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Home My WebLink AboutCLE202100104 Application 2021-08-26Zoning Clearance Application FOR OFFICE USE ONLY Fee Amount: $ 59 + 4% Technology Surcharge Receipt #: 9 e D 865 j 691- 77a 043 Applicant - Fill out the entire page below And return to Community Development 401 Clearance Number.CLEa 62I -00lOy Albemarle County Gamrasay oa'sklpm 401 Mdndm Rd. NOMwry aadoeurHe. 'A 220M + PWW434.296.seaz Date Paid: g�i O/a I By.C, (dpveI A'EW by the Albemarle County Check #: ByC"DID�i6lppment Department FAO cf-(t 2oZ��[o McIntire Rd, North Wing, Charlottesville, VA 22902 Name: C. Novel Martin, III, Authorized Representative E-Mail Address: martinnovel@mfa.net Mailing Address: 917 Penn Forest Blvd, Ste 200, Roanoke, VA 24018 Phone #: 540-989-3618 Tax Map and Parcel number and/or Address of the Business: 505 W. Rio Road Charlotteville, VA 22901 Zoning: staewill fill out eunknown (� I1` �� Parcel Owner: 505 Rio Road West LLC Owner's Address: Penn ores Blvd, to 200 Check any that apply: ® New Business F— Change of Use L_ Change of Ownership D Change of Name Business Name: Charlotte Care Center LLC d/b/a Charlottesville Health & Rehabilitation Cello Description of Business: Describe the business Including use, number of employees number of shills, availability of parking, and any additional Info. Skilled nursing facility with approx. 100 employees. Employee work shifts cover 24 hrs. per day. Previous Business on Site: Skilled Nursing Facility - business changed ownership eff. 05/28/2021 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: Approx. 44,000 sq. ft. Is the Parcel Zoned LI, HI, or PDIP? Yes ® No If yes, fill out a Can fled Engineers Report (CERI 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 Heahh approval Is the Parcel on public sower or septic? ® Public ❑ Septic If on septic, provide Virginia Department of Health approval Will you be putting up any new signage? Yes obtain ® No it yes, appropriate sign permit and list permit #below Will there be new construction or renovations? Yes ® No If yes, obtain appropriate building permit and list permit Of below Please list any applicable Building Permit #a: Zoning Clearance review cannot begin until the application above is complete and all applicable fors 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.! L!/�---' Printed C. Novel Martin, II I Dateg /7- 20� 2 Zoning Clearance Application OF A( �a'� s ' Albemarle County Com�ltya tltlreCRdd,N�WN Chedehe246, VA 22M r �RCIN\' Awne �81.299.SB]2 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, to clearance number provided by Staff or business name Name of landowner on record the owner of Tax Map and Parcel Number TMPnumber ofproperty 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 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 Date K? For Albemarle County Staff Review Only Proposed Use: (t1. D e t. ( i K rm Peitted: as ❑ No Permitted by Section: 5 6 Suppletnesdary Regulations: f GG 5r `MC 2009,Q Applicable Special Use Permit (SP): I 6 S - D Z 6iq j _ 0 S / OfLI 5 t lc Si `l ✓6t" Applicable Rezoning , (ZMA): -` � 0'z ('�Z Xio- 2- / C k5 cie G ` " �.l7 ��- A tror r Applicable site Plans (SDP): j t (q y - 5 6 (? 6' 2 Parking: If there is an approved site plan associated with the parcel, the parking requirements will be defined by the SOP. Some parking requirements are determined by a ZMA or by an approved Code of Development. Parking Formula: 1 Defined by: ❑Site Plan ❑Zoning Ordinance ❑ CoD ❑Existing Total Square Footage of the Use: Y j e0o Required number of parking spaces: Q Q4e . 6 YD Vi 4 SA G,5— S6 Associated Clearances: Z� � lute- I Variances: '7l --O Z Violations: I 1s a site Inspection necessary?: ❑ Yes ❑ No Site Inspection on (date): To Confirm: Notes: J 01/101- GLEZ0O?^Z6 Conditions of Approval: Additional conditions of approval apply to Fireworks and Christmas Trees Approval Information 1a Approved as proposed _ I Approved with conditions _-.7 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: BuildingOHicia %j c✓ Date B�Z�r/%� Zoning Official 1-6- 2 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 �+ u� wana.w, , sos n;, p„d iaW90es.i11� VA 22901 ZONE S ZONE EItRa�.�� E2: N~ p -.. ZONE t Im- �f ZONE ZON1 Commonwealth of Virginia Virginia Department of Health Nursing Home License Number: NH2572 In accordance with the provisions of Title 32.1. Chapter 5, Article 1, Of the Code of Virginia 1950, as amended Charlottesville Care Center LLC (Operator) is Authorized to Operate, Charlottesville Health & Rehabilitation Center (Name of Organization) a Nursing Home, located at: 505 West Rio Road, Charlottesville, Virginia 22901 Approved Capacity 105 Beds I/W1' *�� A4� M. Norman Oliver, M.D. M.A. State Health Commissioner Expiration 12/31/2021 EppEC n VE g/2M021 Kimberly- . Ueazley, Director Office of Licensure & Certification