HomeMy WebLinkAboutCLE201600223 Application 2016-10-12Application for Zoning Clearance
CLE # Cbl&-'Pas
A
OFFICE USE NLY
PLEASE REVIEW ALL 3 SHEETS Check # JaL Date: 'I
Receipt # 1010i-7 Staff:
PARCEL INFORMATION
Tax Map and Parcel: 03200-00-00-041 D1 Existing Zoning Planned Dev. Shopping Center
Parcel Owner- Timberwood Commons LC
Parcel Address, 3428 Timberwood Blvd (top fl, S bldg) City Charlottesville state VA Zip 22911
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project? Jono Sarver
Address • 400 Locust Ave. Ste. 3 City Charlottesville State Virginia Zip 22902
Office Phone: 4( 34) 977,6400 Cell 434.962.7906 Fes# Email jono@tbmcom.Com
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
Business Name/Type: Charlottesville Pediatric Dentistry
Previous Business on this site none, new construction
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:
Pediatric dentist's office, 9 employees, 1 shut (8:00am - 5:00pm - parking spaces total, 9 vehicles. sua y not
more trian a coupe patients at any given time - most in tne morning and end ot tne day,
*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 the a of my knowle I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed Jonathan R. Sarver
APPROVAL INFORMATION
J Approved as proposed f ] Approved with conditions [ ] Denied
[ ] Bacl:flow 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 _ f C,
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 11/02/2015 Page 2 of 3
Intake to complete the following:
YIN
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
YIN
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
Reviewer to complete the following:
Square footage of Use:
YIN
Permitted as: ti
Under Section: ;Z�5. 2
Supplementary regulations section:
Circle the one that applies Parking formula:
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 Required sN.paces: ��
Dept. FAX DATE y
Circle the one that applies
Is parcel on septic or public sewer?
YIN
Will you be putting up a new sign of any kind?
Sign permit.
Permit #
Y 1'PG
Items to be verified in the field:
If so, obtain proper
Inspector : Date:
YJ / N Notes:
Will there be any new construction or renovations?
If so, obtain the proper Peemit.
Permit #
mingtto complete the
Violations:
YI(5
If so, List:
Variance:
YIQ)
If so, List:
Clearances:
offers:
QV IN
If so, List:
2nn A J 2-'7-
� �2J
SP's:
Y /(�
If so, Dist:
SDP's
Revised 11/1/2015 Page 3 of 3
THIS PLAN 8 FOR 7WSOLEPURPCSE SPEOFR:ATIDN AND
INSTAILARON OFTNE; D13TTAL E GLWME IE SUPPUEO BY HENRY
SCHEINDENUL THE IDEAS HMM ARENDT TECE3WLY
RECOMMENDED BY THE HENRYSCHEIN DENTAL HATIOW
DE93N CAMP.
R ISTHE ARCHITE /CONTRACTORSR ®uLYTO vERFY
THAT ALL CODE RESTRICTIONS L CLEA NCES ARE MET.
PROPOSED DENTAL FLOOR PLAN
1/4"=1 9,
F >�
� a>
z o_
o Z,
UZ5
QO
N=
U
A O
a
O O
a
HENRY SCHEIN REP:
ROB WELCH
CENTER:
RICHMOND
PHONE #:
8Q4 641-619
8gogj< O
� a�a
i� d���yyLL�M
O[
®z�Zs�W�O
O�aao �
s K�<�zQy
z g O
'
oz
�z_
ozwE-
DRAWING NAME
STUMP-3G-F
PROJECT START DATE;
1B s'b16
FINALS START DATE:
M$/W2D16
N BY: CA
FINALS BY; LB
CHECKED BY; TA
R NS:
S S T. SizE:
114"=1' 0 p
FLOOR PLAN
SA.0