HomeMy WebLinkAboutCLE201500210 Application 2015-11-04Application for Zoning Clearance
CLE # O VS
~ 'rrrc•l,ht
0 CE USE ONLY
PLEASE REVIEW ALL 3 SHEETS Check# 6a'3,3 Date: ler 5-15
Receipt # 101 f53" 3 Staff: CL
PARCEL INFORMATION -�---
Tax Map and Parcel: Q d 930 Existing Zoning
Parcel Owner: 'ILLrS
Parcel Address: �Yd oc3 -- _ City 0 W6 �� State L+ zip aaao3
aq (ps (ludc suite or floor)
PRIMARY CONTACT ff
Who should we call/write concerning this project? Lo E s r `n
Address., 05 r r � City �d a State Zip
Office Phone: 8lI (o911Cell S 'q -,�'►Y Fax 1/3Q-a45- U& i E-mail
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: r 0 [� Pte•
Previous Business on this site Wig I-s
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: 0j -{'1)! �e or
li
*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 knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signatur M Printed
APPROVAL INFORMATION Denied
Approved as proposed [ ] Approved with conditions [ }
[ ] 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,�af 2�t t
Zoning Official Datea`��
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:
YIIN
i� se in LI, HI or PDIP zoning? 1f so, give applicant a Certified
Engineer's Report (CER) packet.
Y
Wi 7ere1 1
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 q public water.
If private well, provide Hea ment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that ap li
Is parcel on se c or public sewer?
YyN
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
If so, obtain proper I
Reviewer to complete the following:
Square footage of Use: _ - -
P/ N 1
ermitted as: alt l �✓
Under Section: r_..i
Supplementary regulations section.-
Parking
ection:
Parking formula:
Required spacesr
YIN
Items to be verified in the field:
Inspector : Date:
Notes:
Y
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Zoning to complete the followin
Violations:
Pro s:
Y / tfv?
CERTIFICATION THAT NOTICE OF THE
APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER
This form must accompany zoning applications (Home occupation, Zoning Clearance, Zoning
A(lministratorDeterminations or Appeals, Sign Permits, Building Permits) if the application is not the
owner.
I certify that notice of the application,
was provided to
f 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
1� 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].
�Appl����
�
Signature of i
L.U-" ?Mr-s�1
Print Applicant Name
I►5'
Date
L-846
Hospice of the Piedmont
Transitional Care Hospital
EXHIBIT A
Premises
3714—TRANSITIONAL-CARE HOSPITAL
PARTIAL THIRD FLOOR PLAN
{#1864900-3, 115634-00001-03)
d SML avAw ewe a4 Fr.
EXHIBIT A
�fRc[rttp
COUNTY OF ALBEMARLE
Department of Community Development
401 McIntire Road
Charlottesville, Virginia 22902-4596
Phone 434 296-5832 Fax 434 972-4126
MEMORANDUM
TO: Zoning Clearance or Home Occupation Applicant
FROM. Zoning Division
RE: Request for Approval of Letter of Performance Standards or
Certified Engineer's Report
Proposed B usiness/Use: _hon i Ce- Care.
Address: 2q(.5- /vv gtcad C�xvl4 ,,, yU,4 :2Q.9L-3
Re CLE (Zoning Clearance Number): ` of 5 -,210
HO (Home Occupation Number):_
Contact Person: "i-5
Phone Number: t13 Y- 817- (&9677
Fax Number: 3q--Q1s-n1&7 Date Faxed to Applicant:
Please return this form along with all required documentation to the Zoning Division upon
completion.
Thank you.
1 CER Packet Revised 21111U9
Certified Engineer's Reports
According to Zoning Ordinance section 18-4.14.8, Albemarle County requires a
certified engineer's report prior to issuing a zoning compliance clearance or
home occupation permit for uses of an industrial character. The certified
engineer's report must be reviewed by the County Engineer (or designee).
A certified engineers report shall consist of;
Type 1: For uses which will have no discharge, noise, vibration, smell, lighting,
emissions, impulses or radiation beyond a normal office or residential use,
and will not store any hazardous materials, a letter from the owner with the
following information will suffice as a certified engineer's report;
1. a description of the business and the physical process involved.
2. a description of any machinery and operations.
