HomeMy WebLinkAboutCLE200700158 Legacy Document 2014-01-22Application for
,honing Clearance
Cl_o tAy of Albemarle Department of Community Development_
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
511106 Page 2 of 3
3
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OFFICE USE ONLY �y
" 7 ® 0'
Zoning Clearance = $35
CLE #
Checic # _ x3,3 Date: -- '-07
PLEASE REVIEW ALL 3 SHEETS
Receipt # 1!I )boo! Staff: c
/
PARCEL INFORMATION
Tax Map and Parcel: T v--- _5I 0 y'(1- &, cak .3 > Existing Zoning- C --
Parcel Owner: ch �A E- kk L (K to L4 -rCe'm
Parcel Address: R-D City C �� `���'-- State - yr Zip 2219d
(include suite or floor)
PRIMARY CONTACT 6
&cA
Who should we call /write concerning this project? -2-C h.o
Address Boo? DD City 6\-\i AL __. State V (A- Zip! 2 J 'a
Office Phone: S��ell # Fax # � , q .-9,997E-mail %rC L Vu �f c6L� cN r�
qaq q°3a I
APPLICANT INFORM O�N,����' � r ��
Business Name /Type: %��
'
Previous Business on this site
Describe the proposed business, including use, num er of employees, a ib of s ifts, available parking sp ce. nd a y
additi nal inforn ati ii that on can provide-, `. -
I
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I
T
AWN
41w
*This OP2a 11 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.
7 hereby certify th o n or have the owner's pennission to use the space indicated on this application. I also certify that the information provided
is true and accur c to le best of io ledge. I have read the conditions of approval, and I understand them, and that 1 will abide by them. -
iy �c+T
/= mbe Sy.
Signature T Printed
APPROVA INFORMATION
[ ] Approved as proposed [ j,] A proved with conditions [ ] Denied
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977 -4511, x119.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] Thi lies with the site plan as o this date.
Notes:
u -
Building Official Date --I
Zoning Official Date
Other Official % "h "o Date
Cl_o tAy of Albemarle Department of Community Development_
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
511106 Page 2 of 3
3
U
ro
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Intake to complete the following:
❑ YES 5/NO
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
9 YES ❑ NO H ID -C V-0- ILict`j&7
Will there be food preparation? repo- i* CLffe(eiv�d
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE_
[YES ❑ NO
Is parcel on private well or public water?
If private well, provide Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
V YES ❑ NO
Is parcel on septic or public sewer?
Reviewer to complete the following:
Square footage of Use: ?00
(12 YES ❑ NO
Permitted as: Q-
//�� I
Under Section: VS03 — - J
Supplementary re a tions section:
Parking formula:
Required spaces:
U YES L NO U
Items to be verified in the field:
�6p ]gtce- jo
❑ YES [/NO
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Inspector : Date:
Permit #
i YES ❑ NO
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit # (, D q 6(::—
Zonlm!? 'Tech to complete the ionowiniz:
Violations:
❑ YES [ NO
If so, List:
Variance:
❑ YES 0"NO
If so, List:
Notes:
5/1/06 Page 3 of 3
s
COMMONWEALTH OF VIRGINIA
DEPARTMENT OF HEALTH
CERTIFIES THAT
Worksource Enterprises
is hereby granted a permit/license to operate a Fast Food Restaurant
by the Albemarle Health Department in accordance
with the regulations of the Board of Health,
Commonwealth of Virginia.
FACILITY NAME: BREADWORKS - NORTHRIDGE
PHYSICAL ADDRESS: 2955 Ivy Road
Charlottesville, Virginia 22903
MAILINGADDRESS; 923 Preston Avenue, Suite A
Charlottesville, VA 22903
EXPIRATION DATE: December 31, 2007
CONDITIONS:
f
Eric S M ers, R.E.H.S.
Environmental Wealth Food Supervisor
Please direct questions or concerns to the
Albemarle Health Department,
.Environmental Health Services, (4-34) 972 -6259.
This Permit Is NOT TRANSFERABLE From One Individual
or Location to Another.
