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HomeMy WebLinkAboutCLE201100099 Review Comments Zoning Clearance 2011-05-23Application for Zonpg Clearance rr_ m CLE # �%I �'` OFFICE USE ONLY qY,5 PLEASE REVIEW ALL 3 SHEETS Check# 5 Date: Receipt # Z Staff: PARCEL INFORMATION Tax Map and Parcel: (>(d Gt,l Oda OA. 00 ,260 Existing Zoning Parcel Owner: (pU ► Cliu-) Parcel Address: ! Sem lont L TR L City (' NFkQi -d[SJl State VA Zip 2290 (include suite or floor) PRIMARY CONTACT Who should we call /write concerning this project? IAh.) �1N� Address: IS0 ML- ,AQ0.. 6gc)n� UJ City bE,[e_YV ILCk_ State V,4 . Zip +m t f Ofi►ce Phone: (YD3) q27- ZZ?I? Cell # 5AmL Fax # I— SS33 E-mail s 0 -CRA04Z &ACK, C APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: JZAi(j�_ A.6/CINSi 'J)PL)N5, �fi ��5 CF- CNAlU�_E Previous Business on this site ( HAt l O-(SV1LQC f0,j61- E QQl t0-W_k) I Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and any additional information that you can provide: TejjtV SELL OF CLASS C "' UIRbfUr�l &P&ojeb ElaL&iV0 .IGS F2on1 b- Z3 1-HQu 7- U, , z ei i *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 b my luiowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Sign — Printed _1 /i�NYc`L 6• ���0 APPROVAL INFORMATION [ ] Approved as proposed Approved with conditions [ ] Denied [ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117. [ ] 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. Notes: Building Official Date 1 (i Zoning Official Date Other Official Date County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 1/1/2011 Page 2 of 3 1. Intake to complete the following: Is uh LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y (N� Will / ere be food preparation? If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that applies �_.��- Is parcel on private well or{{6blic wIter? If private well, provide Heal'th..Depdrtment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that Is parcel on septic orublic sewer Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N Will there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to com lete the followin : Reviewer to complete the following: Square footage of Use: ;f/N Permitted as: L-4 4 1e Under Section: q Supplementary regulations section: Parking formula: Required spaces: Y/N Items to be verified in the field: Inspector : Date: Notes: Viola . ns: Y /I11 If so, List: Proff rs: Y/ If so, List: Varia ce: Y / (N If so, ist: SP's: Y If so, ist: Clearances: Q C Revised 1/1/2011 Page 3 of 3 7. r 4 .N N4• m • J KJ I cu ch cu p �al�¢ a s� Rl ��' � x.,67 m ' �� a-+ •. 6W6W pq M _ I �O'p ;:r': m a�•.' ;:���'' :526, 26�; �; d' {�. t; .g�„°.. .. .r: 'r �:.,'.�+. °m:,'.¢ ¢N•� ?r,.' +.'. is .',�;.(„ • . ��.� � , tia fig,',; ; •, t. • ENI'1'H91YN An r Ap - - su(�o o, r .;„� •'. ~• .¢:� .r ,l. •`.' ... r•• , 3NI1.H91YH sm Hp1YH mNYO' ; �!' 7', p�l7ig.. '� f ''LL :, F .: QT' ' am Hum • _�� - • ^ry, !.Ira ''t � it - ' •.,;` . , ' ' !g� ,JV< �`� •7;' G. '";1:.�� [Pi h.. • .060 ~ �I • � � �.� I.' �� . �' }t�• r > �io IH .r,;�'�;it,,. i �, m. 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Z w N 'Irl f. m m n LEASE AGREEMENT This agreement of Land Lease is made this STOday of M k * , Zo i j between (., L rHEij , ( LESSOR) and SE,go us of cwAAA, ( LESSEE) for the property described as an area at the front of 114S 5eMINOLE TkL , CHAR -01-6 VI II- , more - specifically described on the attached site plan, LESSOR and LESSEE agree that for and in consideration of the sum of-rwo -rWOUSa ib - P►yE 14j&Q>'eeb� paid by check to the LESSOR at the signing of this document or prior to the commencement date of said lease, LESSEE