HomeMy WebLinkAboutWPO201400013 Preconstruction Form 2014-12-03 �tior u.r�„
Request for Pre-construction Meeting and Grading Permit
from Albemarle County .
Approved Plan Number: WPO- 01`(-1rLt{3
Approved Plan Name: 14- 't
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date: i -t 3 i IL(
(Bonds must be approved and posted prior 10 a pre-construction meeting or permit.)
Responsible Land Disturber:
Print Name: I • — 1-4jCtil
State Certification Number: .3 ($.-
Address ISCz 0'
City 1 i:54."`6j'"} State 4 Zip ); `'i
Daytime Phone(-S"A' 1 C// / 6 4c, E-mail rut j i foiv-N
Primary Contractor: ll
Print Name !v t6 PA t'1 3A". LE-Cy')"` ,s< /k) I 1 "e). )
Address} (lee'
)c'++)J
City 1-kl '.�.%r) State I/4 Zip d)r `''I
Daytime Phone(S ) ,��-�t / {E-mail E'lt:.1) (o•')
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 1 $63.80
l and less than 5 $594.00
5 and less than 10 $748.00
10 and less than 50 $990.00
50 and less than 100 $1.342.00
100 and more $2,112.00
For plans exempt from VSMP,VESCP fees were paid with the application.
7/1/14,Revised: 8/29/14 Page 1 of3
•
Person(s)to attend the Pre-construction Meeting:
Names(type or print) q Firm Contact Number or email
116.") 1-e71/hc+'t. `(G`ft'!P'}1J:`-.. 1�cr ..t:ri�} 5--L-40• 7"iC-O 8)c
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 of 3