HomeMy WebLinkAboutWPO201400054 Preconstruction Form 2014-08-29 01 A144
Request for Pre-construction Meeting and Grading Permit � .'
from Albemarle County , it
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Approved Plan Number: WPO- 2. c7) Li' 0 0 d S
Approved Plan Name: r"q C ' +0144- 1 t) C se. S
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date: /1/
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
i'lResponsible Land Disturber:
QJ [r /
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Print Name: O I p/ 'ft � / C 4 4
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Q r i4c
State Certification Number: 3c1-7(5,6
Address `a 1 /V cs C U) L1 ,n - al ,�1
Ollt t f�
City t, I t e State( A Zip Z 2-9 3
f 71e o r g If7-- Lig za v 1�
Daytime Phone(III)( .2 71"^ E-mail
Primary Contractor: •
Print Name Y Sr1au ( C 4 I/t 471rIat C.+)�?
Address
t ) Ly .r �
��Ih� ; 11 Road
City 1�1 t N)11-h ii State 1,149 Zip 2 tiYQ f
Daytime Phone('I3y 4-/ g5-- ) 1
3 I E-mail 10)) r 'f
Permit Issuance and First Year Maintenance Fees: (Request must include payment)
Total acres proposed to be disturbed is contained on the approved plan and application:
VSMP:
Acres to be disturbed Fee Due at Grading Permit
Less than I $63.80
1 and less than 5 ($594.0)
5 and less than 10 x$748.00
10 and less than 50 $990.00
50 and less than 100 $1,342.00
100 and more $2,112.00
For plans exempt from VSMP,VESCP fees were paid with the application.
7/1/14,Revised:8/29/14 Page 1 of 3
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Person(s)to attend the Pre-construction Meeting:
Names(type or print) Firm Contact Number or email
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II( em+ GrolleAc4
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j Q Co h k-A- 'fit'? CriTy i 471) 13 J31- 1 -,7
The second part of the application fee is required to be paid with this request. This fee amount is;
FOR OFFICE USE ONLY Permit Issued Date
by
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7/1/14.Revised:8/29/14 Page 2 of 3
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Request for Pre-construction Meeting and Grading Permit
Owitis
from Albemarle County
Approved Plan Number: WPO- 2 01 V— 0 0 S Y'
Approved Plan Name: l5 (b\C i 9-y 7 f
(Plans must be approved prior to a pre-construction meetin
g.)
Bond approved date: if
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber:
QJ
Print Name: 611010101 1 }- c- /D f W a I-F6 t-S f h1 ( lir T
State Certification Number: 3 v 7 W
Address ) 1 ( .•v 1 O In C q 'nr (7( r46 q
City C v _Qd 1, I t State V,1 Zip Z 2Q) 3
y3 (I ,Z� f 77 t•
01— `) 13'7"1/310 (C )
Daytime Phone, ,/l - b E-mail
Primary Contractor:
Print Name .19'
J a frit C Q Li f/f cr1 a+)
Address ) ) p -rD(1 VI t'? ; / f R O Gfyl
City 4I V) Y- State V /9 Zip 2- '-/VO f
Daytime Phone(/3x I- ) /3 I E-mail )j 19 r 1 G8 HT c q L' V? @ MQ� • C-4511'3
Permit Issuance and First Year Maintenance Fees: (Request must include payment)
Total acres proposed to be disturbed is contained on the approved plan and application:
VSMP:
Acres to be disturbed Fee Due at Grading Permit
Less than 1 $63.80
1 and less than 5 ($594.00
5 and less than 10 $748.00
10 and less than 50 $990.00
50 and less than 100 $1,342.00
100 and more $2,112.00
For plans exempt from VSMP,VESCP fees were paid with the application.
7/1/14,Revised:8/29/14 Page 1 of3
Person(s)to attend the Pre-construction Meeting:
Names(type or print) Firm Contact Number or email
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L
AAd a C IIQ v (wok S' ick rimrivi L,' 5/0
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.9J)-y1,-)The second part of the application fee is required to be paid with this request. This fee amount is;
FOR OFFICE USE ONLY Permit Issued Date
By who9
G4� lr r C►Liyf ruc/-,`n,
cloKil4 qt, 1/ s 5 ,p--P
j?r,o_k.(Akio. Li 77-1
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7/1/14,Revised: 8/29/14 Page 2 of 3