HomeMy WebLinkAboutSDP201900077 Application 2022-06-23 (2)/ ,4-r Community[) evelopmeA 2932- 59
a Albemarle Coon 401 N' "reRoad C?ea lcYesviile, VA22902-4596
(434) 236-5832 Fax :(434) 972-4126
Planning Application
4RCEL OWNER INFORMATION
TMP 05700-00-000-041L0 ownei (s): CROSS, ROBERT L & ]EANNE K CROSS TRUSTEES OF THE CRO5
Application# SDP201900077
Legal Description 1 ACREAGE PARCEL Y & %
Magisterial Dist,. White Hall v Land Use Primary Residential-- Single-family (Intl. modular homes <
Current AFD:Not in A/F District Current Zoning Primary Rural Areas
Street Address 1406 WILD TURKEY LN CHARLOTTESVILLE, 22903
Application Type ,Site Development Plans_ -
Project Wild Turkey (Cross Property) Tier II PWSF
Received Date 12/09/19 Received Date Final
Closing File Date
Revision Number
Comments I
Legal Ad
Submittal Date 12/30/19
Submittal Date Final
JEntered By
]enmfer Pntcl-
v I 1 12i 1612019
Total Fees
Total Paid
SUB APPLICATION(s)
Type
Sub Applicatia
Convnent
Personal Wireless Facility
12/30/19 '
i
APPLICANT / CONTACT INFORMATION
CantactTvpe Name
Address
C
Phone PhoneCell
r ZApp&v CROSS RO9ERT L & 1£ANNE X CRASS
PO BOX 723597
ATLANTA GA 11139
r. vy t_rxa t NATHAN HOLLAND
513 STEWART ST, STE E
22902 7573058420,
Signature of Contractor or Authorized Agent Date
Application for
Personal Wireless Service Facility
ty(.L.eF'r
IMPORTANT: Your application is considered INCOMPLETE until all of the information on the
Required Application Content Checklist on pages 2 thru 6 has been submitted and the appropriate fee has been submitted.
(See page I 1 for the appropriate fees) related to your application). Staff will assist you with these items.
PROJECT NAME: (how should we refer to this application?): Wild Turkey (Cross Property) Tier II PWSF
PROPOSAL: ❑ Tier I ad Tier II ❑ Tier III ❑ Building Permit after Tier Ii or Tier HI approval
COPIES REQUIRED: Two (2) Sixteen (16) Seventeen (17) Two (2)
EXISTING COMP PLAN LAND USE/DENSITY: Residential / Single Family
LOCATION/ADDRESS OF PROPERTY FOR SPECIAL USE PERMIT: 408 Wild Turkey Lane
TAX MAP PARCEL(s): 05700-00-00-041 LO
ZONING DISTRICT: RA - Rural Areas
# OF ACRES TO BE COVERED BY SPECIAL USE PERMIT (if a portion it must be delineated on a plat): 3,335 Square
Fee
Is this an amendment to an existing Special Use Permit? If Yes provide that SP Number. N/A
❑ YES
® NO
Are you submitting a Special Exception to modify or waive certain requirements with this application?
® YES
❑ NO
If YES, provide the modifications: 5.1.40.b(2)(e) - Proleetion
Does the owner of this property own (or have any ownership interest in) any abutting property?
® YES
❑ NO
If YES, please list those tax map and parcel numbers: Yes - 05700-00-00-041 KO
Applicant (whom should we contact about this project): Nathan Holland- GDN Sites on behalf of Verizon Wireless
Street Address 513 Stewart Street, Suite E
City Charlottesville State Virginia Zip Code 22902
Phone Number (757) 305-8420
Email nathan.holland@gdnsites.com
Owner of Record Robert L. Cross & Jeanne K. Cross Trustees of the Cross Living Trust
Street Address 635 Boone Trail
City Charlottesville State Virginia Zip Code 22903
Phone Number (434) 296-5980
Email rlcrosssr@yahoo.com
Contractor Building Permits and Tier I only)
Street Address
City
Phone Number
Work Value $
Code
FOR OFFICE USE ONLY Application # SIGN # (if an SP)
Fee Amount $ _ Date Paid _ By who? _ -_ _ Receipt # Ck# by:
ZONING ORDINANCE SECTION
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
www.albemarle.org
REVISED 12/7/2017 Page 1 of 11
Personal Wireless Service Facility Application
Tiers
Appill"tion Requirements & Check)ist
f
If
lu
Irr.rtrvrrvinns: are "�["iniPgulic,Uinn 7;rpe indicaaa regvrirernems.
