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PARCEL
TTOWNE INFORMATION _. . . _ ___.._......
Tt1P1 O4500-00-00-O68O2 1 Owner(s): SAM'S REAL ESTATE BUSINESS TRUST C/O WAL-MART PROPEL
Application# A RB2O1 50008
PROPERTY INFORMATION
Legal Description 'ACREAGE PARCEL C
I
Magisterial Dist, Rio ( Land Use Primary Commercial j,
Current 4FD Not in A/F District '*i Currant Zoning Primary Highway Contrttercial
APPLICATION INFORMATION
Street Address 970 HILTON HEIGHTS RD CHARLOTTESVILLE, 22901 __ Entered Sy
.„, __. anielie Roth
Apptfcation Type Architectural Review Board v. „.__„,i X7,'7:'2015
Project ISatrt's Club Remodel
Received Date ;47/42/15 1 Recerved Date Final Submittal Date i 47/46//0671—S71 Total Fees IIIIIIIIIIMIIIIIIII
Closing File Data i Submittal Date Final!.
inal f Total paid ____i
Revision Number {
.Algal Ad ,
SUB APPLICATION(s)
i. TIPe Sub ppr ati.=' _..:n nt
Minor Amendment 07/06/15
!APPLICANT / CONTACT INFORMATION
ContactTim l Name dress 7 City State Zip, e ,,.� e t
c r, ,,_ -a t p t t_ REAL_ESTATE BUSINESS TR ET PO 8D 8050 MS 0555 BENTONVILLE AR l'92712
'rrners Cortsitt tilcAy skirl 2909 AJAX AVENUE,SURE 100 R€}GERS AR 727558 479$783512
Signature of Contractor or Authorized Agent _
Age” Id ceel i) 7/7//r
Architectural Review Board Application 1°
a s
Part A: Applicant, Contact and Parcel Information
Project Name: Sam's Club Remodel
Tax map and parcel(s): 04500-00-00-068D2 Physical Street Address: 970 Hilton Heights Road
Contact Person: Mary Bain
Business Name: pb2 architecture+ engineering
Address 2809 Ajax Avenue, Suite 100 City Rogers State AR Zip 72758
Daytime Phone(479) 878.3512 Fax#(479) 636.1209 E-mail mary.bain @pb2ae.com
Owner of Record: Sam's Real Estate Business Trust
Address 2001 SE 10th St City Bentonville State AR Zip 72712
Daytime Phone(479) 878.3512 Fax#(479) 636.1209 E-mail mary.bain @pb2ae.com
Part B: Review Type and Fee
Select review type
_ Review by the Architectural Review Board
Conceptual Plan/Advisory Review(for a Special Use Permit or a Rezoning) No Fee
Preliminary Review of a Site Development Plan No Fee
Final Review of a Site Development Plan $1000.00
Amendment to an approved Certificate of Appropriateness $225.00
Building Permit Review $590.00
County-wide Certificate of Appropriateness
Structures 750'or more from the EC,no taller than 5 stories No Fee
_ Structures located behind a structure that fronts the EC No Fee
Personal wireless service facilities No Fee
Fencing or Equipment or Lighting No Fee
Additions to ARB-approved buildings No Fee
Minor amendments to site or architectural plans No Fee
Building permits where the change is 50%or less of the altered elevation No Fee
NOTE: For SIGNS, use the combined APPLICATION AND CHEKLIST FOR SIGNS.
FOR OFFICE USE ONLY BP# ARB#
Fee Amount$ Date Paid By who? Receipt# Check# By
County of Albemarle Dept of Community Development,401 McIntire Rd,Charlottesville,VA 22902 Voice:(434)296-5832 Fax:(434)972-4126
11/2010 Page 1 oft
OVER-->
Part C: Description of Proposal
Describe your proposal.Attach a separate sheet if necessary.
General remodel - repaint interior, new photo lab, remodel areas shown on drawings
Part D: Applicant Agreement
Applicant must read and sign
• Each application package must contain(8)folded copies of all plans and documents being submitted. Only
(1)set of building material samples is required. All submittal items,including building material samples,
become the property of Albemarle County. Applicants are encouraged to maintain duplicate copies of all
submittal items in their own files.
• Only complete application packages will be scheduled for ARB review. The application package is not
complete without the appropriate checklist, completed, signed, and included with the required submittal
materials indicated on the checklist.