may land lease the site indicated on Exhibit A hereto during the period of -,Lwg- is - TvLy y j a o i i LESSEE agrees to obtain the necessary permits from gI86m MeE ewurY for the purpose of selling vA. meoAb Ftc,�weKS during this period. LESSEE agrees to provide a certificate of insurance to the LESSOR providing coverage during the above dates, naming 6U', (f g rN as an additional insured. LESSEE agrees to remove all stands, merchandise and refiise from the leased area by ST o j ao , and shall restore the area to the same condition it was u1 before lease began. In addition, Lessor agrees to hold 6 U *, (2 Hr--10 and owners Harmless of any and all accidents, etc. Lessor will be responsible for all activities on property related to there business operations. DATE: DATE: WI LESSOR: LESSEE: -j)AA)yEL G . S i�uo�D Signe AC�R� ® CERTIFICATE OF LIABILITY INSURANCE DATE 5 /10 /2011 ) 05/10/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTERTHE COVERAGE AFFORDED BYTHE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEENTHE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certaln policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Ileu of such endorsement(s). PRODUCER MCGRIFF, SEIBELS & WILLIAMS, INC. P.O. Box 10265 Birmingham, AL 35202 NAME: PH ON o 800 476 -2211 FAX A/c No): E -MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC N INSURER A :James River insurance Company 12203 INSURED Fireworks Over America of South Carolina, Inc. 916 Rosewood Drive Columbia, SC 29201 INSURER B :NOT Covered BERRYVILLE, VA 22611 INSURER C: 000351652 INSURER D: 12/01/2011 INSURER E: $ 1,000,000 INSURER F: $ .. -.tee. rCDTICIr`ATC Al11MRt= R�P{(f]AFI XR REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWNWAY HAVE BEEN REDUCED BY PAID CLAIMS. IN RI LTR TYPE OF INSURANCE ADOL S BR POLICY NUMBER MMIDDY/YYYY MM /DDS LIMITS A GENERAL LIABILITY BERRYVILLE, VA 22611 000351652 12101/2010 12/01/2011 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ X COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $ EXCLUDED CLAIMS -MADE OCCUR PERSONAL & ADV INJURY $ 1,000,000 X $5,000 Deductible GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP /OPAGG $ 2,000,000 $ PRO- X POLICY LOC B NO COVERAGE FOR CERTIFICATE COMBINED SINGLE LIMIT Ea accident $ AUTOMOBILE LIABILITY HOLDERS BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NED PROPERTY DAMAGE Peracdident $ HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE 5 AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION $ WORKERS COMPENSATION vv> LIMITS X OTH- T $ B NO COVERAGE FOR CERTIFICATE AND EMPLOYERS' LIABILITY YIN HOLDERS ANY PROPRIETOR/PARTNERIEXECUTIVE E.L: EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ OFFICERIMEMBER EXCLUDED? ❑ (Mandatory In NH) NIA E.L. DISEASE - POLICY LIMIT $ It yes, describe under DESCRIPTION OF OPERATIONS below $ $ $ $ $ DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, Irmore space Is required) GUI CHEN, 1195 SEMINOLE TRAIL, CHARLOTSVILLE, VA 22901 RACE AGAINST DRUGS, NATIONAL CHILD SAFETY COUNCIL, RONALD STEGER DAN SIMONE LOCATION: 1195 SEMINOLE TRAIL, CHARLOTSVILLE, VA 22901 The above listed are Additional Insured respects to General Liability policy as required by written contract subject to policy terms, conditions and exclusions. TIFICATE HOLDER CANCELLATION CER SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 'THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SEASONS OF CHANGE, LLC _. AUTHORIZED REPRESENTATIVE ' DAN SIMONE 151 MEADOWBROOK LANE j.— W-4 BERRYVILLE, VA 22611 Page 1 of 1 ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD c G w VII �o �I m i N � � �' C