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HomeMy WebLinkAboutCLE202100103 Application 2021-08-26Zoning Clearance Application FOR OFFICE USE ONLY Clearance Number. C1, 6a-09. I - 00103 Albemarle County Comm nky Dewiopm rgt Mdnbm Rd, NO wing ^. ChadonuWis. VA 22M CI Ptwne �2961M Fee Amount: $ 59 + 4% Technology Surcharge Date Paid: 5/ i 0 4 ( By: C. NOvP0 / Receipt* #: by the Alb( County p 7XL5�gI9RG37-1503T Check BYD( by fben h .. ,1 atfi &`L ^tpepartment Applicant -Fill out the entire page below File c r� zort !o And return to Community Development 401 McIntire Rd, North Wing, Charlottesville,-VA-3 _ Name: C. Novel Martin, III, AuthoriC.rRzed RepresenLLCtative ♦ heinalf of Alhpmar'A Canter E461all Address:an Phone #: martinnovel@mfa.net 540-989-3618 Mailing Address: g17 peon Forest Blvd, Ste 200, Roanoke, VA 24018 Tax Map and Parcel number and/or Address of the Business: 1540 Founders Place Charlottesville, VA 22902 Zoning: stefrwill fill out funknown I _ �� Parcel Owner: 1540 Founders Place LLC Owner's Address: I 2917 peon Forest Blvd. Ste 200 Check any that apply: ® New Business j Change of Use D Change of Ownership L Change of Name Business Name: Albemarle Care Center LLC d/b/atiblannilirle Health habilitat " A Describe the business Including use, number of employees, number of shifts, availability of parking, and any additional info. Description of Business' Skilled nursing facility with approx. 115 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. 74,000 sq. ft. Is the Parcel Zoned LI, Hl, or PDIP? El Yes ® No If yes, fill out a Centfied Engineer's Scood (CER) Will there be food preparation? ® Yes No If yes, provide Virginia Department of Heabh 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 ® No If yes, obtain appropriate building permit and list permit # below Please list any applicable Building Permit #a: 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 � /t�� printed C. Novel Martin, III Date O -1 1 Z o 2l r 2 Zoning Clearance Application sr .. "- _it:, �'^ AlCommuNty oe County nyi .D, MdMm ad No WN Q arl.U. pn. VA 22M F/AarN�� Ghana 4U.289.5832 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 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 TMP number of Property 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 3 For Albemarle County Staff Review Only Proposed Use: NUYS I �f Ham . Ce Xu 1C - Permitted: Vas No Permitted by Section: S S Supplementary Regulations: Applicable Special Use Permit (SP): //�� (, LL 'Zp � � — t tj C 6t'�. F�C2 �'�- P' Ao b, Applicable Rezonings CLMA): Zp 1 (_ 06 Applicable Site Plans (SDP): Zu Q ` t Parking: If there is an approved she 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 roved Code of Development. Parking Formula: t J t7r d 5 Defined by: I wilts Plan ❑ Zoning ordinance 0 CoD Existing Total Square Footage of the Use: Required numberof parking spaces: Associated Clearances: Z© Variances: Violations: Is a alto Inspection necessary?: ❑ Yea No Site Inspection on (date): To Confirm: Mfg Notes: rd r�r✓S (,y{, 4 hew c%�rqu� ��r a1t3A vlQ/nie 15 c ( I � Conditions of Approval: Additional condalon& of approval apply to Fireworks and Christmas Trees Approval Information Q 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 J 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 I Building I Zoning O, Other Offl Date L 2�6`1 Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Phone: 434.296.6832 Fax: 434.972.4126 4 ti FECfit'L S�dY.i'il+I Commonwealth of Virginia Virginia Department of Health Nursing Home License Number: NH2780 In accordance with the provisions of Title 32.1. Chapter 5, Article 1, of the Code of Virginia 1950, as amended. Albemarle Care Center LLC (Operator) is Authorized to Operate, Albemarle Health and Rehabilitation Center iName of Organization) a Nursing Home, located at: 1540 Founders Place, Charlottesville, Virginia 22902 Approved Capacity 120 Beds •7 *'nn 0,04,k — M. Norman Oliver, M.D. M.A. State Health Commissioner Expiration 12/31/2021 �j C --j �— Kimberl_ . Beazley, Director Office of Licensure & Certification