T AI fire irr rieht colunm ra con rm re urrenre»fs are met.
1. Application farm and signatures. A completed application form, signed by the parcel owner, the
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parcel owner's agent or the contract purchaser, and the proposed facility's owner. If the owner's
agent signs the application, he shall also submit written evidence of the existence and scope of the
agency. If the contract purchaser signs the application, he shall also submit the owner's written
consent to the application.
2. Plat or survey of the parcel. A recorded plat or recorded boundary survey of the parcel on which the
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facility will be located; provided, if neither a recorded plat nor boundary survey exists, a copy of the
legal description of the parcel and the Albemarle County Circuit Court deed book and page number.
3. Ownership. The identity of the owner of the parcel and, if the owner is other than a real person, the
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complete legal name of the entity, a description of the type of entity, and written documentation that
the person signing on behalf of the entity is authorized to do so.
4. Plans and supporting drawings, calculations, and documentation. Except where the facility will be
located entirely within an eligible support structure or an existing building, a scaled plan and a
scaled elevation view and other supporting drawings, calculations, and other documentation required
by the agent, signed and sealed by an appropriate licensed professional. The plans and supporting
drawings, calculations, and documentation shall show:
(a) Existing and proposed improvements. The location and dimensions of all existing and proposed
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improvements on the parcel including access roads and structures, the location and dimensions
of significant natural features, and the maximum height above ground of the facility (also
identified in height above sea level).
(b) Elevation and coordinates. The benchmarks and datum used for elevations shall coincide with
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the State Plane VA South US Survey Feet based on the North American Datum of 1983 (NAD
83), and the benchmarks shall be acceptable to the county engineer-
(c) Design. The design of the facility, including the specific type of support structure and the
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design, type, location, size, height, and configuration of all existing and proposed antennas and
other equipment.
(d) Color. Identification of each paint color on the facility, by manufacturer color name and color
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number. A paint chip or sample shall be provided for each color.
(e) Topography. Except where the facility would be attached to an eligible support structure or an
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existing building, the topography within two thousand (2,000) feet of the proposed facility, in
contour intervals not to exceed ten (10) feet for all lands within Albemarle County and, in
contour intervals shown on United States Geological Survey topographic survey maps or the
best topographic data available, for lands not within Albemarle County.
(f) Trees. The caliper and species of all trees where the dripline is located within fifty (50) feet of
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the facility. The height, caliper, and species of any tree that the applicant is relying on to
provide screening of the monopole or tower. The height, caliper and species of the reference
tree. The caliper and species of all trees that will be adversely impacted or removed during
installation or maintenance of the facility shall be noted, regardless of their distances to the
facility.
(g) Setbacks, parking, fencing, and landscaping. All existing and proposed setbacks, parking,
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fencing, and landscaping.
(h) Location ofaccesswayr. The location of all existing vehicular accessways and the location and
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design of all proposed vehicular accessways.
(i) Location of certain structures and district boundaries. Except where the facility would be
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attached to an eligible support structure or an existing building, residential and commercial
structures; and residential and rural areas district boundaries.
REVISED 12/7/2017 Page 2 of ll
Personal Wireless Service Facility Application
(j) Proximity to airports. If the proposed monopole or tower will be taller than one hundred fifty
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150 feet, the proximity of the facility to commercial and private airports.
5. Photographs. Photographs of the location of the proposed monopole or tower shall be provided that
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include, for applications for Tier II facilities, the reference tree, and for applications for Tier III
facilities, the area within fifty (50) feet of the proposed monopole or tower. These photographs shall
include reference points to enable the lease area, the vehicular access, the trees that will remain, and
the trees that will be removed, to be identified. In addition, photographs, where passible, or
perspective drawings of the facility site and all existing facilities within two hundred (200) feet of the
site, if any, and the area surrounding the site.
