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HomeMy WebLinkAboutCLE201600084 Application 2016-05-24Application for Zoni g Clearance CLE # "" Ui r OFFICE USE QN1,Y a 5t, `J PLEASE REVIEW ALL 3 SHEETS Check # e `l- V Y5ate: N cc Receipt # Staff: PARCEL INFORM,AO]Y,� I ` Tax Map and Parcel: ++� // Existing Zoning_�,�_ Parcel Owner• Parcel Address: moo P466e aI � CityaarlfflfeS I/r `` �� State It � Zip ZNII (include suite or floor) PRIMARY CONTACT Who should we call/write concerningthis project? _Lk f i- _`� ap Address • ZO �ixr , r� City Wn c-4s4r State r Zip 1760 Office Phone: (I Cell # Fax # 17-290- E-mail CCau qo '222y APPLICANT INFORMATION Check any that apply: Change lofrrowner/`ship Change of use Change of name New bu K Nsiness Business Name/Type: D be—S , hfM"O. LLL Previous Business on this site Describe the proposed business including use, number of employ s n mb r f shift availab e p lung spaces, number of Mr-Mrlesany ditio al ipforma ' n that you can rovide: g �tae or> - *This Cledrance 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. Signature Printed st/ll rs l. VA - APPROVAL INFORMATION [ ' pproved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, xl 17. [ ] 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 co lies ith the site pl as of this date. �Re egu�Q 0a.1AAznA!2k Notes Building Official Date L4 1 I jj 6 Zoning Official JUJDate 6 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 6/14, Flib Intake to complete the following: Y/N Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y/N Will there 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 or public water? If private well, provide 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 septic or public sewer? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. k Permit #' YIN Will there be any new construction or renovations? If so, obtain the p r Permit. Permit # Zoning to complete the following: Reviewer to complete the following: Lquare footage of Use: p Y N itted as: Q Q t Under Section: _ *��-f_ Supplementary regulations section: Parking formula: C' # J l Required spaces: YIN Items to be verified in the field: Inspector • Date: 11. _. O M! 2d:i, ff M0ffl �D /I"6 I�=yi AW Violations: Y/N If so, List: Proffers: Y/N If so, List: Variance: YIN If so, List: SP's: Y/N If so, List: Clearances: SDP's Revised 7/1/2011 Page 3 of 3 7 fY 1q,�fFi . � s IJy l'`'7r'Yi ;1:• rJ fl, 5! ol Fire Prevention Application Start Date: Business Name: Address: City/StatelZip: Violations LOCAL Permit - Fireworks (Wholesale) Assigned To MADDOX, Shawn on 6/21/2016 5/21/2016 2:00:00PM Rivanna Ridge Shopping Center 1900 Abbey RD Charlottesville, VA 22911 Permit - Fireworks Wholesale Fee $500.00 Relnspection Date: Finish Date: 5/21/2016 2:30:OOPM OccupancylD: 05073 Station No.: East Rivanna Phone: Date Found Data Cleared 6/21/2016 Standard: Long Desc: 1. Must comply with all applicable Federal, State, and Local laws, rules, regulations, codes, and ordinances. 2. A permit is required prior to sellinglwholesaling class "C" Fireworks. 3. Must provide the Department of Fire Rescue with a current copy of Certificate of Insurance (minimum $1,000,000.00), a list of fireworks to be sold, and Fireworks Retailer information/permit. 4. Permit will be valid for a period of one year from date issued. Comments: Requestor: Keystone Novelties, LLC Chris Cook 717-394-1078 201 Seymour Street Lancaster, PA 17603 ccook@keystonenovelties.com **Paid fee with check # 3225, receipt # 66285. See attachment on the J Drive titled 1900 Abbey Road - Fireworks Wholesale & Retail & Tent Application 2016-04-05". RM The list of fireworks submitted is approved. Any changes must be submitted to the fire marshal's office for review, sNM STATEMENT OF RESPONSIBILITY I hereby acknowledge that the information contained herein, and declare that It be true and correct to the best of my knowledge and belief. Further, I am the ownerloperator, or a duly authorized agent, acting on behalf of the owner, for all activities at the above mentioned property or location. As such, I hereby agree to comply fully with all the requirements In the Albemarle County Fire Prevention Code governing the operation I wish to conduct. If there has been any false statement or misrepresentation as to the material fact in this application, data, or plans on which the permit or approval was based, the Fire Marshall may revoke this permit Page:1 Flying Betsy ; Killer Bees ; Rising Storm ; �Cr l N i Silver Star , � Mextmum 1 Overload i N ; Sping Doctors ; I HN90 Fountain ; , i 1 Blockbuster , ; Fountain , ;N Tie Dye surprise ; Cr N 1 ;W Waterfront , ' Celebration Tomahawk i Rocket Fountain , w , I , Jumbo Morning ; m Glory ; m , Morning Glory 1 1 Neon Sparklers i CD 1 ' 020 Gold r i Sparklers ; , 00 Color _ Sparklers , #BGold spa