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Home My WebLink AboutCLE202100067 Application 2021-06-03Zoning Clearance Application 4M��.� - the �A22W2 ��RCatsa� Ph"434296.58V FOR OFFICE USE ONLY ClearanceNumber Fee Amount $ 54 Date Paid: i-1 alp gy vX PROVED Receipt #. I my 1a��p Check#. }tea By mmunrtyDevelopmen Department Applicant - Fill out the entire page below le _ And return to Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902 Name: `JErIS&LS OFCrtaac L LC E-Mail Address: (BAN Slti1otiE hsaust*Ct+Ava'z fv,40, tong Mailing Address: 4(0063 JaIN "Hut /itWe ✓A, 2 n 10 5 Tax Map and Parcel Phone III. e (4o3)g27-z7i number and/or Address Zoning: of the Business: 0C1PIWo0o2 OA00:9-00 Staff van mout durkm Parcel Owner. Gul6tiC--ll l/ Owners Address: IIflS SPMtNOfE TQ[,fHgc[�tjN,�j Check any that apply: New ausiness Lj Change of use Chan ge of Ownership Lj Change of Name Business Name: SE.A SUNs OFCH,q,E 11LC RETRit_ ReEltlokK5 Description of Business: I Describe the business including use, number alemployees, number of shifts, auadatiiq, or parla rg, and arty additional inlo- 7t1 R6T81L SAL,� of VA. 7iAokaUEp FikCiW 2KS, 0514)6 A FX46'- r,,, Previous Business on Site: Floor Plan: Total Square Footage Used for the Business: 23 i.A t, 11,11KLO1S V: t—L, rot4ufk i=4�ViPM6�vi 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. 3W 6 Q f-T Is the Parcel Zoned LI, HI, or PDIP? Yes �No Will there be food preparation? ❑ Yes [�'No Is the Parcel on public water or private welt? Public ❑Private Is the Parcel on public sewer or septic? �/ � LYJ ''uw- Q septic Will you be putting up any new signage? El Yes No Will there be new construction or renovations? Yes Please list any applicable Building Permit ys: If yes, fill out a Certified Engineer's Reoort (CER) If Yes. Provide Virginia Deparhnent of Health approval If on Private well, Provide Virginia Deparbrrerd of Health approval If on septic. Provide Virginia Department of Health approval If yes, obtain appropriate sign Permit and Est Permit! below No If yes. obtain appropriate building Permit and fist permit # below ---••- a wa unyrrr until me 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. Signaturrr/ 141 Printed JDIY/I/(iFrC mate `i Zoning Clearance Applicatlon r Rd CI��oltesLiOe, VA 22902 `�flwl� Ph. 439296_5932 Applicant - If you are not the landowner, please fill out the entire page below, confirming that you have either informed or are going to notify the owner of your 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, CL t� zGz( to ClAC-til the owner of Tax Map and Parcel Number G to I b'JUO,2- OA00.E 0 C by either delivering a 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) ❑ Hand delivering a copy of the application to the owner identified above on / Date E Mailing a copy of the application to the owner identified above on Date -".20 -z / to the following address: ii (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 G. Si �ntiv Date Ir—A 3 For Albemarle County Staff Review Only Proposed tie: PlcS6n'wt� permitted:No es ❑ Permitted by section: J. A d �. III d j C.2_ Supplementatrif Regulations - Applicable special Ilse Permit (SPY 2 (p S - 3 % �o i 5 -- 3 (� ✓ ✓tkl`(.I.0 s �r�cs c Applicable R®ornbgs (aA): Applicable site Plans (SDP): l �{— Parking: If there is an approved site plan associated with the panel, the parking requirements will be defined by the SDP. Some Parking Formula: Defined by: ❑site Plan []Zoning Ordinance ❑ Coo [06isfing Total Square Footage of the Use. /L (9 Required number of parldrrg spaces: 54W c elk) Associated Clearances: 1 -F7 z 9(1-OY ZOO -23 Variances: Violations: Is a site inspection necessary?: ❑ Yes Site Inspection on (date): To Confirm:ci Notes: Conditions of Approval: Additional conditions of approval apply to Fireworks and Christmas Trees Approval Information EV'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 rotes: ( Building Official �� 9 / (j. /jam I/1A Date le'I i , Z1 Zoning Official Date F6 Other Official G' '' y— (C5 L.cP— lV1 E o E r Date County of Albemarle Department of Community Development 401 Mcirdire Road Charlottesville, VA 22902 Phone: 434-296.5832 Fax: 434.972.4126 4 LEASE AGREEMENT This agreement of Land Lease is made this i (j\ T" day of_J/ RC 14 Zd 4 / between G u Lt C H E N (LESSOR) and aA50a)5 Cc CHA&XC � )_ ,.0 _ (LESSEE) for the Property described as an area at the front of 119 S Je.M i uo Lr TQA I L , more specifically Described on the attached site plan. LESSOR and LESSEE agree that for and in consideration of the sum of 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 i 7N� Ku '7%S, 20 Z I LESSEE agrees to obtain the necessary permits from CoL) , Y OF ALBEMA &-L for the purposeofselling_VA. /}pp,FOL)ir) FI1Cf--WC'r1CSduring this period. LESSEE agrees to provide a certificate of insurance to the LESSOR providing coverage during the above dates, naming Gu. C 1� �3 as additionally insured. LESSEE agrees to remove all stands, merchandise and refuse from the leased area by t� Zo21 And shall restore the area to the same condition it was before the lease began. In addition, LESSEE agrees to hold _ r2 u , Ct4 C &J 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(2021). LESSOR: 6u (Hl�N Slcir> n• a LESSEE:f)C-Ax CF [ H t IJ,C WITNESS:_Z44 DATE:_ 31i olz % A� oM CERTIFICATE OF LIABILITY INSURANCE a �,3" ' 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: N the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WANED, 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.e One Cleveland Center, Floor 30 FAx - 216-658-7100 A/c No:216658-7101 AfMRE55: info@brittongallagher.Com 1375 East 9th Street Cleveland OH 44114 INSURERS AFFORDING COVERAGE NMCi INSURER A : Everest Indemnity Insurance Co. 10851 INSURED 131fi5 Fireworks Over America of South Carolina, Inc. INSURER B: 916 Rosewood Drive INSURER C: INSURERD: Columbia SC 29201 INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 971537642 REVISION NUMBER: 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. lijp TYPEOFINSURANCIE iWSR W6R WD POUCYNUMBER POLICY fB=F POLlcr FlfP LIMITS A GENERAL LIABILITY SMGLOO655-201 1211r 0 12/112(21 EACH OCCURRENCE S t,DpD.0t0 'X! COMMERCIAL GENERAL LIABILITY -DAMAGE TO RENTED PREMISES 1Fa orrurmncel is . X OCCUR '.. APED EXP (Arty or,e Person) ' S X'-S2`M D� — PERSONALaADVINJURY 'S1.000.WO GENERAL AGGREGATE S2.000,000 GENY AGGREGATE LIMIT APPLIES PER PRODUCTS -COMPIOP AGG S7,=.00 )i7 PRQ X POLICY LOC - S AUTOMOBILE LIABILITY BI=EDSINGLE LIMB ICES i ANY AUTO j BODILY INJURY Per person) S ALL OWNED SCHEDULED - AUTOS _� AUTOS ',. BODILY INJURY (Per aaidem) :' S HIRED AUTOS _ AUTOS WNED PREOPFRDAMAGE S 5 UMIIRELILI lUAB OCCUR. — :. EACH OCCURRENCE S EXCESS LIAB CLAIMS -MAD= AGGREGATE : S DED ! RETENTIONS S WORMERS COMPENSRTION WCSTATU- OTH-. AND ELIPLOYERS' UABUTTY YIN'.. TORYUMITS g ANY PROPRIETGRFARTNERIEXECImVE . EL EACH ACCIDENT : $ OFFICER MEMBER EXCLUDED. MIA ❑ •. pAar dMm i NI) EL DISEASE- EA EMPLOYEE, S IT Yes. RIPTIDE, ' DESCRIPnON OF O OF OPERATIONS [allow �, EL DISEASE -POLICY LIMIT . $ DESCRIPTION OF OPf:TUtIONS / LOUmON$ / ViIBCLE9 (A1GrJl ACORD 101. AdGluonal RemMl¢ Soh *. Amore space a regwmt) 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 insureds. Property Owner. Gui Chen Stand Owner. Dan Simone DBA Seasons of Change Location: 1195 Seminole Trail, Charlottesville, VA 22901 Dates: 6/1/21 - 777/21 Seasons of Change Dan Simone 40463 John 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 PROVIStOM. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD .Joe14 ::s 19 •�' � 3fl1 AfT( i + - r - •o."f.. 'fry a . °'s: �_ ,e y® all oa � � �c •r - eT Rooc Vic-w F 1 REWORKS SWrNbaN SKNIAMOW SALes 8l wlNDav WNtJLOw WWAd41 THIS IS A 8'X qD' sTEE4- Sr,: --A CWT-AwE.0 W141 cH W1LL M u5F-p FOB 714E tA(-E OF C1ASS "C„ VA. 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