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HomeMy WebLinkAboutSUB201800038 Approval - Agencies 2018-02-01 Commonwealth Of Virginia Permit No 743-19163 Department Of Transportation tit" Land Use Permit Status APPROVED This permit only grants permission to use whatever rights the Commonwealth Transportation Board and the Department of Transportation have in the right of way and no more,and it is the obligation of the permittee to secure any other releases or permission that may be needed in order to perform the work. Effective Date Feb 01,2018 Expiration Date Jul 31,2018 Reinstatement Date Permitee Information Your Job# Surety&Account Receivable Information Owner& Mark Lyons Agent Name Virginia National Bank Address PO Box 331 Surety Account 1094 Free Union Virginia 22940 Surety Type Cash/Check Amount 500.00 Obligation Amount 500.00 Contact Mark Lyons Contact Surety Holder CUSTOMER Phone# 434-249-0565 Phone# Fax# Fax# 24 Hr# 24 Hr# AUTHORIZATION: In compliance with your application,permission is hereby given insofar as the Commonwealth Transportation Board has the right,power,and authority under sections 33.2-210;33.2-240;33.2-241 of the Code of Virginia as amended,to grant by Special Agreement and/or by Land Use Permit for you to perform the work and or activity(s)described below: Location County/City/Town Albemarle County Highway Route(s) 664-Markwood Road From Route Number 671 From Route Name Davis Shop Road To Route Number 665 To Route Name Buck Mountain Road Work Description Install a low volume commercial entrance using 30'of 15"CMP with 9"of#21 B or#26 stone compacted from edge of road back 25'and a 25'radii on both sides of entrance.Remove trees and underbrush for sight distance and entrance to property.See entrance detail and all other attachments.Stabilize all disturbed areas with seed and straw.Work shall be in accordance with 2015 Virginia Work Area Protection Manual.Call Willis Bedsaul(540-219-5492)for questions,changes and final inspection.'NOTE:Applicant meets required stopping sight distance." Fee Description Fee Permit Fee $100.00 Applicant has compiled with VA Code Section 56-265 15 Affidavit is attached. TERMS:Applicable as stated in the VDOT Land Use Permit Regulations(current edition)and/or as per approved plans,and/or regulatory instructions,including but not limited to the LUP-SPG and/or agreement(s)attached hereto. COMMONWEALTH TRANSPORTATION BOARD Call before you dig Allow the required time for marking Z �.� Feb 01,2018 By: fi d . tlek, �J1Excavate carefully Respect and protect the marks/flagsa hey Oai Adam Moore,PE Call Miss Utility 811 FINAL INSPECTION&SURETY REQUIREMENTS:Upon completion of the work or activity(s)authorized under this Land Use Permit,the permittee shall contact the following office in writing or by electronic communication to request final inspection and release of the surety obligation for this permit. Charlottesville Residency 701 VDOT Way Charlottesville,VA VA 22911 Permit No.743-19163 VDOT's Web Site:www.vdot.virginia.gov Permittee Copy August 1.21)!6 IA © E a ` , C_ V LD NYDE3T; '': : , JAW 3 0 2018 tend use Permit Appicauee(tUP•A) RESIDENCY i i APPLICATION is hereby made for permit as shown on the accompanyingCHAR;oTTESV er and VA AIn accordance with the rotes and plan or sketch and as described below Said acts s wi0 be done under and regulations of the Commonweath Transportation Board of Virginia,In so far as said rules are applicable thereto and any agreement between the parties herein before referred to Where applicable agreements may be attached and made a part of the permit assembly including any cast responsibilities covering work under permit Applicant agrees to maintain work in a manner as approved upon Its completion Applicant also hereby agrees and Is bound and held responsible to the owner for any and all damages to any other Installations steady in place as a result of work covered by resulting permit Applicants to whom permits are Issued shah at al times indemnify and save harmless the Commonwealth Transportation Board members of the Board,the Commonwealth and all Commonwealth employees agents,and offices,from responsibility.damage.or lability arising from the exercise of the privileges granted in such permit to the extent allowed by law, In consideration of the Issuance of it permit the applicant agrees to waive for itself successors in interest or assigns any entitlements it may otherwise have or have hereafter under the Uniform Relocation and Assistant Act of 1972 as amended In event the Department or its successor chooses to exercise its acknowledged right to demand or cause the removal of any or all Nx:tuues,personality of whatever kind or description that may hereafter be located,should this application be approved $Sgelicant(nformationi A(o( 2 5? 3 8'e Driver's license or Tax ID No, Contact Name ( t ,C 1-YON3 Owner Name,,,,L•(GC„N'IGk)r IA rev. lrL--C- ---1'm'1CRq, L'*NS E-mal Address M L.7 i"- I V' q M i L. Cates Address_ 5L,$°4_. tMAgtC L . Y , Telephone Number v2 1 I-05(0 5, City is A24.'1 S U t t-L-£ State ft Zip Code '22?L ((aa Emergency Telephone Number( ), - _ Fax Number(___ -_ ) Agent Information; Driver's License or Tax ID No. — Contact Name Agent Name . -— n�..._.._..