HomeMy WebLinkAboutWPO202100003 Preconstruction Form 2021-09-27q' Al./al
Request for Pre -construction Meeting and Grading Permit a
from Albemarle County — VSMP J:y. v
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Approved Plan Number: WPO-202100003 DEQ Permit # (if applicable): VARI O- NIA
Approved Plan Name: Starbucks - 2231 Seminole I
(Plans must be approved prior to a pre -construction meeting.)
Bond approved date: 9I 2--_3A zl
(Bonds must be approved and posted prior to a pre -construction meeting or permit)
Responsible Land Disturber:
Print Name:
State RLD Number. I C, SO 1
Address: 210 Carlton Road
City: Charlottesville State: VA Zip:22902
Daytime Phone: (_) (434) 293-6171 E-mail:
Primary Contractor:
Print Name:
Address: 210 Carlton Road
City: Charlottesville State: VA Zip:22902
Daytime Phone: (—) (434) 293-6171 E-mail:
Permit Issuance Fees (Request must include payment) (Code §17-7081,
Total acres proposed to be disturbed as shown on the approved plan and application: Acres
Acres to be Disturbed
Total Fee Due for Grading Permit
Tonal Fce = (Applicalion Fee + 4% Technology Surcharge)
Less than 1
574.88
$72 + 52.88
Single -Family Dwelling only —
574.88
less than 5
($72 + 52.88)
1 and less than 5 acres
$700.96
$674+$26.96
5 and less than 10 acres
$881.92
$848 + $33.92)
10 and less than 50 acres
$1,167.92
$1.123 + $44.92
50 and less than 100 acres
$1,581.84
$IS21 +$60.84
100 acres and more
$2,490.80
$2.395 +595.80)
Annual maintenance fees are assessed in arrears on April 1 each year or portion of a year that this permit is active
[Code § 17-208].
7/1/14, Revised: 8/29/14, 10/18/18, 7/1/2021, 7/2612021 Page 1 of
Person(s) attending the Pre -construction Meeting:
The second part of the application fee is required to be paid with this request. Thisfee amount is:
FOR OFFICE USE ONLY Permit Issued Date
By who?
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7/1/14, Revised: 8/29/14, 10/18/18, 7/1/2021, 7/2612021 Page 2 of
9/24121, 12:33 PM
Centralized Payments
0 Your Payment Was Submitted
Transaction ID:
Transaction Time:
Total Paid:
69J60614RW651081U
09/24/2021 12:33 PM
$77.11
We will receive notification of your online payment at the time that it is made and we will
credit your payment as of that day. However, you will not see the payment on your
account for approximately 48-72 hours due to the time that it takes to get those funds
into our bank account.
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