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Home My WebLink AboutCLE201600100 Application 2016-06-07Application for Zoning Clearance A` CLE # ,•a , •rr f F�AGlS�� OFFICE USE ONLY PLEASE REVIEW ALL 3 SHEETS Check# Date: 4 afa/ito Receipt # Staff: PARCEL INFORMATION Tax Map and Parcel: _ (Q h 5lO ns-1 IA 0040� Existing Zoning Parcel Owner:__ Qi CliGti) Parcel Address: QS Iv, City C e4�L 6i5ys T State A• Zip �c j (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? i�� Address : fso WAbaWBP_Me_ W City_B6WyVj� State Zip 2241l Office Phone: Ira q2%� 27fe Cell # Fax # E-mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: SQ& [� i,�►sy PA(� �FE.�lr.�li�lku6�< "- Previous Business on this site- C14.4ge L 03 V ° 1f PD, -*,e Q uy p! e U p Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and any additional information that you can provide: TeAW. �lL.4_ DF VA . fl;AqWLk ]b FIKE1 1C,�_2QM a_UA)E I12— TULY 5,k-, ZOI (e _ *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 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 f my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signa CPrinted J&U t— 6. 51 A-J CW APPROVAL INFORMATION "Q Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 9774511, 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 Date ;--tL Z Y (G Zoning Official Date 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 11/1/2015 Page 2 of 3 114 Intake to complete the following: Is /s'�-tn Is u LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y I Will tre 6e 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 o pu�Dep ll er? If private well, provide He en form. Zoning review can not begin unti we receive approval from Health Dept. FAX DATE Circle the one tha ies Is parcel on sep c or public sew r? Y/N Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y/N Will 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: 0/ N 1 Permitted as: '11 Under Section: _. _ A �m , Supplementary regulations section: Parking formula: Required spaces: YI Items to be verified in the field: Inspector: Notes: Date: 'ations: N so,List: // 0 Gr'9j Proffers: Y/Q If so, List: - Variance: 40/N If so, List: 7� SP's: Y/<� If so, List: Clea rances: SDP's Revised 11/1/2015 Page 3 of 3 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 orAppeals, 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] and Parcel Number manner identified below: Hand delivering a copy of the application to the owner of record of Tax Map by 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 APP-1L Date 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 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]. Signature of Applicant Print Applicant Name Date LEASE AGREEMENT This agreement of Land Lease is made thisday of MW1L between -- GU'w -�- - - ,(LESSOR) and�� (Y CHAP ,(LESSEE) for the Property described as an area at the front of j �4� �bt� T r� _ more speefcally Described on the attached site plan. LESSOR and LESSEE agree that for and in consideration of the sum of1kV .�-FoVk I.W. (�Z�w } Paid by check to the LESSOR at the signing of this document or prior to the commencement date of said Lease, LESSEE may land lease the site indicated on Exhibit A here to during the period of tv-10 'Tfia; 1-1042016 LESSEE agrees to obtain the necessary permits from C0 _ _[* Au5&1,iez—�r for the purpose of selling &6 t , V _ ____A p rWakilS during this period. LESSEE agrees to provide a certificate of insurance to the LESSOR providing coverage during the above dates, naming CEO s C HW as additionally insured. LESSEE agrees to remove all stands, merchandise and refuse from the leased area by 71 is- Zo1C, And shall restore the area to the same condition it was before the lease began. In addition, LESSEE agrees to hold Go,. CHI and owners harmless of any and all accidents; etc. LESSEE will be responsible for all activities on leased premises related to their business operations. /' LESSOR: H&V SIGNED: WITNESS: DATE: 6-1 LESSEE:sj Sjli _ SIGNED WITNESS- brr DATE: 2� %G L _- CERTIFICATE OF LIABILITY INSURANCE OWM 3/232016 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 INSURERS} 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 lieu of such endorsemen s . PRODUCER Britton -Gallagher and Associates, Inc. One Cleveland Center, Floor 30 1375 East 9th Street CONTACT NAME: PHONE .21 8-7100 FAX Na a E,on IIL..ssL:inf I INSURE S AFFORDING COVERAGE NAICN Cleveland OH 44114 INSURERA:Everest lndemnmiy Insurance INSURED 18166 INSURER B INSURERC: Fireworks Over America of South Carolina, Inc. 916 Rosewood Drive Columbia SC 29201 INSURER 0., INSURER E • INSURER F COVERAGES CERTIFICATE NUMBER:1989031295 REVISION NUMBER: 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 CERTfFICATE 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. IL7R R TYPE OF INSURANCE !INSR WVD POLICY NUMBER MLOLIICY FU=F LI I EXP D MI LIMITS A GENERAL LIABILITY 816GLOO655-151 12JI12015 12/1/2016 EACH OCCURRENCE $1,000 D00 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F1 OCCUR DAMAGE TO RM;ffff PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL BAOVINJURY $1,000,000 x $2500Deductible GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOPAGG $2.000000 POLICY11 PRO ElLOC $ AUTOMOBILE LIABILITY Ea aeader� $ BODILY INJURY (Per person) $ ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS AUTOS�ED PROPERTY DAMAGE $ S UMBRELLALIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE S EXCESS LIAB DED I I RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YINLIM ANY PROPRIETORIPARTNERlEXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? NIA EL. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYE Id $ (Mandatary in NH) If yes describe under DESNIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AcWttanal Remarks Schedule, M more space Is required) The below listed are Additional Insured respects to General Liability policy as required by written contract. The Certificate Holder is Additional Insured with respect to General Liability as required by written contract. Additional Insured extension of coverage Is provided by above referenced General Liability policy where required by written agreement Gui Chen, 1195 Seminole Trail, Charlottesville, VA 22901 County of Albemarle See Attached... CERTIFICATE HOLDER CANCELLATION Seasons of Change, LI_C Dan Simone 150 Meadowbrook Lane Berryville VA 22611 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 M_ 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Certiftcate of Plame Resistance REGISTERED FABRIC ISSUED BY Date of Manufacture NUMBER JOHNSON OUTDOORS INC. BINGHAMTON, NEW YORK 13902 JAN 2004 T'-140A I Manufacturers of Me Finest Tent Products Descnb&d Hefeln Th Is is to certify that the products heroin have boon manufactured from material Inherently flame retardant as here after specified by the material supplier. NAME: GIBSON RENTALS CITY: BARBOURSVILLE STATE: VA Cartlflcauon is hereby made that: The articles described on this certificate have been manufactured with an approved flame retardant chemical in compliance with Califomla State Fire Marshal Code, NFPA-701', Underwriters Laboratory of Canada, and have been tested In accordance with the Federal Test Method Specfications and meet or exceed the Military Flame Specifications of MIL-C-43006G. Type, color and weight of material: 14 OZ Vinyl WHITE BLOCKOUT Description of item certified: 20X40 ELITE PARTY CANOPY Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric Snyder Manufacturing, Inc. TENT DEPARTMENT, JOHNSON 'Large Scale I II b y 64a it N IJ k2 4e. al .3 j Fi .Jdgrpj, cok