HomeMy WebLinkAboutCLE202200033 Application 2022-03-25POWER COMPANY _ _ = WORK VALUE $ oV, 16b166
/i�t.ttq County of Albemarle Community Development Department
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� ruefp 401 McIntire Road Charlottesville, VA 22902-4596
Sub -Contractor Application Inspection Line: (434) 972-4179 Voice: (434) 296-5832
PARCELIOWNER INFORMATION
TMP ( S C G Current Owner(s) OVA
APPLICATION• •
Application # Sub Application Type
Address
APPLICATION• .•• • •
Company Name IG f furl =FNG Contractor# ��IoII
Address II.A) G Phone# (SVJ 3yri �18/S
City/State ROww46 VA A60- Email Address S !(/er•,CArrt
ELECTRICAL 7
Alarm Systems
Bonding
Early Services FElectrical Wiring
CFuel Dis ensin Pumps
Other
C
C
C
C
C
C
C
C
C
C
C
C
MECHANICAL? Count rwmomur
I-1 r..,iinATnnk I r _ n AutomaticWashers
❑
Air Handler C ❑ Back Flow
❑�
Boiler �— n Bath Tubs F
Condenser Unit ❑Water Cooler
❑
Duct Work C DI Floor Drains
❑
Exhaust Fan C [:]I Fire Line
C ❑ Interceptor
❑
Electrical Grease
❑ Line C
❑
Exhaust CI Grease
C
[:]I
Fireplace =r� ❑ Hot Water Heaters
Gas Furnace L� ❑ Lavatories C
❑
❑
Gas Loos ❑ Medical Gas C
❑
Hood
❑
Mobile Homes
C
F_]j
Hood Suppression
��
I
❑Mop
❑
Sink
❑
Heat Pump
Outside Faucets
[:]I
Mobile Homes
❑
❑
I Prefab. BuildingC
C_
❑
Oil/Gas Line
Root Drains
❑
Oil Furnace
O
❑
❑
Re Pie
I
C
C
❑
Prefab Building
Sinks
❑
I Propane
[:]I
Shower Baths
C
❑
I Radiant
❑
Sewer Laterals I
C
❑
Retums
Q
S rinkler Head
Oas :4
❑
Roof Top Unit
F_�
IFR
Urinals
❑
Supplies
r
I _7
I
1 Water Closets
❑
Unde round Tank
❑Water
Lines
C
❑
Wood Stove
❑
Whirl Pool
C
Ell
Other
❑1
Wash Trey
C
Other
C
LE__
El
Page 1 9/14/2020
Separate permits may be required for Electrical, Plumbing, Heating, Ventilating, and Air Conditioning.
This permit becomes null and void if work or construction authorized is not commenced within six (6) months, or if construction
or work is suspended or abandoned for a period of six (6) months at any time after work is commenced.
I hereby certify that I have read and examined this application and know the same to be accurate and correct. All provisions of
laws and ordinances governing this type of work will be complied with, whether specified herein or not. The granting of a permit
does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction.
By signing this application, the owner and/or their agent hereby grant employees of the Albemarle County Community Develop-
ment & Real Estate Departments the right to enter and inspect the subject property Monday through Friday between the hours of
5:00 a.m. and 5:00 p.m., holidays excepted.
If you are not the owner of record, please check which applies:
❑ I certify that I am the agent for The Owner, and am authorized to
submit this application on behalf of the Owner under the agency granted to me.
I am neither the Owner nor the Owner's agent. I certify that written notice of this application, by providing a copy of
d
this application, will be
mailed to the Owner at the (following address:
Cr1C�rwY�eSV i !i VA. ;
within 10�ay's date as required by Virginia Code 615 2-2204(H) I understand that, if I do not provide the
notice to the Owner as provided herein, the application and every other subsequent approval, application, or certifi-
cate related thereto could be determined to be void.
1�1C/ccs al _ o21yl�
Signature o Owner, Contractor, or Authorized Agent Date
Si lure of Owner, Contractor or Authorized Agent Date
ELECTRONIC RECORDS STATEMENT: Albemarle County is creating and using electronic records and electronic signatures as
allowed by the Uniform Electronic Transactions Act (Virginia Code § 59.1-479 at. Seq.). As an applicant to the Building and Zon-
ing Application process, you may consent to receive or have online access to electronic records and receive and create records
having electronic signatures related to Building and Zoning Applications, Correspondence, Inspection Tickets, and Certificates of
Occupancy (the transactions).
0
Initials of Owner. Contractor or Authorized Agent Date
Your agreement to conduct the transactions by electronic means does not prevent you from refusing to conduct other transac-
tions by electronic means.
Page 2 9/14/2020