3. a statement or explanation for meeting each of the performance
standards of section 18-4.14; noise, vibration, glare, air pollution, water
pollution, radioactivity, electrical interference.
Examples of type 1 uses might be offices or warehouse storage of clothes or
home occupations for wood workers. An example letter is available.
Type 2: For uses which will have any discharge, noise, vibration, smell, lighting,
emission, impulse or radiation which might reasonable be expected to exceed
the performance standards of 18-4.14.4 at any time, or which have any permit
requirements from DEQ, EPA, Health Department or other local, state or
federal agency, a full certified engineers report is required. This report must
contain a signed and dated seal from a professional engineer. It must contain
copies of any local, state or federal permits. It must contain plans and
descriptions of physical and operational measures to meet all of the
performance standards, with actual supporting measurements and data
where applicable. Examples of type 2 uses might be a contractor's office and
storage yard or equipment repair shop, or a manufacturer of electrical
components.
CER Packet Rwlaed 2111M9
4.14PERFORMANCE STANDARDS
No use shall hereafter be established or conducted in any industrial district in any manner in
violation of the following standards of performance;
4.14.1 NOISE
All sources of noise (except those not under direct control of occupant of use, such as vehicles)
shall be subject to and comply with section 4.18.
(§ 4.14-12-10-80; Ord. 00-18(3), 6-14-00)
4.14.1.1 (Repealed 6-14-00)
4.14.1.2 (Repealed 6-14-00)
4.14.2 VIBRATION
The produce of displacement in inches times the frequency in cycles per second of earthborne
vibrations from any activity shall not exceed the values specified below when measured at the
points indicated.
4.14.2.1 METHOD OF MEASUREMENT
Earthborne vibrations shall be measured by means of a three component recording system,
capable of measuring vibration in three mutually perpendicular directions. The displacement shall
be the maximum instantaneous vector sum of the amplitude in the three directions.
4.14.2.2 MEANING OF TERMS
Vibrations means the periodic displacement of oscillation of the earth.
Area of Measurement
Type of vibration At residential district boundaries At other lot lines
within district
Continuous
.00 .015
Impulsive (100 per .006 .030
Minute or less)
Less than 8 pulses .015 .075
per 24 hours
4.14.3 GLARE
No direct or sky reflected glare, whether from flood lights or trom high temperature processes
such as combustion, welding or otherwise, so as to be visible beyond the lot line, shall be
permitted except for signs, parking lot lighting and other lighting permitted by this ordinance or
required by any other applicable regulation, ordinance or law. However, in the case of any
operation which would affect adversely the navigation or control of aircraft, the current
regulations of the f=ederal Aviation Administration shall apply.
CER Packet Revised 2111109
4.14.4 AIR POLLUTION
Rules of the State Air Pollution Control Board shall apply within Albemarle County, Such rules and
regulations include coverage of: emission of smoke and other emissions from stationary sources;
particulate matter; odor; particulate emission from indirect heating furnaces; open burning;
Incinerators; and gaseous pollutants.
4.14.5 WATER POLLUTION
Rules of the State Water Control Board shall apply within Albemarle County.
4.14.6 RADIOACTIVITY
There shall be no radioactivity emission which would be dangerous to the health and safety of
persons on or beyond the premises where such radioactive material is used. Determination of
existence of such danger and the handling of radioactive materials, the discharge of such
materials into the atmosphere and streams and other water, and the disposal of radioactive
wastes shall be by reference to and in accordance with applicable current regulations of the
Department of Energy, and in the case of items which would affect aircraft navigation or the
control thereof, by applicable current regulations of the Federal Aviation Administration, and any
applicable laws enacted by the General Assembly of the Commonwealth of Virginia or the
requirements of the Virginia Air Pollution Act, whichever is greater.
4.14.7 ELECTRICAL INTERFERENCE
There shall be no electrical disturbance emanating from any lot which would adversely affect the
operation of any equipment on any other lot or premises and in the case of any operation which
would affect adversely the navigation or control of aircraft, the current regulations of the Federal
Aviation Administration shall apply.