6. Balloon tests. For any proposed monopole or tower, photographs taken of a balloon test, which shall
be conducted, if requested by the agent, w follows:
(a) Scheduling. The applicant shall contact the agent within ten (10) days after the date the
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application was submitted to schedule a date and time when the balloon test will be conducted.
The test shall be conducted within forty (40) days after the date the application was submitted,
and the applicant shall provide the agent with at least seven (7) days prior notice; provided that
this deadline may be extended due to inclement weather or by the agreement of' the applicant
and the agent.
(b) Marking key boundaries and locations. Prior to the balloon test, the locations of the access
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road, the lease area, the tower site, the reference tree, and the tallest tree within twenty five (25)
feet of the proposed monopole shall be surveyed and staked or flagged in the field.
(c) Balloon height. The test shall consist of raising one or more balloons from the facility site to a
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height equal to the proposed facility.
(d) Balloon color or material. The balloons shall be of a color or material that provides maximum
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visibility.
(e) Photographing balloon test. The photographs of the balloon test shall be taken from the nearest
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residence and from appropriate locations on abutting properties, along each publicly used road
from which the balloon is visible, and other properties and locations as deemed appropriate by
the agent. The applicant shall identify the camera type, film size, and focal length of the lens for
each photograph.
7. Additions ofantennas. If antennas are proposed to be added to an eligible support structure or an
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existing building, all existing antennas and other equipment on the structure, building, or facility, as
well as all ground equipment, shall be identified by owner, type, and size. The method(s) by which
the antennas will be attached to the mounting structure shall be depicted.
8. Site under conservation or open space easement. If the proposed facility would be located on lands
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subject to a conservation easement or an open space easement, a copy of the recorded deed of
easement and the express written consent of all easement holders to the proposed facility.
9. Photographic simulations. At the request of the agent, photographic simulations of the proposed
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facility.
12. Special exception. If the proposed facility does not comply with any provision of section 5.1.40, the
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applicant shall request a special exception in writing as part of the application. The request shal I
identify which regulation in section 5.1.40 for the special exception is requested and a justification
for the special exception.
REVISED 12/7/2017 Page 3 of 11
Personal Wireless Service Facility Annlieation
Devel"ent Requirements & Checklist
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111
Instrin dons. an "'Y" in Appticwton Type indicates requiremems
Use the tar r g hr column roe m requirements are met.
1. General design. The facility shall be designed, installed, and maintained as follows:
(a) Guy wires. Guy wires are prohibited.
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(b) Outdoor lighting. Outdoor lighting for the facility shall be permitted only during maintenance periods;
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regardless of the lumens emitted, each outdoor luminaire shall be fully shielded as required by section
4.17; provided that these restrictions shall not apply to any outdoor lighting required by federal law.
(c) Ground equipment. Any ground equipment shelter not located within an eligible support structure or
an existing building shall be screened from all lot lines either by terrain, existing structures, existing
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vegetation, or by added vegetation approved by the agent.
(d) Whip antenna. A whip antenna less than six (6) inches in diameter may exceed the height of the
facility, the eligible support structure, or the existing building.
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(e) Grounding rod. A grounding rod, whose height shall not exceed two (2) feet and whose width shall
not exceed one (1) inch in diameter at the base and tapering to a point, may be installed at the top of
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the facility, the eligible support structure, or the existing building.
2. Antennas and associated equipment. Antennas and associated equipment that are not entirely within a
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proposed facility, an eligible support structure, or an existing building shall be subject to the following:
(a) Number ofarrays. The total number of arrays of antennas shall not exceed three (3). All types of
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antennas and dishes, regardless of their use, shall be counted toward the limit of three arrays.
(b) Size. Each antenna proposed under the pending application shall not exceed the size shown on the
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application, which size shall not exceed one thousand four hundred (1400) square inches.
(c) Projection. No antenna shall project from the facility, structure or building beyond the minimum
required by the mounting equipment, and in no case shall the closest point on the back of the antenna
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be more than twelve (12) inches from the facility, structure, or building; and in no case shall the
farthest point of the back of the antenna be more than eighteen (18) inches from the facility, structure,
or building; and
(d) Color. Each antenna and associated equipment shall be a color that matches the facility, structure, or
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building.