$J n
COUNTY OF ALBEMARLE
Department of Community Development
Inspections Division
401 McIntire Road
Charlottesville, Virginia 22902 -4596
(434) 296 - 5832
Fax (434) 972 - 4126
June 1, 2007
Jinn Baber
BreadWorks Bakery & Deli
923 -A Preston Avenue
Charlottesville, VA 22903
Re: Permit # 2006 -2604 AC
Northridge
Dear Mr. Baber:
Pursuant to your written description, of May 23, 2007, of the BreadWorks operations at
Northridge, this office agrees that a grease trap is not required in the drainage system. This is
based on the understanding that there will be minimal food preparation on -site, that the food will
be transferred from the Preston Avenue facility and that food servings will be with disposable
tableware. Also, it is acknowledged that the previous food concessions at this same location at
Northridge did not include a grease trap.
Sincerely,
Jay Schlothauer
Building Official
JS /j s
cc: Keith Huckstep
Billy Gilbert
John S eay
06 -2604 AC
Reading File
Breadworks - Northridge
Albemarle County Health
Department
PO Box 7546
Charlottesville, VA
22906
Phone: (434) 972 -6259
Fax: (434) 972 -6221
COMMONWEALTH OF VIRGINIA
VIRGINIA DEPARTMENT OF HEALTH
Foodservice Establishment Evaluation Report
Establishment Information
Establishment Name:
Breadworks - Northridge
Establishment Type:
Fast Food Restaurant
Address:
2955 Ivy Road
upright freezer (one door)
Charlottesville, VA 22903
Evaluation Information
Inspection Type:
Routine
Evaluation Date/Time:
June 05, 2007 01:47 PM to 02:45 PM
Evaluation Length:
1 hour (s)
Equipment Temperatures
Description
Temperature (Fahrenheit)
sandwich preparation unit
39 °F
upright refrigerator (one door)
38 °F
upright freezer (one door)
1 °F
Food Temperatures
Description
Temperature (Fahrenheit)
n/a
OF
Person In Charge
Person In Charge:
Food Certification:
Certified Manager
Manager's Certificate Number:
Manager's Certificate Expiration:
06/01/2009
Critical Hazards
Total Number: 1
2520 - Backflow Prevention*
Observation: A direct connection exists between the drain line of the food preparation sink and the
sewer line.
Corrective Action(s): Eliminate the direct connection between the sewer line and the cited equipment.
Follow plan review letter issued by this department on 4/13/07 by Mark Mapili, MPH. Correct by 6/5107.
Received by EHS Gem Page #1 of #2
Breadworks - Northridge
Non - Critical Hazards
Total Number: 3
2810 - Floors, Walls, and Ceilings - Cleanability
Observation: 1)Wall or wall covering in the mop sink closet is not smooth and easily cleanable. 2)
Vinyl cove base requires more sealing.
Corrective Action(s): Repair or replace wall or wall covering to make it smooth and easily cleanable.
Correct by 6/15/07.
3045 - Handwashing Signage /Handwashing Facilities
Observation: (CORRECTED DURING INSPECTION): A sign or poster that notifies food employees
to wash their hands is not provided at all lavatories used by food employees
Corrective Action(s): Provide a sign or poster that notifies food employees to wash their hands at all
handwashing lavatories used by food employees.
3220 - Mops - Drying Mops
Observation: No mop rack was observed. Recommend installing single mop rack/ holder above the
service sink (mop sink).
Corrective Action(s): Wet use maintenance items such as mops must be hung in a position that allows!i
them to air dry so they are not allowed to grow contamination which can then be spread through the
establishment at the next use. Operator agreed to correct. Correct by 6/15/07.
Comments
Substantial compliance observed with the Virginia Food Regulations. Recommend additional shelving
above the three compartment sink for more air drying surface area for cleaned & sanitized food contact
surfaces. Discussed having a Person -In- Charge (PIC) trained in food safety procedures available
during operating hours. Chef s thermometer and chemical test kit were available. Recommend for
The above listed observations, violations and specified periods of time for correction of the violations are issued in accordance with
the Food Regulations. It is the responsibility of the permit holder "to comply with directives of the regulatory authority including time
frames for corrective actions..:." An opportunity for a hearing on the inspection results, a time limit, or both, shall be granted
provided that a written request is filed with the local health department within 30 days following the inspection report.
Received By: Eric'S Myers
Environment Health Specialist
T' -7 "__2 625 i
Received by EHS Page #2 of #/2
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