__. .� E-mail Address .... Address Telephone Number( City State Zip Code Emergency Telephone Number( ? __• _— Fax Number( ) • Permit Term Requested_ _Fees- _Fees Enclosed S,I..m Check Number - -- _z Money Order_ ._ ,_ . „_. Estimated cost of work to be performed on VDOT Right of Way S _ Surety Information: Surety Posted by DOwner DAgent DCounty Resolution QWaived Amount of Surety S 5tjcs, , •see-_Ottrigaton Amount S.-_ .. T. Bonding Company Name irrevocable Letter of Credit • Bank Name Surety paid by Check- Check Number_ ,_ __ �� If check/cash surety is posted,please complete form W9, fleauest salon to.erform the fdlovw4no_ecttvilvts! �Z7S/$77 C.0 e,,,,., .4„ ✓e' r�a3�' o ',�s ,,,.�p 2'S' o-( TT ! J NYC���/?l,l cifaE5..sCie !!t Ws-- C 4f p. .'f6j�SQe�Z' ���'� �'.. �-+Cv.�.r__..._.a:_.__tr�4G of �� s..¢.__ . ..._ ��. ram: ->< �, ,.� I - -- �_G�7� _.�,.,���• .F�,�,•.�j� r�c�- �5��i G�-�..�_.f.��A�as per attache�j plans Location. ®County[Town Deity of Ail . . Route No��4 Street Name tt'1 f4R.K i,.)Oo0 1`-0 Between Route No _ Street Name Vt S �IqO and Route NoCoat. Street Name - / - Latitude 3`' • I i 04 Longitude "1%40061( Tax Map Number i% - alai F _Applicant Job No. Applicant shalt provide proof at reaitb etloo a,an op sswerw M the appropriate notlmc:Han center in scoordance te kilned in 22 list I m the code or vmrgbur s mutt poovde a notartz,d obit vtt.stating that due sanity[WIN nodded the curt Wi and residential developer.moor or ronwnerdaf sr muldbrey real estate er lees!Qarenrnrertl entitle/with a property Worn, any dime of land located ediacent to the properly neer vddidt the land use la Wind regcussed that application for the permit has been made. ®IF APPLICABLE,I AGREE TO PAY THE FULL SALARY AND EXPENSES OF A STATE ASSIGNED INSPECTOR IN CONJUNCTION WITH ACTIVITIES AUTHORIZED UNDER THE AUSPICES OF A VDOT LAND USE PERMIT. 1 the undersigned hereby ack dg that I am fusty cognizant of oil of the following attached requirements associated with the Issuance of a VDOT Land Use Permit: /r�A Signature of Applicant �..._.._ _ .r_.__..�.._. Title �'261.rtJ I .,.�.. ...�. - ___ Date® Signature of Agent Title Date M sapFcabne items on ads!can mug be eetroieted to weld deity In processing the luuacal of a MDOS tend the Perrot Prep.rre l rotund ent r tetwaanca arable to Vacuum'Department of Trantportaba VDOT USE ONLY Receipt is hereby acknowledged for: CHECK No: MONEY ORDER No.: In the Amount of S for PERMIT FEE S CASH SURETY S, , Authorized VDOT Signature Date: i •Agent mean Appkrrnt corttadors or a person or imams autiorized b act on motes bdsatt 1AJs c5. t9 4- ,4e4-1. IA/de S ,.Ie- "N Aeeoe "AATI7 Cu r— %'nP.-Gi v(A Gdid.2',46 zoki,4-(A&U4 . ;Jere; c4,07,f_fe rs- eE- u e -0 %of0,%v ; 5k-6f7- D':>`,ryk .e, August 1,2016 NVDOarTh;:;'::',c,'.,1'. LAND USE PERMIT LUP-SPG Special Provisions—General permittee Agreement for Land Use Permit issuance • I the undersigned hereby acknowledge that I am fully cognizant of all of the following requirements associated with the Issuance of a VDOT Land Use Permit: J�jq� type or Print clearly Applicant Name: r " "'�K L 1oN$ Applicant Federal Tax ID No.or Driver's License No.: 6 i 2 S7-Cg Project Name: 5639 014eicLinoo 4) £1(?(7S0U-f Za93 L , County: A`el. r►na2�-4C Cr\ out Number: Applicant/Property Owner Signature: Agent/Contractor Signature: %DOT Land Use Permit Required by Law The General Rules and Regulations of the Commonwealth Transportation Board provide that no work of any nature shall be performed on any real property under the ownership,control,or jurisdiction of VDOT until written permission has been obtained from VDOT. Written permission is granted for the above-referenced activity through the issuance of a land use permit. By issuing a permit,VDOT is giving permission only for whatever rights it has in the right-of-way,the permittee is responsible for obtaining permission from others who may also have an interest in the property. The permittee will be civilly liable to the Commonwealth for expenses and damages incurred by VDOT as a result of violation of any of the rules and regulations of this chapter. Violators shall be guilty of a misdemeanor and, upon conviction,shall be punished as provided for in§33.2-21O of the Code of Virginia. Application Requirements Application shall be made for VDOT land use permits through the local district permit office where the activity is to take place. Application forms and general information regarding VDOT land use permitting can be obtained by contacting the central office permit manager or at the following VDOT web site: http://wvnrv.pirelpladotorc/husIness/bu- la rul Ll f ePerm i ts.a s P The applicant shalt provide a notarized affidavit indicating compliance with the registration and notification requirements outlined in 4 22-tnI.1 of the Code of Virginia.