4.14.8 CERTIFIED ENGINEER REPORT SUBMITTAL
Each future occupant of an industrial character shall submit to the county engineer as precedent
to Issuance of a zoning compliance clearance a certified engineer's report describing the
proposed operation, all machines, processes, products and by-products, stating the nature and
expected levels of emission or discharge to land, air and/or water or liquid, solid or gaseous
effluent and electrical impulses and noise under normal operations, and the specifications of
treatment methods and mechanisms to be used to control such emission or discharge. The
county engineer shall review the applicant's submittal and make comment and recommendation
prior to final commission action on the site development plan. (Amended 9-9-92)
CER Packet Revised 2111!39
EXAMPLE LETTER FOR TYPE 1 CERTIFIED ENGINEER'S REPORT
[Date]
Community Development Department
Division of Zoning and Current Development
401 McIntire Road
Charlottesville, VA 22902
To the County Engineer:
We are a small mail order business distributing clothing and fan based products.
We store t -shirts, hats, and jewelry, and package them for distribution. We have
four employees in our warehouse, and three employees at call centers in the
warehouse office.
We have addressed the performance standards of Zoning Ordinance Section 18-
4.14:
Noise: Our operation will not create sound or impact noise levels in excess of
the values specified in Section 4.14.1. We are surrounded by an embankment
on three sides and a block wall on the fourth. Our major sources of noise are: 1)
music and telephones. 2) truck deliveries of merchandise.
Vibration: We operate no equipment in our warehouse.
Glare: Our operation is completely contained within the building. The interior
lighting associated with this operation does not produce glare that is visible
beyond the lot line.
Air Pollution: There will be no emission of smoke, odor or gaseous pollutants.
Water Pollution: No liquid wastes will be generated by this operation. Our
operation does not represent a hazard to water quality.
Radioactivity: My operation does not require handling of radioactive materials.
There will be no radioactive emissions.
Electrical Interference: My operation does not require any equipment that would
generate electrical disturbances.
Please feel free to contact me with any further questions you may have at
[telephone] or by e-mail at [e-mail address].
Sincerely,
[Name of applicant]
CER Parket Revised 2111109
EXAMPLE LETTER FOR TYPE 4 CERTIFIED ENGINEERS REPORT
[Date]
Community Development Department
Division of Zoning and Current Development
401 McIntire Road
Charlottesville, VA 22902
To Whom it May Concern:
We are a small business building custom cabinets and furniture with four
employees and are currently starting a shop at (address of your business). The
parcel is zoned Industrial (L-1). It is my understanding that in order to occupy
this space we will need to submit this Letter of Performance Standards along with
our zoning clearance application.
We have addressed the standards referenced in Section 4.14 and provided the
following responses:
Noise
Our operation will not create sound or impact noise levels in excess of the values
specified in Section 4.14.1. We are surrounded by an embankment on three
sides and a block wall on the fourth. Our major sources of noise are: 1) outside
Shp Air Compressor that runs five minutes during an hour throughout the day. It
is enclosed in a dog house to protect it from weather and to cut down noise; 2)
dust collection system, located outside with a 3hp electric motor develops a low
noise level; and 3) Inside shop equipment includes a 10" table saw, 3 hp shaper,
20: surface planner, 24" surface sander, 8 by 56" joinerlplanner, drill press, radial
arm saw, and assorted hand held power tools, all of which do not have an
unacceptable noise level.
Vibration
Equipment operated by shop does not produce any detectable earthborn
vibration.
Glare
Our operation is completely contained within the building. The interior lighting
associated with this operation does not produce glare that is visible beyond the
lot line.
CER Packet Revised 2111109
Air Pollution
There will be no emission of smoke, odor or gaseous pollutants. By-product of
the operation is saw dust. A dust collection system has been installed to remove
airborne saw dust from each station to an outside collection per OSHA
standards. System is self contained and does not represent a hazard to air
quality.
Water Pollution
No industrial liquid wastes will be generated by this operation. All finishing will be
handled off-site by a local finishing company, because of this there will be no
paints, lacquers or solvents store on site. A permit has been issued by the
Health Department on our sewage disposal. Our operation does not represent a
hazard to water quality.
Radioactivity
My operation does not require handling of radioactive materials. Therefore there
will be no radioactive emissions or danger to health and safety of person on or
beyond the premises.
Electrical Interference
My operation does not require any equipment that would generate electrical
disturbances that would adversely affect the operation of equipment on any other
lot or premises.
Please feel free to call me with any further questions you may have.
Sincerely,
[Name of applicant]
CER Packet Revised 2/11109