Loading...
HomeMy WebLinkAboutCLE202100168 Application 2021-12-20Envelope ID: 16976714-C91 E401 B-8CE9-E75779248F93 Zoning Clearance Application FOR OFFICE USE ONLY Fee Amount: $ 61.36 Application fee: $59 + Technology Surcharge: $2.36 Receipt #: 71Zi y of At 2 Albemarle County Community Developmemt "12 401 M ttein Rd. North 2 �ChadodeaWtle, VA 22%2 haGI Phone 4342%.5832 Clearance Numberci—Ei3ca I — My Date Paid: I I /� }� I By�^ rg(� &n d Check #UUU�cj')gl� CD By' un / Applicant - Fill out the entire page below and return to: � DfivelopmeZ I r- ment Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902Fffe Name: Bankers Life and Casualty Company E•Mail Address: p.cardona@banklife.com Mailing Address: 1410 Rolkin Court, Unit 202 Phone #: TBD Tax Map and Parcel number and/or Address of the Busin 07800-55-AB-20200 1410 Rolkin Ct - Unit 202 Zoning: staffwill fill out if unknown ,t 1ff �I�.,_ (v l Parcel Owner: Owner's Address: 195 Riverbend Dr, Charlottesville 229 Check any that apply: X❑ New Business ❑ Change of Use ❑ Change of Ownership ❑ Change of Name Business Name: Plankers Life and Casualty Comps" Description of Business: Describe the business including use, number of employees, number of shifts, availability of packing, and any additional info. Previous Business on Site: Association Specialists LLC 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: 1283 Is the Parcel Zoned LI, HI, or PDIP? Yes X❑ No If yes, fill out a Certified Engineer's Report fCERt Will there be food preparation? Yes Q No If yes, provide Virginia Department of Health approval Is the Parcel on public water or private well? 1XI Public Private If on private well, provide Virginia Department of Health approval Is the Parcel on public sewer or septic? X� Public 0 Septic If on septic, provide Virginia Department of Health approval Will you be putting up any new signage? X� 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 #s: 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. oocusigned by: SignatureL� , NAIUiwSlLy Printed Brenda Makowsky "'.E`n""`1 1412021 1 10:26 PDT Date 2 DocuSign Envelope ID'. 16976714-C91E-401B-8CE9-E7577924BF93 y oP AL 2A Albemarle County Zoning Clearance Application' `0mm°°1yDevB1opme01 41 McIntire RA. N29 Wing � ChaAonesmlle. VP 22902 r?3C(Mt' Phone 434.296. 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 I certify that I will provide (or have provided) notice of this clearance application, Lt FE2-,('z( l6 clearance number provided by Staff or business name Luxor LLC to the owner Name of landowner on record of Tax Map and Parcel Number 07800-55-AB-20200 by either delivering a TMP number of property 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) XHand delivering a copy of the application to the owner identified above on Date 0- 3— Z i 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 bl 144 Applicant Name Printed ' Date 3 For Albemarle County Staff Review Only IN Proposed Use: Wic Permitted: I Yes ❑ No Permitted by Section: Z 6 2t I C Q —' Z 2r I L Supplementary RegLullatio2nsp ZGL Z D 13 — 19 Applicable Special Use Permit (SP): /'L 2Do 5� ZC'�f(,t (Q %� _ CS W ZDO I / O (-1(LQIA(� I {/L2 Applicable Rezonings (ZMA): Z�� L�— I Z CBh4W1[Y A 11C— Applicable Site Plans (SDP): 'Z©©g-o C mp 79-55AD --+. 00 PMCEL'11r.y S'e Parking: If there is an approved site 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 aroved Code of Development. Parking Formula: trZTJ® Defined by: de Plan [_]zoning ordinance ❑Coo ❑Existing Total Square Footage of the Use: Z 0 227 4,9. (: 4 ve S c Required number of parking spaces: 2 l rD()1 Associated Clearances: 200-73 201-�-7 3 Z00-W Zpf2-212 `�� Variances: Violations: Is a site inspection necessary?: Yes No Site Inspection on (date): —'"' To Confirm: ci Notes: qj�c_ l,it �Reb ce✓1 �l©45rwP `t f5 lRk jS a -'e71r OM sv)22008-©`t fia .5 Conditions of Approval: Additional conditions of approval apply to Fireworks and Christmas Trees Approval Information 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 Notes: VBuilding Officia Date Zoning Official Date L / 7 Z 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 DocuSign Envelope ID. 6501FDFC-E35D-4A8C-AB9C-65786C38BB6A EXHIBIT A FLOOR PLAN AND IMPROVEMENTS Floor Plan Attached Ift P41111111110 out 86mWFbOf 8t60-1 M BF 'Pao nl Improvements: Tenant requires build -to -suit improvements provided by Landlord at Landlord's sole cost and expense, per this space plan, using materials outlined below. Landlord shall design and build -out Premises per Tenant's specifications that shall accompany these proposed terms. Bankers Life and Casualty Company - 21 -