HomeMy WebLinkAboutCLE201500133 Application 2015-07-10Application for Zonin Clearance
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CLE # i,S '- 13�
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PLEASE REVIEW ALL 3 SHEETS
OFFICE USE ONLY
Check # �1a `ASS "� Date:
Receipt # 1005'0 Staff:��
PARCEL INFORMATION f p Mt -11
Tax Map and Parcel: Tax/Parcel ID: 07800-00-00-031 KO Existing Zoning Commercial
Parcel Owner: Brandywine Realty Trust
Parcel Address: 652 Peter Jefferson Parkway, Suite 3Mity Charlottsville State VA Zip 22911
(include suite or floor) ,�- 131Q
PRIMARY CONTACT
Who should we call/write concerning this project? John Halford
Address :515 Eastern Ave City Allegan State MI Zip 49010
Office Phone: ( 269) 686-1917 Cell # 269-903-8022 Fax # E-mail john.halford@perrigo.com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: PBM Holdings LLC
Previous Business on this site Offices, multi tenant office park
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:
These are administrative and Marketing offices for Nutritional manufacturing business. On the first floor this is a call
center for customer service
*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 best of my knowled e. I have read the onditions of approval, and I understand them, and that I will abide by them.
John G. Halford, CPM, CEM
Signature Printed RF2 ilirortnr, Global inr7iron4 Drnrnrnman4
AP OVAL 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
Zoning Official Ali 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 7/1/2011 Page 2 of 3
Intake to complete the following:
Y/N
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /C N
Will there 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 o ublic water?
If private well, provide Health epartment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic o,public s� wer
Y /®
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 # _-4
Zoning to complete the following
Reviewer to complete the following:
Square footage of Use: a `I � (..(�
JI N kJ
Permitted as:
Under Section:
Supplementary regulations section:
Parking formula: ^ 6D
Required spaces:
Y/ /Ite be verified in the field:
Inspector:
Notes:
Viol ns:
Y/
If so, t:
roff ers:
/N
so, List:
Variance:
IfsJ S
Ifs , t:
SP's:
Y/
If so, ist:
Clearances:
SDP's 2
�605-1,
Revised 7/1/2011 Page 3 of 3
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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,
[County application name and number]
was provided to Zac Price representing Brandwine Realty Trust the owner of record of Tax Map
[name(s) of the record owners of the parcel]
and Parcel Number Tax/Parcel ID: 07800-00-00-031 KO by delivering a copy of the application in the
manner identified below:
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
X Mailing a copy of the application to Zac Price representing Brandwine Realty Trust
[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 / �-s to the following address:
Date
652 Peter Jefferson Parkway, Charlottesville, VA. 22911
[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].
Aignature Applicant
John G. Hatford, CPM, CEM
SR Director, Global Indirect Procurement
Print Applicant Name
Date