Fare; 1 Lightning Rod ; Candies ; , , Dragon Slayer ; 1 , , , Smoke Balls - Party Poppers ; r Mammoth Smoke ;rr - , ro Snappers Crackling Balls_ Magic Snakes ; r , , Magic Color ' Burst � N Do not skirt the rear of this table i ; Crowd Pleaser Jackpot Assortment Assortment 1 mro l a Table #5 (no trays) ----------------------------------------i � r Display area for Glow 1 ra I sun BU— Sticks, ED Glasses, Punk, , o Santl dae Safety Fuse, Big Stinker, ,W'p`y, p8RIZ-d i Penguin Blowing Balloon Checkout $tep aSM Prloe Area ; Purchase Irsl S , taped to Credit Card ; 1 te6k � 0a 3 m as 2 , l C n Qfn I f ; N 1 ' v , W x o ; CD 1 $ 1 v q.' w� o j CD 3 iD , r� Im r vl Monkey Business C jr1 C Chase the Ace!' trl , r"F Dester Moon ; Crackling Crystal 1 T , 1 Fire Tower 1 1 ; �■ Cuckoo , 1 ; ; , JokeYs Revenge , , � Red Riot Dancing Diamonds Keystone Lights Fountain Open Flower Happy Biro Devils CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This forma must accompany zoning applications (Home Occupation, Zoning Clearance, Zoning Administrator Determinations or Appeals, Sign Permits, Building Permits) if the application is not the owner. 1 certify that notice of the application, was provided to [County application name and number] [name(s) of the record owners of the parcel] and Parcel Number manner identified below: Hand delivering a copy of the application to the owner of record of Tax Map delivering a copy of the application in the [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 Mailing a copy of the application to S a N rAc,MS� [Name of the record 6wner 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 to the following address: Date 13e'M- 44,4 W K STg.CC ? QviNc 6Z b [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]. 02�z__ Signature of Applicant -ir)I �_4 Print Applicant Name :31.?11z2ne,e to Date ACORL7r CERTIFICATE OF LIABILITY INSURANCEF,,�DA,,T,,,m,,m E16DfYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Ileu of such endorsements . PRODUCER Britton Gallagher One Cleveland Center, Floor 30 1375 East 9th Street GONTACT NAME: I FAX ° A'D N° - E-MAIL ADDRESS: Cleveland OH 44114 INSURE S AFFORDING COVERAGE NAIC 0 INSURER A:Maxum Indemnity Company43 INSURED 8086 INSURER B:EVereSt Indemnity Insurance Co. 10851 INSURER C : Keystone Novelties Distributors LLC 201 Seymour Street Lancaster PA 17603 INSURERO: INSURER E : INSURER F : 1_Uv=r%A%a=a UhK11FIGATE NUMBER: 9nr,9d19FA4 RRVI@Inld IdIII1111:1190. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE. TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADD INSR WVD POLICYNUMBER POLICY EFF MMIDDNYYY1 POLICY EXP (MM1DD11YYYYI LIMITS B GENERAL LIABILITY X COMMERCIALGENERAL LIABILITY CLAIMS -MADE ITI OCCUR SI8ML00041-151 12/31/2015 12/31/2016 EACH OCCURRENCE $1,000,000 DAMAGE TO NTED PREMISES Ea oomurrancel $600,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO )( LOC PRODUCTS - COMPIOP AGG $2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL AUTOS OWNED AUTOS U�D NON -OWNED HIRED AUTOS AUTOS COMBINI;U SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peracrldent $ A UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE F-XC6010961 12131/2015 12131/2016 EACH OCCURRENCE $4,000,000 X AGGREGATE $4,000,000 DED RETENTION $ S WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ (Mandatory In NH] If yes, deaotibe under DESCRIPTION OF OPERATIONS below NIA WCSTATU- OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE 5 E,L. DISEASE -POLICY LIMIT I S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD ID1, Additional Remarks Schedule, It more space is required) a.orc r rrwn r nUwct[ GANGELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD �4 ''.��_s-_IG March 31, 2016 County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Keystone Novelties Distributors, LLC is in the process of planning for our Fourth of July tent sale at 1900 Abbey Road in Charlottesville, VA. I have included in this package everything that I believe is necessary for the purposes of applying for our Zoning Clearance. In this package I have included the following: • A completed Application for Zoning Clearance • A copy of the permission letter • A Plot plan showing the location of the tent • Interior Layout of the tent • A copy of our Liability Insurance Certificate • A check for $50 to pay for the clearance Our set up will be for the period from June 24 through July 5. The tent will be put up a few days in advance and removed as soon as possible after July 5. Of course, we have "No Smoking" signs placed at the entrance and will have a fire extinguisher. I hope that this information is helpful to you and I thank you again for your consideration. Should you have any questions or concerns, please cal] anytime at 717- 394-1078. Thank you. Cordially, Chris Cook Field Operations Manager