HomeMy WebLinkAboutARB202200062 Application 2022-06-22 (2)POWER COMPANY
- WORK VALUE $
Community Development Department
County of Albemarle
401 McIntire Road Charlottesville, VA 22902-4596
Sub -Contractor Application Inspection Line: (434) 972-4179 Voice: (434) 296-5832
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ARCEL/OWNER INFORMATION
MP o& 1 wo - 03- 00 - O i 9 A0 Current Owner(s) OGT 54DAeA'61d f8MWjy Oaaner U
Application # Sub Application Type
Address 0ec1 e. __ _ __ _ u _ 'L 1-3. AS __r _
Company Name EdgUe Edwgds Contractor# 270501a$I$
Address I-IA'71 S Vadeq i a Phone # O y3y - $595
City/State I A44 ArawQrd VA Email Address G1�af�lnan%%.P�S QnS.biZ
ELECTRICAL ?
❑ I Alarm Systems
1-11 Bonding
❑ Early Services 7
❑ Electrical Wiring
n Fuel Diwensina Pumos
II Mobile Homes
Other
C
C
C
C
C
C
Generator
Pool
MECHANICAL? Count
❑ I Above Ground Tank
❑ Air Handler C
Boiler C
❑ Condenser Unit F
❑ Duct Work C
Exhaust
❑
Hood
❑
Hood Suppression
C
❑
Heat Pump
C
❑
❑
Mobile Homes
OiiiGas Line _
r
❑
Oil Furnace
❑
FPrefab BuildingC
❑
Propane
C
❑
Radiant
C
❑
Returns
C
[ ]I
Roof Top Unit
[711
Supplies
❑
[j
Underground Tank
—
❑
Wood Stove
C,
❑
I Other
❑l
C
❑
C'
PLUMBING? Count
❑ Automatic Washers CI
❑ Back Flow C
❑ Bath Tubs C
❑ Water Cooler
❑ Floor Drains C
F_]j Fire Line ❑I
Greaselnt
Grease Lir
Hot Water
❑ Medical Gas
C
C-
C
i
C
❑ Shower Baths C
F-11 Sewer Laterals C
C
C
C
C
C
❑ Wash Tray �I
I JI Other �-
❑
home on vacant land in tht
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
8:00 a.m. and 5:00 p.m., holidays excepted.
If you are not the owner of record, please check which applies:
0 I certify that I am the agent for 4� W, The Owner, and am authorized to
submit this application on behalf of the O er 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
this application, will be mailed to the Owner at the following address:
within 10 days of today's date as required by Virginia Code 615.2-2204(11). 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.
Signature of Owner, Contractor, or Authorized Agent Date
Signature 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 6 59.1-479 et. 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).
In1 � 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.