HomeMy WebLinkAboutCLE202200141 Application 2022-10-24Zoning Clearance Application
FOR OFFICE USE ONLY Clearance Number:
Fee Amount: $ 61.36
Application fee: $59 + Technology Surcharge: $2.36
Receipt #:
Date Paid: By:
Check #: By:
Applicant - Fill out the entire page below and return to:
Community Development 401 McIntire Rd, North Wing, Charlottesville, VA 22902
.t 04
Albemarle County
Uy II Community Development
Qlm 401 McIntire Rd, Nonh Wing
Chadotlesville, VA 22902
Phone 434.296.5832
Name:
Andrew Chambers, MD
E-Mail Address:
achambers@cvillepsychiatry.com
Mailing Address:
630 Peter Jefferson Pkwy, Ste 130, Cville, VA 22911
Phone #:
434-328-8787
Tax Map and Parcel
number and/or Address
of the Business:
Tax Map and Parcel Number 78-15C6
175 South Pantops Dr, Ste 303
Charlottesville VA, 22911
Zoning:
Staff will fill out if unknown
HC, Highway Commercial
Parcel Owner:
GNA, LLC
Owner's Address:
1175 S Pantops Dr, Ste 106
Check any that apply:
New Business ® Change of use Change of Ownership Change of Name
Business Name:
Charlottesville Psychiatry PLLC
Description of Business'
Describe the business including use, number of employees,
number of shifts, availability of parking, and any additional info.
Psychiatry private practice. One psychiatrist. No employees. Parking lot outside the building. This is a
change of address from Peter Jefferson Place to 175 South Pantops Drive.
Previous Business on site:
travel agency
Floor Plan'
Please attach either an architectural drawing or a sketch of the proposed business indicating the location of uses, the
uses of rooms, the total square footage of the use, and any additional information.
Total Square Footage Used
for the Business:
270 square feet
Is the Parcel Zoned LI, HI, or PDIP?
Yes ® No
If yes, fill out a Certified Engineers Report (CER)
Will there be food preparation?
Yes ® No
If yes, provide Virginia Department of Health approval
Is the Parcel on public water or private well?
Public Private
If on private well, provide Virginia Department of Health approval
Is the Parcel on public sewer or septic?
Public Septic
If on septic, provide Virginia Department of Health approval
Will you be putting up any new signage?
Yes ® No
If yes, obtain appropriate sign permit and list permit # below
Will there be new construction or renovations?
Yes ® No
If yes, obtain appropriate building permit and list permit # below
Please list any applicable Building Permit #s:
Zoning Clearance review cannot begin until the application above is complete and all applicable forms and fees are submitted.
This Clearance will only be valid on the parcel for which it is approved. If you change, intensify, or move the use to a new
location, a new Zoning Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the
information provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand
them, and that I will abide by them.
Signature 4 - / . r 1 L) Printed Andrew Chambers, MD
Date 10/22/2022
R� Op ALR
Zoning Clearance Application �2 Albemarle County
O r Community Development
401 McIntire Rd, North Wing
Charlottesville, 229ottesville, VA 22992
yRCIN�P Phone 434296.5832
Applicant - If you are not the land owner, please fill out the entire page below confirming that you have either
informed or are going to inform the owner of your zoning clearance application.
CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN
PROVIDED TO THE LANDOWNER
I certify that I will provide (or have provided) notice of this clearance application,
Charlottesville Psychiatry PLLC
clearance number provided by Staff or business name
to GNA, LLC the owner
Name of landowner on record
of Tax Map and Parcel Number 78-15C6 by either delivering a
TMP number of property
copy of the application to them in person or by sending them a copy of the application by
mail. (Please check one of the following below)
❑ Hand delivering a copy of the application to the owner identified above on
Date
❑� Mailing a copy of the application to the owner identified above on
Date 10/22/2022 to the following address:
175 South Pantops Dr, Ste 106, Charlottesville, VA 22911
(Written notice to the owner and last known address on our record books will satisfy this
requirement. Please see staff for help determining this information if needed)
Signature of Applicant GG ' 64�11 /- I L)
Applicant Name Printed Andrew Chambers, MD
Date
10/22/2022
3
For Albemarle County Staff Review Only
Proposed Use:
Permitted:
❑ Yes ❑ No
Permitted by Section:
Supplementary Regulations:
Applicable Special Use Permit (SP):
Applicable Rezonings (ZMA):
Applicable Site Plans (SDP):
Parking:
If there is an approved site plan associated with the parcel, the parking requirements will be defined by the SDP. Some
parking requirements are determined by a ZMA or by an approved Code of Development.
Parking Formula:
Defined by:
❑Site Plan ❑ Zoning Ordinance ❑ Coo ❑Existing
Total Square Footage of the Use:
Required number of parking spaces:
Associated Clearances:
Variances:
Violations:
Is a site inspection necessary?:
❑ Yes ❑ No
Site Inspection on (date):
To Confirm:
Notes:
Conditions of Approval:
Additional conditions of approval apply to Fireworks and Christmas Trees
Approval Information
❑ Approved as proposed ❑ Approved with conditions ❑ Denied
❑ Backf low prevention device and/or current test data needed for this site. Contact ACSA, 434.977.4511 ext. 117
❑ No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance
with the existing site plan.
❑ This site complies with the site plan as of this date.
Conditions:
Additional Notes:
Building Official Date
Zoning Official Date
Other Official Date
County of Albemarle Department of Community Development
401 McIntire Road Charlottesville, VA 22902 Phone: 434.296.5832 Fax: 434.972.4126 4