HomeMy WebLinkAboutWPO201400041 Bond 2014-05-06 Request for Pre-construction Meeting and Grading Permit eao,
from Albemarle County
Approved Plan Number: WPO- t) 1:(4_ (l'?(;;7 4 {
Approved Plan Name: Cr e)ce;i4;i, I TY) , (r-r't'e-�7
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date:
• ; I�'
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber:
Print Name: L)C dt: `"
1 . �- a its, )
State Certification Number: r" - — CG 3 I b
Address ?ct l x "C f '
City C State Zip
Daytime Phone 4#) $ ( c` qt%'E-mail h red X
Primary Contractor:
Print Name r S , �tJ{ ,WlC-4 I= i f 1r
Address t C d tit + n `s !
t�r9
City Slci . A-r" L- A } 2i4t1 State Zip
Daytime Phone 040 G° & - 7 j j E-mail ,v) no( s t 4 F .. ( •,"'"'1
1
c ( ` '`
Permit Issuance and First Year Maintenance Fees: (Request must include payment)
Total acres proposed to be disturbed is contained on the approved plan and application:
VSMP:
Acres to be disturbed Fee Due at Grading Permit
Less than I $63.80
1 and less than 5 $594.00
5 and less than 10 1 $748.00
10 and less than.50 $990.00
50 and less than 100 1 SI,342.00
100 and more $2,112.00
1
For plans exempt from VSMP,VESCP fees were paid with the application.
7,1(14,Revised:8/29/14 Page 1 of 3
Person(s)to attend the Pre-construction Meeting:
Names(type or print) Firm Contact Number or email
J
y, ‘ L� ..
The second part of the application fee is required to be paid with this request. This fee amount is;
FOR OFFICE USE ONLY Permit Issued Date
By who?
7/1/14,Revised: 8/29/14 Page 2 of3
Project Name: Goodwill - Mill Creek Dr
WPO file number: WP0201400041
Erosion and Sediment Control Bond Estimate
Item Item
Number
stabluation (PS, TS)
silt fancs(SF)
safety farce (SAF)
diversion (DD, FD, RW D)
temporary stape drain (TSD)
pipe length
earthwork for tmp/basin
0 ft
cut at high side
height of dam at too
0 ft
height of fili at face
0 it
length of dam
length of cut
tap width
0 It
(area above transition)
0 ft
(total width of tlam)
(area below transition)
(height below Transition)
0 ft
toes below ranstion)
0 ft
length of spillway
(depth below Imnsilior
width of spillway
structures for basin
(area above transition)
0 sf
riser height
( tolal Fill volume)
rear diameter
0 ft
barrel length
0 cy
barrel diameter
sift fence inlet protection (IP)
0 tons
stone inlet protection (IP)
outlet protection (OP)
length
channel (SCC, matted)
length
check dam
depth in channel
onstruaim entrance (CE)
0 It
wash rack
0
paved construction entrance
rip -rap, placed
depth
barrel collars
width
survey and layout (price par 0.1 mi.)
acres
mobilization
0 ft
stream crossing (computed independently)
0 ft
pipe diameter
0 in
0 ft
cut at high side
0 ft
0 ft
cut at face
0 it
0 ft
length of cut
0 ft
0 It
width of cut
0 ft
0 sf
(area below transition)
0 sf
0 ft
(total witlth of cut)
0 ft
0 ft
(depth below Imnsilior
0 ft
0 at
(area above transition)
0 sf
0.0 cy
( tolal Fill volume)
0.D cy
0 ft
(TOAL Cy estimate)
0 cy
0 It
(spillway alone tons)
0 tons
0
Oft
0 in
$0.60
0 It
base plate or fdn
0
0 in
-. .
barrel collars
0
baffle length
0 ft
0 ft
width
0 ft
0 ft
width
0 It
0 ft
channel width
0 ft
0 ft
length
0.0 ft
0.0
ins)
11 tons
0
traps and basins
0
No. Unit
Unit Cost
cost
(installed)
0.8 acres
55.000.00
$4,000.00
200.0 ft
$5m
$1,000.00
0.0 ft
$5.00
$0.00
120 ft
$13.00
$1,560.00
$0.06
$0.00
0
2
0
T
1
1
0
cost sum
prq mgmt
contingency
Total
$1100 $0.00
$50.00 $0.00
$0.00
$200.00 $0
$0.00
$200.00 $0
$50.00 $0
$100.00 $0.00
$200.00 $400.00
$0.00 $0.00
$0.00
$0.00 $0.00
$2,000.00 $2,000.00
$2,000.00 $2,000.00
$3,500.00 $0.00
$60.00 $0.00
$0.00
$500.00
$0.00
$11,460.00
$1,719.00
$1,317.90
$14,500
10/14/2014
,'
Now
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porresi Vie Oa,' i
Data Retraood. 7 7 c./
o,s•A tt 4,"i44:4:1,,71
,0 i i t 0//i r
toratr Forward sorlidorsagenasto Adok$1
14,
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Th
REQUEST TO ESTABLISH A BOND
it
APPROVED PLAN 4 P I 1 I /0
PROJECT NAME: I , 1
C700(betil ii Miit GireUz
As listed on the approved plan)
All parcels in the project,including any off-site work if easements are not provided,and current owners. Use a
separate sheet if more owners are required. Owner and tax map infonnaton must be correct,and plans mest be
approved prior to bond estimates being prepared
* i h Yi t yis,. LL.ei,
TAX MAPs 'PARCELs: ril 1 API Ac OWNER'S NAME;
SIGNATURE: I/41INV -- date: 101 114
-,,, - -
TAX MAPS.' PARCELS: OWNER'S ,-. AMP,:
SIGNATURE: date:
TAX MAPs/PARCELs: OWNER'S NAME:
..*
SIGNATURE: date:
TAX MAPs r'PARCELs: OWNER'S NAME.
... ...._ _
SIGNATURE. date: _
TAX MAPs i PARCELs: OWNER'S NAME:
SIGNATI:RE: date:
_. .
NOTE: 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 corporation,partnership,limited liability company,
trust,association,etc., documents acceptable to the County must be submitted certifying that
the person signing above has the authority to do so.
The requested estimates are,
0 yESCP Erosion&Sediment Control per Water Protection Ordinance section 17-207;50 fee
sevsmp Erosion and Sediment Control,Stormwater Management and Mitik,:mon per Water
Protection Ordinance section l 7-208; 5250 fee required
0 Subdivision(roads,drainage,etc.)per Subdivision Ordinance section 14-435:
&Water& Sewer per Sabdivisiun ordinance section 14-435;5250 fee required
A bond estimate will be prepared by tic plan resiewer.The estimate n,a:.,',he sent to the owner. Prease provide
contact information.
EMAIL: V'
.i
cif
OR REGULAR M.AIL ADDRESS: )a i _ (
_ 1 k&----..00, k,Yi
Roistd 6,25,2C I 4