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Home My WebLink AboutWPO201500022 Application 2015-04-07 Albemarle CountyCommunity Development Department • 401 McIntire.Road CharlottesviIIe,VA22902-4596 `err Voice 14)296-5832 Fax:(434)972-4126 -�- Planning Application • PARCEL I OWNER INFORMATION TMP Q7800-O0-O0-020F1 Owner(s): STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY All Application# WPO201500022 PROPERTY INFORMATION Legal Description j ACREAGE PARCELX f ' Magisterial Dist. Rivanna Land Use Primary Open �r Current AFD { Not in A/F District ...i®:] Current Zoning Primary Commercial Office 3 APPLICATION INFORMATION Street Address Entered By A Type l Application yp Water Protection Ordinances =l Emil Lantz ,r Project State Farm Blvd &S. Pantops Dr Sidewalk Project Received Date 04/03/15 Received Date Final Submittal Date 04/06/15 Total Fees Closing File Date Submittal Date Final Total Paid Revision Number Comments Legal Ad SUB APPLICATION(s) Type Sub Applicatio Comment iStormwater Management/BMP Plan • Erosion and Sediment Control Plan Stream Buffer Mitigation Plan APPLICANT /CONTACT INFORMATION ' ContactType Name Address CityState Zip Phone PhoneCell OrmerfAcplicsnt STATE FARM MUTUAL AUTOMOBILE ONE STATE FARM BLVD i BLOOMINGTON IL 61710 cry Ccntect FRANK POHL 401 MCINTIRE RD ROOM 222 :CHARLOTTESVILL 22902 4348724501 Signature of ContractororAuthorized Agent Date 'fire Nome Virginia Stormwater Management Program (VSMP) tY �� Application for Albemarle County it �nr Project Name: State Farm Boulevard and South Pantops Drive Sidewalk Project (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No Is this a revision or resubmission for review? Yes D 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. Not Applicable VDOT Locally Administered Project 1 '— 20 Fl 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 Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Contact Information for the Owner(s)to receive correspondence: Print Name Frank Pohl- Project Manager Albemarle County Office of Facilities Development Address 401 McIntire Road, Room 222 City Charlottesville State VA Zip 22902 Daytime Phone(434) 872-4501 E-mail fpohl@albemarle.org 7/1/14,Revised: 7/10/14, 1/7/14 Page 1 of2 Nape Now° ▪ B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 0.75 acre Acres to be Total Fee Fee Due with this Fee with Transfer or disturbed Application modification of permit Less than 1 $290 $145 $20 Albemarle County Proj. 1 and less than 5 $2,700 $1,350 $200 5 and less than 10 $3,400 $1,700 $250 Fees are waived 10 and less than 50 $4,500 $2,250 $300 50 and less than 100 $6,100 $3,050 $450 100 and more $9,600 $4,800 $700 For(minor)amendments to an approved plan; $200 per review Variances;$150(per request) Mitigation Plan;$150 VI C. Registration Statement on the official DEQ form. D D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ® E. Stormwater Management Plan satisfying the requirements of code section 17-403. VI F. Pollution Prevention Plan satisfying the requirements of code section 17-404. VI G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. N/A ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. N/A ❑ J. Construction Record Drawings (as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. N/A Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Brian McPeters, PE Address 1700 Willow Lawn Drive, Suite 200 City Richmond State VA Zip 23230 Daytime Phone(804) 672-4721 E-mail brian.mcpeters@kimley-horn.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ Date Paid By who? Receipt# Ck# By: 7/1/14,Revised: 7/10/14, 1/7/14 Page 2 of 2 ,or Virginia Stormwater Management Program (VSMP) Application for Albemarle County > ; /uG4-4\'. Project Name: State Farm Blvd & South Pantops Drive Sidewalk Project (The name should be the same as it appears on plans) Is this an amendment to an approved plan? Yes ❑ No 0 Is this a revision or resubmission for review? Yes E1 No ❑ County File Number: WP0201500022 (to be provided by the County for new applications) The following are required elements of new applications[from code section 17-401 J. For revisions or amendments,please indicate which items are being amended. Signatures must be provided for any submission. E 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. State Farm Blvd Public Right-of-Way 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 Tax Map&Parcel Print Name of Property Owner Signature of Owner Date Contact Information for the Owner(s)to receive correspondence: Print Name Frank V. Pohl Address Office of Facilities Development City State Zip Daytime Phone(ext ) 7914 E-mail fpohl@albemarle.org 7/1/14,Revised: 7/10/14, 1/7/14 Page 1 of 2 Nir N1\ IE B. All Fees [Code section 17-208] For new or modified plans; Total acres proposed to be disturbed 0.75 acres Acres to be Total Fee Fee Due with this Fee with Transfer or disturbed Application modification of permit Less than 1 $290 $145 $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 100 $6,100 $3,050 $450 100 and more $9,600 $4,800 $700 For(minor)amendments to an approved plan; $200 per review Variances; $150(per request) Mitigation Plan;$150 0 C. Registration Statement on the official DEQ form. El D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. 0 E. Stormwater Management Plan satisfying the requirements of code section 17-403. Pi F. Pollution Prevention Plan satisfying the requirements of code section 17-404. IE G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. N/A ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. N/A ❑ I. Requested Variations or Exceptions as provided in code sections 17-407 and 408. N/A ❑ J. Construction Record Drawings(as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Kimley Horn and Associates, Inc. c/o Brian McPeters, PE Address 1700 Willow lawn Drive, Suite 200 City Richmond State VA Zip 23230 Daytime Phone(804) 673-3882 E-mail brian.mcpeters@kimley-horn.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn. Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount$ Date Paid By who? Receipt# Ck# By: 7/1/14,Revised: 7/10/14, 1/7/14 Page 2 oft