUITE E CHARLOTTESVILL 22902 757305842G Signature of Contractor or Authorized Agent Date Architectural Review Board Application Part A: Applicant, Contact and Parcel Information Project Name: Verizon -Scruby Property Tier Ill PWSF Tax map and parcel(s): 05400-00-00-072A0 Physical Street Address: Greenwood Station Road Contact Person: Nathan Holland - GDN Sites Business Name: Verizon Wireless Address 513 Stewart Street, Suite E City Charlottesville State Virginia Zip 22902 Daytime Phone( ) 757-305-8420 Fax#( ) E-mail nathan.holland@gdnsites.com Owner of Record: Brian Gray Scruby Address P.O. Box 83 City Greenwood State Virginia Zip 22943 Daytime Phone( ) 540-255-6030 Fax#( ) E-mail Part B: Review Type and Fee Select review type Review by the Architectural Review Board Conceptual Plan/Advisory Review(for a Special Use Permit or a No Fee Rezoning) Preliminary/Initial Review of a Site Development Plan No Fee Final Review of a Site Development Plan $1075.00 Amendment to an approved Certificate of Appropriateness $242.00 Building Permit Review $634.00 County-wide Certificate of Appropriateness Structures 750' or more from the EC,no taller than 5 stories No Fee Structures located behind a structure that fronts the EC No Fee X Personal wireless service facilities No Fee Fencing or Equipment or Lighting No Fee Additions to ARB-approved buildings No Fee Minor amendments to site or architectural plans No Fee Building permits where the change is 50%or less of the altered elevation No Fee NOTE: For SIGNS, use the combined APPLICATION AND CHEKLIST FOR SIGNS. FOR OFFICE USE ONLY BP# ARB# lJ I Xi Fee Amount$ Nyy\ Date Paid ,_ _ County of Albemarle Dept of Community Development,401 McIntire Rd,Charlottesville,VA 22902 Voice:(434)296-5832 Fax:(434)972-4126 10/2015 Page I of 2 OVER-.,X Part C: Description of Proposal Describe your proposaL Attach a separate sheet if necessary. Installation of a Tier III Personal Wireless Service Facility with a 94' monopole tower (See attached site plan). Part D: Applicant Agreement Applicant must read and sign • Each application package must contain (8) folded copies of all plans and documents being submitted. Only (1) set of building material samples is required. All submittal items, including building material samples, become the property of Albemarle County. Applicants are encouraged to maintain duplicate copies of all submittal items in their own files. • Only complete application packages will be scheduled for ARB review. The application package is not complete without the appropriate checklist, completed, signed, and included with the required submittal materials indicated on the checklist I hereby certify that I own the subject property or have the legal power to act on behalf of the owner in filing this application. *See submittal requirements below. I also certify that the information provided on this application and accompanying information is accurate, true, and correct to the best of my knowledge, and that the attached plans contain all information required by the appropriate checklist. 10/7/2020 Signature of owner, owner's representative Date or contract purchaser Nathan Holland Printed name, Title 757-305-8420 Daytime phone number of Signatory *Ownership Information: • If ownership of the property is in the name of any type of legal entity or organization including, but not limited to, the name of a corporation, partnership or association, or in the name of a trust, or in a fictitious name, a document acceptable to the County must be submitted certifying that the person signing above has the authority to do so. • If the applicant is a contract purchaser, a document acceptable to the County must be submitted containing the owner's written consent to the application. • If the applicant is the agent of the owner, a document acceptable to the County must be submitted that is evidence of the existence and scope of the agency. Attach the owner's written consent. 11/2010 Page 2 of 2 OVER,