HomeMy WebLinkAboutSDP200800016 Application Letter of Revision 1 2010-09-21 4,
Application for' V.` �
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Letter of Revision N,11.0
(Xi Letter of Revision=$95
Final Site Plan Name and Number: Martha Jefferson Hospital SDP-AP -00016
Contact Person(Who should we call/write concerning this project?): Dan Knapp
Address 125 S . 84th St. , Suite 401 City Milwaukee State WI Zip 53214
Daytime Phone(414) 2 5 9-15 0 0 Fax#(414) 2 5 9-0 0 3 7 E-mail dan.knapp@graef-us a. c om
Owner of Record Martha Jefferson Hospital
Address 459 Locust Avenue City Charlottesville State VA Zip 22902
Daytime Phone(43i 971-5255 Fax#(43i 295-9224 E-mail barbara.elias@mjh.org
Applicant(Who is the Contact person representing?): GRAEF
Address 125 S . 84th St . , Suite 401 City Milwaukee State WI Zip 53214
Daytime Phone(414 2 5 9-15.0 0 Fax#( 41)1 2 5 9-0 0 3 7 Eil dan.knapp@graef-us a. com
SUBMITTAL REQUIREMENTS:
EX The appropriate fee,
g The site plan number that the change applies to,
A request letter describing the proposed changes from the owner or authorized agent,
4 copies of the plan that shows the proposed changes,
Ci Changes must be shown on the sheet or sheets from the approved final site plan,or on an 11"X17"copy of that portion of the
approved final site plan.
Owner/Applicant Must Read and Sign
I hereby certify that the information provided on this application and accompanying information is accurate,true and correct to the
best of my knowledge and belief.
9,A7/6.
Signature of Owner,Agent Date
Print Name Daytime phone number of Signatory
FOR OFFICE USE ONLY LOR#
Fee Amount$ U. (/`. Date Paid /( _3/(By who? *tur Receipt# D.=2 Y'Ck#a"( . 353 By US
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville,VA 22902 Voice: (434)296-5832 Fax: (434) 972-4126
7/1/09 Page 1 of 1
Martha Jefferson
Replacement Hospital
Transmittal
To: County Of Albemarle/Phil Custer
From: Ellen L.Winston,Martha Jefferson Hospital
Date: 09-21-10
Re: MJH—Letter of Revision Submittal
Qty Date Description
4 09-21-2010 Revised C204
1 09-21-2010 Application
1 09-21-2010 Frederick Transmittal
1 09-21-2010 MJH check for$95.00
MJH Construction Services
575 Peter Jefferson Parkway
Charlottesville,VA 22911
(434)971-5255 Phone
(434)295-9224 Fax
• Page 1
MEM One Honey Creek Corporate Center
t 125 South 84th Street,Suite 401
TRANSMITTAL FORM Milwaukee,Wisconsin 53214-1470
414/259 1500
414/259 0037 fax
www.graef-usa.com
Date: September 20, 2010
To: Albemarle County - Department of Re: Martha Jefferson Hospital
Community Development
401 McIntire Road Letter of Revision
North Wing
Charlottesville, VA 22902
Attn: Phil Custer GRAEF Job #: 20060001.10
We are sending you: ❑ Herewith ❑ Under Separate Cover
COPIES NO. DESCRIPTION
4 1 Revised C204
1 1 Application and Fee
❑ Per your request ❑ For your use ❑ Copies for distribution
® For your approval ❑ Review& return [' Corrected prints
REMARKS: Summer, please call with any questions regaring the letter of revision.
Sincerely,
411110
Daniel J Knapp, LEED AP
Associate
Copy to:
Formerly Known as Graef,Anhalt,Schloemer&Associates,Inc.