3. Tree conservation plan; content. Before the building official issues a building permit for the facility, the
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applicant shall submit a tree conservation plan prepared by a certified arborist. The plan shall be submitted
to the agent for review and approval to ensure that all applicable requirements have been satisfied. The plan
shall specify tree protection methods and procedures, identify all existing trees to be removed on the parcel
for the installation, operation and maintenance of the facility, and identify all dead and dying trees that are
recommended to be removed. In approving the plan, the agent may identify additional trees or lands up to
two hundred (200) feet from the lease area to be included in the plan.
4. Creation ofslopes steeper than 2: 1. No slopes associated with the installation of the facility and its
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accessory uses shall be created that are steeper than 2:1 unless retaining walls, revetments, or other
stabilization measures acceptable to the county engineer are employed.
5. Ground equipment shelter, -fencing. Any ground equipment shelter not located within an existing building
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shall be fenced only with the approval of the agent upon finding that the fence: (i) would protect the facility
from trespass in areas of high volumes of vehicular or pedestrian traffic or, in the rural areas, to protect the
facility from livestock or wildlife; (it) would not be detrimental to the character of the area; and (iii) would
not be detrimental to the public health, safety or general welfare.
REVISED 12/72017 Page 4 of l l
Personal Wireless Service Facility Application
Development Requirements & Checklist
i
if
III
fnstrac,tams: an "Y' in Apphcatunt Tvpe iodirntes regatrements.
Use thefur right column to confirm requirements are met.
6. Screening and siting to minimize visibility. The site shall provide adequate opportunities for screening and
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the facility shall be sited to minimize its visibility from adjacent parcels and streets, regardless of their
distance from the facility. The facility also shall be sited to minimize its visibility from any entrance
corridor overlay district, state scenic river, national park, or national forest, regardless of whether the site is
adjacent to the district, river, park or forest. If the facility would be located on lands subject to a
conservation easement or an open space easement, or adjacent to a conservation easement or open space
easement, the facility shall be sited so that it is not visible from any resources specifically identified for
protection in the deed of easement.
7. Open space plan resources. The facility shall not adversely impact resources identified in the natural
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resources chapter of the county's comprehensive plan and the parks and green systems chapters in any coup
master plan.
8. Horizontal separation of multiple facilities. The facility shall not be located so that it and three (3) or more
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existing or approved personal wireless service facilities would be within an area comprised of a circle
centered anywhere on the ground having a radius of two hundred (200) feet.
9. Diameter ofmonopole. The maximum base diameter of the monopole shall be thirty (30) inches and the
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maximum diameter at the top of the monopole shall be eighteen (18) inches.
10. Height ofmonopole. The top of the monopole, measured in elevation above mean sea level, shall not be
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more than ten (10) feet taller than the tallest tree within twenty-five (25) feet of the monopole, and shall
include any base, foundation or grading that raises the monopole above the pre-existing natural ground
elevation.
11. Color of monopole, antennas, and equipment. Each monopole shall be a dark brown natural or painted
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wood color that blends into the surrounding trees. The antennas, supporting brackets, and all other
equipment attached to the monopole shall be a color that closely matches that of the monopole. The
ground equipment, the ground equipment shelter, and the concrete pad shall also be a color that closely
matches that of the monopole, provided that the ground equipment and the concrete pad need not closely
match the color of the monopole if they are enclosed within a ground equipment shelter or within or
behind an approved structure, fagade or fencing that: (i) is a color that closely matches that of The
monopole; (ii) is consistent with the character of the area; and (iii) makes the ground equipment, ground
equipment shelter, and the concrete pad invisible at any time of year from any other parcel or a public or
private street.
12. Placement ofeables, wiring, and similar attachments. Each wood or concrete monopole shall be
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constructed so that all cables, wiring, and similar attachments that run vertically from the ground
equipment to the antennas are placed on the monopole to face the interior of the site and away from public
view, as determined by the agent. Metal monopoles shall be constructed so that vertical cables, wiring,
and similar attachments are contained within the monopole's structure.
