HomeMy WebLinkAboutWPO201500012 Bond 2015-06-10 Interne Use Only • 7 . ' t" j1 C,\Uale Received: .i " r/aid: 7. I ,oy'1' tki 1 t/
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REQUEST TO ESTABLISH A BOND
APPROVED PLAN ii WPO201500012
PROJECT NAME: Water Protection Ordinance Plan - 1-64 Treatment Facility
(As listed on the approved plan)
All parcels in the project, including any off-site work if easements are not provided,and current owners. Use a
separate sheet if more owners are required. Owner and tax map information must be correct,and plans must be
approved prior to bond estimates being prepared.
TAX MAPS/PARCELs:076M1-00-00-002A00WNER'S NAME: 5th Street Station Ventures, LLC
SIGNATURE: �61- " date: 6/1/15
TAX MAPs I PARCELs: 076M1-00-00-002BOOWNE 'S NA : 5th Street Station Ventures, LLC
SIGNATURE: j2 -� 0-2-er--- date: 6/1/15
TAX MAPs/PARCELs: 076M1-00-00-004A0OWNER'S NAME: 5th Street Station Ventures, LLC
SIGNATURE: 7'"Q, &":„:746-} date: 6/1/15
TAX MAPs/PARCELs:07700-00-00-011EO OWNER'S N : Avo a oldings, LLC
SIGNATURE: date: a I I j,-
TAX MAPs/PARCELs: OWNER'S NAME: l!
SIGNATURE: date:
NOTE: 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 corporation, partnership,limited liability company,
trust,association, etc.,documents acceptable to the County must be submitted certifying that
the person signing above has the authority to do so.
The requested estimates are;
❑ VESCP Erosion&Sediment Control per Water Protection Ordinance section 17-207;$0 fee
I VSMP Erosion and Sediment Control, Stormwater Management and Mitigation per Water
Protection Ordinance section 17-208;$250 fee required
❑ Subdivision(roads,drainage, etc.) per Subdivision Ordinance section 14-435;
&Water&Sewer per Subdivision Ordinance section 14-435; $250 fee required
A bond estimate will be prepared by the plan reviewer. The estimate must be sent to the owner. Please provide
contact information.
l
EMAIL: steve @sjcollinsent.com /121-4-em f
OR REGULAR MAIL ADDRESS: -imps
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Revised 6/20/2014
BOHLER EN
GINEER.ING
28 Blackwell Park Lane,Suite 201,Warrenton,VA 20186
Professional Engineering Services Telephone:(540)349-4500 Fax:(540)349-0321
LETTER OF TRANSMITTAL
VIA: Hand Delivery
TO: Albemarle County RE: Bond Estimate Request Form
401 McIntire Road,Room 227 WP0201500012
Charlottesville,VA 22902 5th Street Station
5th Street SW&Avon Street Ext.
(434)296-5832 Charlottesville,VA 22902
Albemarle County
ATTN: Ana Kilmer DATE: June 1,2015
JOB NO: V122001
WE ARE SENDING YOU ❑Shop drawings ❑Copy of letter ZAttached ❑ Prints ❑Change order
COPIES JOB# DATE REVISION REVISION SHEET NO. DESCRIPTION
DATE
1 V122001 5/29/15 Check#002282 Check in the amount of$250.00 made
payable to Albemarle County
1 V122001 6/1/15 1 of I Bond Estimate Request Form
These Are Transmitted: ®For approval ['For your use DAs requested
El For review and comment DApproved as submitted ❑Approved as noted
Cl Returned for corrections
REMARKS:
Please find enclosed the Bond Estimate Request Form for the above mentioned project in Charlottesville,VA.
If you have any questions or require additional information, please do not hesitate to contact this office at (540)
349-4500.
COPY TO: SIG
t
4leass
b aniel R. Hines,P.E.
File