I hereby certify that I own the subject property or have the legal power to act on behalf of the owner in filing this
application. *See submittal requirements below. I also certify that the information provided on this application
and accompanying information is accurate, true, and correct to the best of my knowledge, and that the attached
plans contain all information required by the appropriate checklist.
(1)71 0_ 8LV1 �. ), ,s
Signature of os ther,owner's representative Date
or contract purchaser
' I� r )Ial q. 27V , 3jIa
Printed - e,Title Daytime phone number of Signatory
*Ownership Information:
• If ownership of the property is in the name of any type of legal entity or organization including, but not
limited to, the name of a corporation,partnership or association, or in the name of a trust, or in a fictitious
name, a document acceptable to the County must be submitted certifying that the person signing above has
the authority to do so.
• If the applicant is a contract purchaser, a document acceptable to the County must be submitted containing
the owner's written consent to the application.
• If the applicant is the agent of the owner, a document acceptable to the County must be submitted that is
evidence of the existence and scope of the agency.Attach the owner's written consent.
11/2010 Page 2 of 2
OVER—>
iclr-
Y Architectural Review Board
Amendment to a Site Development Plan
ci
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Submittal Requirements Checklist
Part A: Applicant Contact and Parcel Information
Project name: Sam's Club Remodel ARB#
Tax map and parcel#: 04500-00-00-068D2
Physical street address(if assigned): 970 Hilton Heights Road
Location of property(landmarks, intersections, or other):
Contact person: Mary Bain
Business name: pb2 architecture+ engineering
Address: 2809 Ajax Ave., Suite 100 City: Rogers State: AR Zip: 72758
Daytime phone: 479.878.3512 Fax: 479.636.1209 Email: mary.bain @pb2ae.com
Important Note: Submittal packages must contain(8)collated copies of all information unless otherwise
indicated.
A. Written description of the proposal
❑ Provide a description of the revised/amended proposal. Identify all proposed changes from the
previously approved submittal.
❑ Provide a revised materials list if any of the building materials or material color(s) have changed.
B. Site plan showing the following (drawn to the scale of 1"=20', clearly legible and folded):
❑ Show all proposed changes to the previously approved plan including site layout, landscaping,
lighting, and all site features, with changed features clouded and clearly identified on the plan.
El Sheet number,total number of sheets,date of the drawing, date and description of the latest revision, and
contact information for the firm preparing the drawings in the title block on all drawings.
❑ Provide the original plan and existing conditions.
C. Appearance of the building(s) (architectural elevations, color perspective sketches, site sections):
V] Dimensioned architectural elevations of the proposed building(s) showing all changes to the
previously approved building(s) design. Elevations must be drawn to a minimum scale of
1/16"=1'-0". A larger scale may be required. Include a building materials schedule and key on the
elevation drawings.
• One set of all building materials/colors if changed from the previously approved submittal.
1
Revised 7/28/10
D. Additional material
❑ The applicant is welcome to submit any additional material that will make the revision to a certificate
of appropriateness/amendment to a site development plan review more productive. Drawings or
other submittal items that clarify topography, visibility, utilities, landscaping, or other unique or
unusual conditions are welcome.
Part C: Applicant Agreement
Applicant must read and sign
• Each application package must contain (8) folded copies of all plans and documents being submitted.
Only(1)set of building material samples is required if the building materials have changed. All submittal
items, including building material samples, become the property of Albemarle County. Applicants are
encouraged to maintain duplicate copies of all submittal items in their own files.
• All information in this checklist is required, unless specifically waived by the ARB, prior to processing
a revision to a certificate of appropriateness / amendment to a site development plan review by the
ARB. Additional submittal materials may be required, depending on the proposal.
• Only complete application packages will be scheduled for ARB review. The application package is not
complete without this checklist, completed, signed, and included with the required submittal materials
indicated on the checklist.
In representing the above referenced firm submitting this application for review, I hereby state that the
information provided in this application, and all accompanying information, is accurate, true and correct to
the best of my knowledge, and that the attached plans contain all information required by this checklist.
June 18, 2015
Signature of person completing checklist Date
Mary Bain/applicant 479.878.3512
Printed Name/Title Daytime phone number of Signatory
County of Albemarle Department of Planning and Community Development
401 McIntire Road, Charlottesville, VA 22902-4596
(434)296-5832 Tel, (434)972-4126 Fax
www.albemarle.orq
2
Revised 7/28/10