13. Special use permit conditions. All conditions of approval of a special use permit.
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REVISED 12/7/2017 Page 5 of I1
Personal Wireless Service Facility Application
Applicability or other Development Requirements
Type of
in this Chapter & Checklist
Applics on
t
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III
Instructions: an :l"' in Application 'ripe indicates requirements,
0.- the (ar right column to con irm re uiremerns rim met.
2. Vehicular access. Vehicular access to the facility site or tower site shall be subject to the requirements of
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section 4.2 and shall not be exempt under section 4.2.6(c).
3. Setbacks. Notwithstanding section 4.10.3. 1(b), the agent may authorize a facility to be located closer in
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distance than the height of the tower or other mounting structure to any lot line if the applicant obtains an
easement or other recordable document showing agreement between the tot owners, acceptable to the
county attorney as to addressing development on the part of the abutting parcel sharing the common lot line
that is within the monopole or tower's fall zone. If the right-of-way for a public street is within the fall zone,
the Virginia Department of Transportation shall be included in the staff review, in lieu of recording an
easement or other document.
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Performance Standards, Requirements & Checklists
Please check those that apply to acknowledge these requirements
1. Building permit application; submitting certification of monopole height and revised plans. The following
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shall be submitted with the building permit application: (i) certification by a registered surveyor stating the
height of the reference tree that is used to determine the permissible height of the monopole; and (ii) a final
revised set of plans for the construction of the facility. The agent shall review the surveyor's certificate and
the plans to ensure that all applicable requirements have been satisfied.
Work Value S
2. Tree conservation plan; compliance; amendment. The installation, operation, and maintenance of the
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facility shall be conducted in accordance with the tree conservation plan. The applicant shall not remove
existing trees within the lease area or within one hundred (100) feet in all directions surrounding the lease
area of any part of the facility except for those trees identified on the plan to be removed for the
installation, operation, and maintenance of the facility and dead and dying trees. Before the applicant
removes any tree not designated for removal on the approved plan, the applicant shall submit and obtain
approval of an amended plan. The agent may approve the amended plan if the proposed tree removal will
not adversely affect the visibility of the facility from any location off of the parcel. The agent may impose
reasonable conditions to ensure that the purposes of this paragraph are achieved.
3. Completion of installation; .rubmilting certifications of compliance. Within thirty (30) days after
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completion of the installation of the facility, the applicant shall provide to the agent prior to issuance of a
certificate of occupancy: (i) certification by a registered surveyor stating the height of the tower or
monopole, measured both in feet above ground level and in elevation above mean sea level, using the
benchmarks or reference datum identified in the application; and (ii) certification stating that the lightning
rod's height does not exceed two (2) feet above the top of the tower or monopole and its width does not
exceed a diameter of one (1) inch.
4. Discontinuance ofuse; notice thereof, removal; surety. Within thirty (30) days after a tower or monopole's
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use for personal wireless service or any service facilitated by transmission equipment is discontinued, the
owner of the facility shall notify the zoning administrator in writing that the facility's use has discontinued.
The tacility and any transmission equipment shall be disassembled and removed from the facility site
within ninety (90) days after the date its use for personal wireless service or any service facilitated by
transmission equipment is discontinued. If the agent determines at any time that surety is required to
guarantee that the facility will be removed as required, the agent may require that the parcel owner or the
owner of the facility submit a certified check, a bond with surety, or a letter of credit, in an amount
sufficient for, and conditioned upon, the removal of the facility. The type and form of the surety guarantee
shall be to the satisfaction of the agent and the county attorney. In determining whether surety should be
required, the agent shall consider the following: (i) whether there is a change in technology that makes it
likely that the monopole or tower will be unnecessary in the near future; (ii) the permittee fails to comply
with applicable regulations or conditions; (iii) the permittee fails to timely remove another monopole or
tower within the county; and (iv) whenever otherwise deemed necessary by the agent.
REVISED I2/7/2017 Page6of11
Personal Wireless Service Facility Application
TIER I, II, and III BuildinE Permit & or Site Plan APPLICATIONS
If this is a Tier I application requiring a building permit, the permit becomes null and void if work or construction authorized is not
commenced within 6 months, or if construction or work is suspended or abandoned for a period of 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 true and correct. All provisions of laws and
ordinances governing this type of work will he 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 Development &
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.
