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Home My WebLink AboutCLE201500218 Application 2016-03-28Application for ZoningClearance CLE # 40 k — X � 4 - c i��ti PLEASE REVIEW ALL 3 SHEETS OFFICE USE ON Y _ Check # C G Date: (7 - a� Receipt # 5 9 Staff - PARCEL INFORMA N Tax Map ?IN and Parcel:i p� Existing Zoning C Parcel Owner:AL2 rcQ e. o-at'-LLl ar 69 F -P Parcel Address: d'E: �� City t State V P'r Zip .� (include suite or floor) PRIMARY CONTACT w l Who should we call/write concerning this project? Address: _7 %4S r -(t IGQ�° �£1t� � " City (i State Zips �`f G elhone: � 3l �'V 3� �� Cell # 3 i Fax # E-mail C. � t4 �►S / a+�i , t/ i4—"�� J �i-d O lam'► APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name ew business Business Name/Type:� Li1� ��1 4 CE1�i Previous Business on this site ' i�A 4e4e,s Describe the proposed business including use, number of employees, number 9f shifts, available parking spaces, number of vehicles and any additional infor tion t it ,D ca rovi e: 9 to is 4R.S 7 C cp A tit O -A �(C 1Btin ` *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 locatio , a-ikw Zonir Clearance will be required. I hereby certify that I o or ave the owner's permission to use the space indicated on this application. I also certify that the information provided is true and accur to e b to my o edge I have read the conditions of approval, and I understand them, and that I will abide by them. r' Signature r Printed�� AL 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 Zoning Official If I Other Official Date [ Date 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 Intake to complete the following: Y l� Is use in Ll, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y Wi ere 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 r public:wa�te�r9 If private well, provide He nt form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE _ Circle the one that app Is parcel on septictullew? Y Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y Wit -there be any new construction or renovations? If so, obtain the proper Permit. Permit # Zoning to complete the following: Reviewer to complete the following: Square footage of Use: 90 ZY / N rmitted as: LC Under Section: 16. 2.1 Supplementary regulations section: Parking formula: j /16 Required spaces: Y /JN Items to be verified in the field: Inspector : Date: Notes: s: Y ViC'N' If sIf Pro YIN so, ist: Var' If / If so, ist: SP's: If Ifs ist: Clearances: SDP's Revised 7/1/2011 Page 3 of 3 Virginia Department of Social Services REQUEST FOR BUILDING EVALUATION OR INSPECTION SECTION I (To be completed by applicant) 4#1e 4 ,roes 'IA Com• , _ cf.3�f -G 744-1 (ApplicarW s Name) (Telephone number) 762C .Pb4K@.r- s m V,4L (Applicant's Address) I hereby request the building located at the following address be evaluated by the Building Official (and inspected if determined necessary by the Building Official) for compliance with the Virginia Uniform Statewide Building Code (VUSBC): ?bIg- F0 ad . Ir Es, �Ic 'Soko / Building Address (provide complete address) Building name or number NOTE: If multiple buildings are used, please enter information for each building on a separate form. I plan to use the building to operate the following: ❑ Family Day Home* Ql<icensed Child Day Center* ❑ Children's Residential Facility* ❑ Religious Exempt Child Day Center* ❑ Certified Preschool or Nursery School* ❑ Adult Day Care Center f ❑ Assisted Living Facility - *For children's programs, specify the total number of children to be served: R _o ; and the number of children served who will be 2% years of age or less: p 'For adult programs, specify the total number of adults to be served: ; and the maximum number of adults who at any given time will not be capable of self-preservation (non-ambulatory): I will bearass ted costs incurred. Date: ' 20/ Signature of Applicant SECTION H (To be completed by the Building Official) The VUSBC Group Classification required for the use indicated above: (� Maximum Occupancy Load (including staff): Z 0 ( non-ambulatory) The building identified above has been evaluated based on the information provided and inspected, if necessary, and is determined to be properly classified under the VUSBC for the indicated use and number of occupants. Comments (if any): Date: (a Signature of Building Official: ..1 14 1 Printed Name of'Building Official Telephone Number 032-05.034144-eng (10111) 1 MEMORANDUM OF UNDERSTANDING This Memorandum of Understanding is made this _ day of September, 2015 between the Albemarle County School Board, a body corporate pursuant to Virginia Code §22.1-71, and Little Learners, a Virginia nonprofit entity. Whereas the Albemarle County School Board (hereinafter "ACSB") supports pre-school programs to help children to be better prepared for successful participation as students in our schools; and; and Whereas the School Board recognizes that there currently exists space at Benjamin F. Yancey Elementary School (hereinafter "Yancey"), located at 7625 Porters Road, Esmont, Virginia, that could be utilized as a pre-school classroom; and Whereas the Little Learners organization (hereinafter "Little Learners"), a tax exempt entity created for the purpose of establishing pre-school programs in southern Albemarle County, has approached Albemarle County Public Schools with a request for classroom space at Yancey for a pre- school program for 3-4 year old children; Now therefore, be it therefore resolved that the ACSB directs staff to enter into a contract with Little Learners for the use of a classroom at Yancey, so long as the following terms and conditions, and any others determined by staff as being necessary, are agreed to as a part of the building use agreement: A maximum of 20 children will be enrolled in this program with priority being given to children who reside in the County of Albemarle. Priority enrollment also should be given to children of Yancey staff members The hours and days of operation will be consistent with those of Albemarle County Public Schools. * School bus transportation will not be provided by Albemarle County Public Schools + Little Learners pre-school students may participate in the breakfast and lunch program under terms and conditions agreed to by the Child Nutrition Services Department and the principal of Yancey. + Little Learners pre-school students will have access to and use of the media center, the gymnasium, the playground and playing fields under terms and conditions established by the principal of Yancey • Little Learners staff and volunteers must undergo background checks and the results of these checks must be shared with ACPS before these individuals can be present at Yancey Is Little Learners must obtain and provide proof to ACPS of liability insurance consistent with that required in the ACPS building use policy. • Little Learners students must be supervised at all times by Little Learners staff members. MEMORANDUM OF UNDERSTANDING This Memorandum of Understanding is made this _ day of October, 2015 between the Albemarle County School Board, a body corporate pursuant to Virginia Code §22.1-71, and All God's Children Child Development Center, dba Little Learners - Tri -County, a Virginia nonprofit corporation (hereinafter "Little Learners"). The School Board accepts Litter Learners application for community use of a classroom in Benjamin F. Yancey Elementary School (hereinafter "Yancey"), located at 7625 Porters Road, Esmont, Virginia, for the purpose of providing a pre-school program for 3 and 4 year old children. All standard community use policy requirements will be a part of this agreement but in addition the following terms and conditions will apply. • The program offered will meet all standards set by the Commonwealth of Virginia. • A maximum of 20 children will be enrolled in this program with priority being given to children who reside in the County of Albemarle. • Priority enrollment also should be given to children of Yancey staff members. • The hours and days of operation will be consistent with those of Albemarle County Public Schools and Club Yancey. • School bus transportation will not be provided by Albemarle County Public Schools • Little Learners students may participate in the breakfast and lunch program under terms and conditions agreed to by the Child Nutrition Services Department and the principal of Yancey. • Little Learners pre-school students will have access to and use of the media center, the gymnasium, the playground and playing fields under terms and conditions established by the principal of Yancey. • Little Learners staff and Little Learners volunteers must undergo background checks and the results of these checks must be shared with ACPS before these individuals can be present at Yancey. Little Learners will receive copies of background checks of volunteers approved by the school and who will volunteer to interact with the students in the Little Learners, classroom. • Little Learners must obtain and provide proof to ACPS of liability insurance consistent with that required in the ACPS building use policy. Current policy requires no less than $1M in liability coverage and that Albemarle County Schools be named as additionally insured. • Little Learners students must be supervised at all times by Little Learners staff members. • Student medications will be handled and administered by Little Learners staff members, with security of these medications required to be consistent with the practices and requirements of ACPS. • Little Learners students can visit the school nurse if situations occur during the school day that require medical expertise. • Little Learners will pay a fee of $150 per month for the use of this space to cover the cost of custodial support and utilities. 2-o O� A&AO �c 114 -e -y- 6L(^c7z-t �7 S�-40 -mss ly a, JU t e -lc -J 41P -F4 o e S do/1-p- Rc( Al T 7 ro old usrc 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, was provided to [County application name and number] [name(s) of the record owners of the parcel] the owner of record of Tax Map and Parcel Number 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 j" 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 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]. Print Applicant Name la -7 )/,S -- Date