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Home My WebLink AboutWPO201400097 Application 2014-12-02 (fi A7i :� , f Albemarle Cc; nty �, l,�lii � Community Development Department fl°1w"' 401 McIntire Road Charlottesville,VA 22902-4596 Planning Application Voice: (434)296-5832 Fax: (434)972-4126 1�RCI'>i1� PARCEL/ OWNER INFORMATION TMP 05900-00-00-02380 Owner(s): Application # WP0201400097 UNIVERSITY OF VIRGINIA PHYSICIANS GROUP PROPERTY INFORMATION Legal Description ACREAGE PT L-B Magisterial Dist. Samuel Miller Land Use Primary Commercial Current AFD Not in A/F District Current Zoning Primary Cl Commercial APPLICATION INFORMATION Street Address 2955 IVY RD CHARLOTTESVILLE, 22903 Entered By Emily Lantz Application Type Water Protection Ordinances 12/02/2014 Project University of Virginia Physicians Group Northridge Medical Center- VSMP Received Date 11/26/14 Received Date Final Submittal Date Total Fees Closing File Date Submittal Date Final Total Paid Revision Number Comments Legal Ad SUB APPLICATION(s) Type J Sub Applicati l Comment Stormwater Management/BMP Plan Erosion and Sediment Control Plan ,.,.,, .. s........ .::.::.:�.:,..ct::t.._:::s t::'';':7"5't;i,:;'t°; .• .;:°°,..;::t;s': <;� °.:.•;ac,.,:.or:..:,.,.,,,.. ,,.,.. �.;�.a'.. :'�.i'rr�,;;;;;;;;;;;,,i:�?i6: °�,'�;ziii=`i:,.�::.......,..,.<.., ..,.,,.. .,,..,,...,,.Pf,.,...... ..,,.., (APPLICANT/ CONTACT INFORMATION ContactType Name Address, , State Zip Phone PhoneCell kw 3E-eAt rl t... i I . '`t. t t I* °.' ' 1ltC b::,.•,F �': '1 5 .. :;`: ::s`:; `r:i:,• 4 #2 .. Primary Contact GARY LOWE 500 RAY C HUNT DR CHARLOTTESVILL 122903 4349806132 Signature of Contractor or Authorized Agent Date Virginia Stormwater Management Program (VSMP) 10* Application for Albemarle County Project Name: University of Virginia Physicians Group Northridge Medical Center (The name should be the same as it appears on plans)pl Is this an amendment to an approved plan? Yes I No ❑ / Is this a revision or resubmission for review? Yes ❑ No County File Number: (to be provided by the County for new applications) The following are required elements of new applications[from code section 17-401]. For revisions or amendments,please indicate which items are being amended. Signatures must be provided for any submission. [A. Signature of the Property Owner for each parcel: (Required with every submission or revision,NOT TO BE SIGNED BY AN AGENT OR CONSULTANT) By signing this application as the owner,I hereby certify that all requirements of these plans and permits will be complied with,and I have the authority to authorize the land disturbing activities and development on the subject property. I hereby grant the County of Albemarle the right to enter upon the property as'required to ensure compliance with the approved plans and permits. TM 59-23B University Physicians Group /, ,z4--'U, ) 1/�,J� ` Tax Map&Parcel Print Name of Property Owner Signature of Own Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Contact Information for the Owner(s)to receive correspondence: Print Name University of Virginia Physicians Group c/o Gary Lowe Address 500 Ray C Hunt Drive City Charlottesville State VA Zip 22903 Daytime Phone(434) 980.6132 E-mail gel3w @hscmail.mcc.virginia .edu 7/1/14,Revised:7/10/14 Page 1 of 2 Ell . All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 0.51 acres Acres to be Total Fee Fee Due with this Fee with Transfer or disturbed Application modification of permit Less than 1 $290 $145 k $20 1 and less than 5 $2,700 $1,350 $200 5 and less than 10 $3,400 $1,700 $250 10 and less than 50 $4,500 $2,250 $300 50 and less than $6,100 $3,050 $450 100 100 and more $9,600 $4,800 $700 For(minor)amendments to an approved plan;$200 per review Variances;$150 Mitigation Plan;$150 C'C. Registration Statement on the official DEQ form. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. CAE. Stormwater Management Plan satisfying the requirements of code section 17-403. F F. Pollution Prevention Plan satisfying the requirements of code section 17-404. ErG. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. EOM. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. -RI"'I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. VI. Construction Record Drawings(as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Timmons Group do Craig Kotarski Address 919 2nd Street SE City Charlottesville State VA Zip 22902 Daytime Phone(434) 327.1688 E-mail craig.kotarski @timmons.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY rr WPO# Fee Amount$1�7 Date Paid 4 4/C[ By who? Receipt# OM; Ck# 7/1/14,Revised:7/10/14 Page 2 of 2 TIMMONS GROUP • Transmittal YOUR VISION ACHIEVED THROUGH OURS. To: Date: November 25, 2014 Albemarle County Community Dev 401 McIntire Rd Job No.: Charlottesville, VA Regarding:Northridge UVA Physicians Group We are sending you the following items: Attached n Under separate cover via Courier n Shop Drawings ❑ Prints n Plans ❑ Specifications ❑ Copy of Letter n Change Order ❑ Other Copies Date Description 18 November 25, 2014 16 Site Plan Sets 2 plan sets for VSMP 2 November 25, 2014 Calcs Booklets 2 November 25, 2014 VSMP / SWPPP Books - Application 1 November 25, 2014 Application for Site Plan Amendment 2 November 25, 2014 Submittal Fee Checks This information is transmitted as checked below: ® For Approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use n Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints n For review/comment ❑ Other n for bids due n Prints returned after loan to us Remarks: Copy to: Signed: J dY) 1j-Pij.9-1 �j . Trate/ tarski, PE C� Phone: 434.295.5624 Received by: Name(printed) Signature If enclosures are not as noted,please notify us at once