By signing this application I certify that the information provided on this application and on supporting documents is correct and accurate
to the best of my knowledge. I also consent and understand that providing incorrect and inaccurate information about the nature of this
application renders this application incomplete and it shall have be deemed to have not been officially submitted.
Please check which applies:
® I certify that I am the agent for Robert L. Cross & Jeanne K. Cross Trustees of the Gros; who is the Owner, and I am
authorized to submit this application on behalf of the Owner wider the agency.
❑ 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 § 15.2-2204(H). I understand that, if I do not provide the notice to the Owner
as provided herein, the building permit application and every other subsequent approval, permit or certificate related thereto could be
determined to be void.
❑ I certify that��I arrpmp the owner.
/V
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 § 59.1-479 et. Seq.). As an applicant to the Building Permit process,
you may consent to receive, or have online access to, electronic records and receive and create records having electronic signatures related
to Building Permits, Correspondence, Inspection Tickets and Certificates of Occupancy (the Building Permit transactions).
Initials of Owner, Contractor or
Date
Your agreement to conduct Building Permit transactions by electronic means does not prevent you from refusing to conduct other
transactions by electronic means.
TIER III Special Use Permit APPLICATIONS
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.
I also certify that the information provided on this application and accompanying information is accurate, true, and correct to
the best of my knowledge. By signing this application I am consenting to written comments, letters and or notifications
regarding this application being provided to me or my designated contact via fax and or email. This consent does not
preclude such written communication from also being sent via first class mail.
Signature of Owner/Agent
Print Name
Date
Daytime phone number of Signatory
REVISED 12/7/2017 Page 10 of 11
Personal Wireless Service Facility Application
Required FEES to be paid at time of application:
What tvDe ofPersonal Wireless Service Facility are you applvinQ for?
❑
Tier I Facility
$113.60
61
Tier 1IFacilities — Site Plan
$1,957
❑
Tier III Facilities — Special Use Permit
$2,150
❑
Amend existing Special Use Permit
$1,075
®
Special Exception
$457
®
Notification Requirement for Tier]] and Tier III for up to 50 notices
$215
❑
Notification Requirement for Tier It and Tier III for each notice over 50 notices*
$1.08 plus the cost of
osta e
❑
Published notice cost for Tier III Facilities **
Cost is based on a cost
quote from the ublisher.
❑
Building Permit after Tier II or Tier III approval
$1 I3.60
*This fee is not collected at the time of initial submittal. This lee. if anp, will be calculated bv.cmjj*ctnd the applicant will be notified
of the fee amauni ctrrd the deadline for pe(vment. Il'the jee is not submitted by the deadline the applicant shall be deemed incomplete.
**To be paid after staff review for public notice:
Mast applications for a Special Use Permit require at least oiw public hearing Iry the Planning Commission unit one public
hearhvt br the Bourcl c±fSupervirars. I4rgnnia State Cade requires that noticefar public hearings be made by publishing a legal
advertisement in the newspaper and by mailing letters to adjacent properyv owners. Therefore, at least two fees far public notice
are required before a Special Use Permit mnv be heard by the Board of Supervisors.
The totaije•efor public notice will be provided to the applicant utter thelaud d cost is dwerntined and must be paid betare the
application is heard bV a public both. 5'tal]'eslimcrtes the total cost oj'legal adveriisentent and adjacent owner notilieation to be
between $350 card Sd50 per hearing. Thi.r estimate reflects the average cost ofpublic notice.fecs for Special Use Permit
applications, but the cost ofcerlain applications neap' Gc_hitther.
Other FEES that may apply:
➢
Deferral of scheduled public hearing at applicant's request
1 $194
Resubmittal fees for Tier 111 Facilities
➢
First resubmission
I FREE
➢
Each additional resubmission CFO BE PAID WHEN THE RESUBMISSION IS MADE TO INTAKE STAFF)
1 $1,075
➢
Each additional resubmission of an amendment to an existing SP (TO BE PAID WHEN THE RESUBMISSION
IS MADE TO INTAKE STAFF
$ 538
REVISED 12n/2017 Page ll oFll