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HomeMy WebLinkAboutCLE201400086 Legacy Document 2014-06-02Application for Zoning ClearancetSZ CLE # nr � PLEASE REVIEW ALL 3 SHEETS OFFICE USE ON Check # Date: 5 . l 4 - ( 4 Receipt # Stnff; i�rl� r± i- PARCEL INFORMATION Tax Map and Parcel: % [ W C)O Z QA ()_Q .200 Existing Zoning_ Parcel Owner; l�U- CHEF Parcel Address: M N n`1 N LQ —ML • City CH %O1S State VA , Zip ZZ901 (include suite Dr floor) PRIMARY CONTACT Who should we call /write concerning this project? Address: is0 A-b6mc)&t0Q1C Rt1 City 13",ev/ k _State VAS Zip 20611 Office Phone: (Z3j q27- 2718 Cell # Ste' Fax # E-mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name /Type: 5kAfg ,(1S tom` CH.' &9 E ` OrCE "Ar�US i U&S y Previous Business on this site__CHMLoT5V- ki Po UE !2V1 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: `?W, ttte bF VA • AAPROU49 flikWOCCS p UN -] Zbl *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 ownces 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 6. 1,* f40eJ 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, xl 17. [ ] 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 �z l �f Zoning Official Date— � ZJ%4 Other Official -% Date ld Z County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 Revised 7/l/201 1 Page 2 of 3 Intake to complete the following: Reviewer to complete the following: Y N Square footage of Use: — -70 Is e i LI, HI or PDIP zoning? If so, give applicant a Certified Engi er's Report (CER) packet. �' J N Permitted as: A/ Y N W l e be food preparation? If so, give applicant a Health Department Zoning review can not begin until we r Dept. FAX DATE Circle the one that applies Is parcel on private well or If private well, provide Hea Zoning review can not begh Dept. FAX DATE/ Under Section: ol 4'jC.RJ approval from Health I Supplementary regulations section: : water? rartment form. we receive approval from Health Circle the one that appli 9 Is parcel on septic or p blic sewer? YJN Will you be puffin up a new sign of any kind? If so, obtain proper Sign permit. Permit # YIN Will there any new construction or renovations? If so, obta)' the proper Permit. Permit #/ rl—;— Fn nn.nnlata An fn11nxvinn- Parking formula: Required spaces: YI Ite be verified in the field: Inspector : Date: Notes: - -- - - -- I Vio tons: YI Ifs , List: Pro ers: YJ If so, ist: Variance: qJN rso, List: �s z SP's: YJ If so, 1st: Clearances: SDP's Revised 7/1/2011 Page 3 of 3 CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This form must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the owner. I certify that notice of the application, was provided to [County application name and number] [name(s) of the record owners of the parcel] and Parcel Number manner identified below: the owner of record of Tax Map by delivering a copy of the application in the Hand delivering a copy of the application to [Name of the record owner if the record owner is a person; if the owner of record is an entity, identify the recipient of the record and the recipient's title or office for that entity] on Date Mailing a copy of the application to [Name of the record owner if the record owner is a person; if the owner of record is an entity, identify the recipient of the record and the recipient's title or office for that entity] on Date to the following address: [address; written notice mailed to the owner at the last known address of the owner as shown on the current real estate tax assessment books or current real estate tax assessment records satisfies this requirement]. Signature oT Applicant 0 i9 /f �. Print Applicant Name ,T- llev/.el Date LEASE AGREEMENT TN This agreement of Land Lease is made this !_ day of MAY , 20 between Gal rtw I ( LESSOR) and S pF crr g,c.u� , LESSEE) for the property __ — __ described as an area at the Mont oft 112S -"ZCM1 oLe.3eL, CHAkr.¢, -XL1 more specifically described on the attached site plan. LESSOR and LESSEE agree that for and in consideration of the sum of -ruo RVO WA'"✓E c- (LAok" (2'soo.od) 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 June 15 -July 15, Za 1 LESSEE agrees to obtain the necessary permits from }[ v#wele eo , for the purpose of selling Class C Virginia Approved Fireworks during this period. LESSEE agrees to provide a certificate of insurance to the LESSOR providing coverage during the above dates , naming 6u: C'rtgw as an additional insured. LESSEE agrees to remove all stands, merchandise and refuse from the leased area by July 12«', -4�ZL, and shall restore the area to the same condition it was in before lease began. In addition, Lessor agrees to hold & 6Y6Q and owners Harmless of any and all accidents, etc. Lessor will be responsible for all activities on property related to there business operations. DATE: S /Z / LESSOR: (�(Jr A&U WITNESS: Signed: LESSEE: L 46. Sr�-15 DATE: z Signe, WITNESS: L-W ACOROP CERTIFICATE OF LIABILITY INSURANCE 7C4117/2014 (MMJDDIYYYYI THIS CERTIFICATE 1S 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 ALTER THE COVERAGE AFFORDED BY THE 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, certain policies may require an endorsement, A statement on this certificate does not confer rights to the certificate holder In Ilea of such endorsoment(s). PRODUCER MCGRIFF, SEIBELS 8 WILLIAMS, INC. RO. Box 10285 Birmingham, AL 35202 roPITACT NAME PHONE 800 -476 -2211 C ho x � A1C Nn E -MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC N .aP.