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Home My WebLink AboutARB202200045 Application 2022-05-09Architectural Review Board Application�� Part A: Applicant, Contact and Parcel Information Project Name: Verizon - Scruby Property Tier III PWSF Tax map and parcel(s): 0550000-00-01400 Physical Street Address: Greenwood Station Road Contact Person: Nathan Holland - GDN Sites Business Name: Verizon Wireless Address 513 Stewart Street, Suite E City Charlottesville State Virginia zip 22902 Daytime Phone C_) 757-305-8420 Fax # C__) E-mad nathan.holland@gdnsites.com Owner of Record: Brian Gray Scruby Address P.O. Box 83 City Greenwood State Virginia zip 22943 Daytime Phone C_) 540-255-6030 Fax # C__) E-mail Part B: Review Type and Fee Select review type Review by the Architectural Review Board Conceptual Plan/Advisory Review (for a Special Use Permit or a No Fee Rezoning) Preliminary/Initial Review of a Site Development Plan No Fee Final Review of a Site Development Plan $1075.00 Amendment to an approved Certificate of Appropriateness $ 242.00 Building Permit Review $ 634.00 County -wide Certificate of Appropriateness Structures 750' or more from the EC, no taller than 5 stories No Fee Structures located behind a structure that fronts the EC No Fee Personal wireless service facilities No Fee Fencing or Equipment or Lighting No Fee Additions to ARB-approved buildings No Fee Minor amendments to site or architectural plans No Fee Building permits where the change is 50% or less of the altered elevation No Fee NOTE: For SIGNS, use the combined APPLICATION AND CHEKLIST FOR SIGNS. FOR OFFICE USE ONLY BP# ARB# Fee Amount $ Date Paid By who? Receipt # Check # By County of Albemarle Dept of Community Development, 401 McIntire Rd, Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9724126 102015 PW 1 oft OVER , Part C: Description of Proposal Describe your proposaL Attach a separate sheet if necessary. Installation of a Tier III Personal Wireless Service Facility with a 140' monopole tower (See attached site plan). Part D: Applicant Agreement Applicant must read and sign • Each application package must contain (8) folded copies of all plans and documents being submitted. Only (1) set of building material samples is required. All submittal items, including building material samples, become the property of Albemarle County. Applicants are encouraged to maintain duplicate copies of all submittal items in their own files. • Only complete application packages will be scheduled for ARB review. The application package is not complete without the appropriate checklist, completed, signed, and included with the required submittal materials indicated on the checklist I hereby certify that I own the subject property or have the legal power to act on behalf of the owner in filing this application. *See submittal requirements below. I also certify that the information provided on this application and accompanying information is accurate, true, and correct to the best of my knowledge, and that the attached plans contain all information required by the appropriate checklist. 3/31 /22 Signature of owner, owner's representative Date or contract purchaser Nathan Holland Printed name, Title 757-305-8420 Daytime phone number of Signatory *Ownership Information: • If ownership of the property is in the name of any type of legal entity or organization including, but not limited to, the name of a corporation, partnership or association, or in the name of a trust, or in a fictitious name, a document acceptable to the County must be submitted certifying that the person signing above has the authority to do so. • If the applicant is a contract purchaser, a document acceptable to the County must be submitted containing the owner's written consent to the application. • If the applicant is the agent of the owner, a document acceptable to the County must be submitted that is evidence of the existence and scope of the agency. Attach the owner's written consent. 11/2010 Page 2 of 2 OVER,