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Home My WebLink AboutCLE201700030 Application 2017-02-15A Application for Zoning C earance -W 11,01ig, OFFICE UMONL:y,, be=: C ck # PLEASE REVIEW ALL 3 SHEETS Check Date: R eeeipt#nIL4(,o Stam - WOL_ , PARCEL INFORMATION E Tax Map and Parcel: V6 -r) I - ri�) -- � A IA A Existing Zoning_ LA - Parcel Address: i 0 (,;::, < A� City (include suite or floor) vli(estate ---V4 - 'A'�TN :N�ziw� PRIMARY CONTACT Who should we call/write concerning this project? Address. 03Vq— - -L I"— city State —VA — Zip 4Z�Q' 0mce Phone: ct36 -ZY-5 CCU # Fax �7S Fmail X t0i7 APPLICANT INFORMATION Check any that apply: Change of ownership 1,�_ change of use Change of name New business Business Namefl)rpe: Previous Business on this site It If o 4 ,Y frjh a,& Describe the proposed business Including use, number of employees, number of shifts, available pa I 9!peft, number of vehicles, and any additional information that you can provide: 'Ibis 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 Spam indicated an this application. I also certify that the information Provided is true and accurate to best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature APPROVAL INFORMATION Approved as proposed Approved with conditions Denied Backflow prevention device and/or current test data needed for this site. Contact ACS& 9774511, xI 17. No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan. I I This site complies with the site plan as of this date, Notes: Building Official Date Zoning Official Date Other Official Date County of.Mbemsirle Mpartment Of Community Development — 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 9724126 Revised I 112015 Page 2 of 3 Intake to complete the following: Y/N Is use in LI, Hl or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y 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 o ublic :w:s:te;) If private well, provide Heal pamnent 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? IN ill you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # Y G) 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: R 2—)1 0 Permitted as: Under Section: Supplementary regulations section:. Parking formula: 1 Required spaces: I V Y 1 ' Items be verified in the field: Vio�la4ors: Yr(N) If ist: pro Y N , If : Variance: Y/N If so, List: SP's: Y/N If so, List. Clearances: n ` 1! —I D S SDP's Revised I I/1/2015 Page 3 of 3 CERTIFICATION THAT NOTICE OF THE APPLICATION HAS BEEN PROVIDED TO THE LANDOWNER This form must aezompairy zoning app(kamtons (Home Oecupadon, Zoning Clearance, Zoning A&xintiifrator Dett nrtnadons or Appeals, Sign Plerndds, Building Pennh) iffhe application is not the owner. I certify that notice of the application, [County application name and number) was provided to Greenbrier Office Park LLC the owner of record plaTs he record owners of the parcel) and Parcel Number b PAelivering a copy of the application in the manner identified below: Hand delivering 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 XXX Mailing a copy of the application to Greenbrier Office Park LLC /Irvin Cox _ [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; j on Date'2.3.17 1410_1440 Greenbrier place Charlottesville, VA to the following actress: —`—`—" [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]. C -- f�y� 0C'�5, �gnature �Appl °scant Joshua Bailey Print Applicant Name 2.3.17 Date EXHIBIT C - LANDLORD'S WORK [TO BE INSERTED BY TENANT] 5 E E a "TT !\ CCO IM � - N T S ((o) P:\J9190271 .DOC TITLE: Charlottesville, Va. COMPANY: U.S. Physical Therapy CREATOR: FILENAME: Electrical.vsd )DRAWING SCALE: 1/8in : 1ft Treatment' Area Curtains supplied by tenant installed by G.C. Treatment Area R VCT,, 50 gal water heater supplied Wet 10" x 10" floor sink W! by G.C. -- Area wall mounted mixing Washer 8 Dryer � valve \ supplied by tenant Closed Treatment 4 e Board cal Panel Storage � L220v for dryer, vent to ®ior \ Break vcT Room i Refrigerator supplied ADA by tenant 1 RR Gym ................ ................ Ref a Dedicated outlet Upper and lower P - ---- O Lam cabinets W/ sink Office VCT ADA �.: RR Fiie 0 0 Copier t— Dedicated outlet Reception Fax Junction Box fo 1 reception desk Waiting C3 C3 0040 F-xI,t ►�-sfT TITLE: Charlottesville, Va. COMPANY: U.S. Physical Therapy CREATOR: FILENAME: Ceiling.vsd )DRAWING SCALE: 1/8in : 1ft Ott sCT C i TITLE: Charlottesville, Va. COMPANY: U.S. Physical Therapy CREATOR: FILENAME: Plumbing.vsd DRAWING SCALE: 1/8in : 1ft i Fx6- if-5 a C �, TITLE: Charlottesville, Va. COMPANY: U.S. Physical Therapy CREATOR: FILENAME: Finish.vsd DRAWING SCALE: 1/81n : 1ft Fxv4oCsl-T C TITLE: Charlottesville, Va. COMPANY: U.S. Physical Therapy FILENAME: Area.vsd DRAWING SCALE: 1/8in: 1ft CREATOR: 81-10, Treatment Area o Closed J:1 Treatment Curtains supplied by tenant installed by G.C. Treatment Area Storage LO Wet 10* x 10" floor sink W1 0 00 Blocking Area wall mounted mixing Washer & Dryer valve supplied by tenant Break LO 04 VCT Room Cq Mt . Irigerator supplied �2 ADA RR Gym .................... Ref by tenant —L.Dedicated outlet Rest Rooms to include F 0 Water Fountain Upper and lower P 1)Mirror Q 01 Lam cabinets W/ 2)Grab bars sink 3)Towel dispenser b VCT Office 4)Toilet paper holder 36H. wall with wood sill both bo ADA ends to extend to ceiling RR Reception Waiting E X �4tv-61-r C'A TITLE: Charlottesville, Va. COMPANY: U.S. Physical Therapy CREATOR: FILENAME: Proposed.vsd )DRAWING SCALE: 1/8in : 1ft Treatment Area Curtains supplied by tenant installed by G.C. 'Treatment Area 50 gal water R VCTy : heater supplied Wet 10" x 10" floor sink W/ by G.C. Area wall mounted mixing washer &Dryer valve supplied by tenant VCT ADA RR Gym �SC Upper and lower P Lam cabinets W/ sink VCT LADA RR Note: 1) All furniture supplied by tenant including reception desk 2) Carpet through -out unless noted otherwise 3) 6" wall boarder through -out Gym 4) VCT to be Armstrong Stepmaster Tile 5) One -- 2' x 4' light fixture for every 80 VWC square foot Closed Treatment 0 Storage LU VCT `CBreak' Room, TO / Office File Copier Reception 0 Fax Waiting 220v outlet for dryer, Exhaust vent to exterior Refrigerator supplied by tenant--I Dedicated outlet Dedicated outlet Junction Box fo reception desk FX"iRIT r