• i�s•� INSURER A :Admiral Insurance Company 24856 12!01!2014 INSURED Fireworks Over Amarica of South Carolina, Inc, INSURER B :NOT Oovered -- INSURER C - 916 Rosewood Odve Columh{a, SO 29201 PREMISES Ea occurrence INSURER 0 MED EXP (Any one person) INSURER E; PERSONAL 8 ADV INJURY S 1,000,000 INSURER F: 55,000 Deductible COVERAGES CERTIFICATE NUMBER:F5QTED8S REVISION NUMFIFR- 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 CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIWTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE SEASONS OF CHANCE, LLC POLICY EFF POLICY NUMBER MMIDOryYYY POLICY MMlDO/YYYY L1MTT9 A GENERAL LIABIDTY .aP.• i�s•� CA00001718112 12/0112013 12!01!2014 EACH OCCURRENCE S 1,000,000 %� COMMERCIAL GENERAL LIABILITY CLAIMSJJADE OCCUR JX PREMISES Ea occurrence S MED EXP (Any one person) S EXCLUDED PERSONAL 8 ADV INJURY S 1,000,000 55,000 Deductible GENERAL AGGREGATE S 2,000,000 1E1 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG S 2,DOO,ODO X POLICY c LOC S B AUTOMOBILE LIABILITY NO COVERAGE FOR CERTIFICATE HOLLERS COMBINED SINGLE LIMIT Ea acdden! BODILY INURY (Per person) S ANYAUTO ALLOWNEC SCHEDULED AUTOS AUTOS BODILY INJURY (Per am'denl) S NON -OWNE -D HIREC AUTOS AUTOS ROP RTY ]ANA r ecc!derr O. S S UMBRELLA L" OCCUR EACH OCCURRENCE $ AGGREGATE S H?(CESS LIAR CLAIMS -MADE DIED RETENTIONS $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN NO GOVZRAGE FOR CERTIFICATE HOLDERS WC STATU• X 107b- rR E.L.EACHACCIDENT S ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERJMEMBEREXCLUDED? f7 NIA E.L. DISEASE • EA EMPLOYEE S (Mandatory In NH) If gyee, describe under 0 SCRIPTEON OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S S S IS $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AddlUenal Remarks Scheddla, If more space In required) GUI CHEN, 1195 SEMiNOLETRAIL, CHARLOTTESVILLE, VA 22901 COUNTY OF ALBEMARLE DAN SIMONE, SEASONS OF CHANGE, LLC RACE AGAINST DRUGS, NATIONAL CHILD SAFETY COUNCIL, RONALD STEGER LOCATION: 1195 SEMINOLE TRAIL, CHARLOTTESVILLE, VA 22901 The above 0sled are Additional Insured respects to General Liability policy as required by written contract. CERTIFICATE HOLDER CANCELLATION Page f of 2 ©1988.2010 ACORD CORPORATION. All sights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SEASONS OF CHANCE, LLC AUTHORIZED REPRESENTATIVE DAN SIMONE 150 MEADOWBROOK LANE BERRYVILLE, VA 22811 .aP.• i�s•� Page f of 2 ©1988.2010 ACORD CORPORATION. All sights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD i Fig pin V.M M1.1 e°uM .fie:. .:at° ^ : �,! #s i•. y ,�Tp` - xn.ww I � �� ! fir. •' • . • d4 •�• � >.,si'S�' �� � �� � 1 �S�C�� � �� ��. 1 ., ' -� •.. � � '.fit {.�- ' �* � i5 . vR '. :p' '. \ . .:.;y•'1 '•;, � :.., fir. v A ak;c n' yu.'. . fit.,'' 6 .. 6.. # ., F�;rygy. a \•.y�ry4ryj,� d �p'i�ui_�% ,.:: • !8 � 0 ' Yq�jj 7 .: yY:%lY;YYJ't Vll u q R ,, �;y 9•-g ��', 3 03 6p 5: I .. J;p: +° m,..h '; .. rb4�a14 '�� ,i� : � 1 �9.. •° y.� � R�15 �B�` . ryKer •r•r ,u,v, tnd. - tl if I 'y rc �+ p () ~ ~~ 4 i l I 1 E kL S i ,T V _ J rz 1 � :2S � r �l r T, r r} s � µJ i P u T� 9-11�' E2�j 1 E kL S f j _ s � µJ i P u T� 9-11�' E2�j 1_ n kL W J 1_ n Certificate of f .Name Resistance REGISTERED F B I ISSUED BY A R C Date of Manufacture NUMBER JOHNSON OUTDOORS INC. BINGHAMTON, NEW YORK 13902 JAN 2004 F- 140.01 4lenufactumrs of the Finest Tent F7aducts Described Herein This is to certify that the products herein have been manufactured from material Inherently flame retardant as here after specified by the material supplier. NAME: GIBSON RENTALS CITY: BARBOURSVILLE STATE: VA certification Is hereby made that: The articles described on this certificate have been manufactured with an approved flame retardant chemical In compliance with California State F1re Marshal Code, NFPA•701', Undermiiers Laboratory of Canada, and have been tasted in accordance with the Federal Test Method Spedflcatons and meet or exceed the Military Flame Specifications of MIL- C-43006G. Type, color and weight of material: 14 OZ Vinyl WHITE BLOCKOUT Description of Item certified: 20X40 ELITE PARTY CANOPY Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric Snyder Manufacturing, Inc. /--0 TENT DEPARTMENT, JOHNSON Large Scale