Loading...
HomeMy WebLinkAboutCLE201700105 Application 2017-05-09Application for Zoning Clearance ��`` `� �:. �7l�Y:;INt PLEASE REVIEW ALL 3 SHEETS OFFICE U E ONLY _ Check #P`�1U Date: G Receipt # z9. Staff: JJ PARCEL INFORMATION n i . ' Tax Map and Parcel: O� V�/ t 002 OA Q 20O Existing Zoning e" I Parcel Owner: Gu j CVIEN Parcel Address: AqS7 SeMrVOLE IRf" City H:nQI oTS V, 4 State VJ Zip 2Z70 [ (include suite or floor) PRIMARY CONTACT PRIMA`S1 Who should we call/write concerning this project? Iry Oti6— �Lj Address: )so WAMA)P"k 2eV City [3flftv: ale State VA, Zipz2 Office Phone: 7( 03J 907-J7/ e Cen # Si`l.M f Fax # E-mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: 5 A<or4S C(_ t-KN = n � Previous Business on this site l }} e, OTSV. Ile powfR Ec Vyl Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of . vehicles, and any additional information that on can provide: evy. SALL DF VA = APPCOV&L) ,— Fi a wa*nk5 1 2a(y:1,)N6- 12 - 1 vLY S> "' , z o J '7 *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 h e the owner's permission to use the space indicated on this application. I also certify that the information provided is true and accurate tot st my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Sign I;o-- Printed 11- S1_We)AJ_D �— APPROVAL INFORMATION Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-451 1, 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 complies with the site plan as of this date. Notes: Building Official Date Zoning Official Date Other OfficialDate 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 Intake to complete the following: Y / b Is use in LI, HI 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 �c wa If private well, provide Health rtment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that ap Is parcel on septic or ubGc 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: �2-0 t)6 / N f Permitted as:7�.q Under Section: 1qj AA Supplementary regulations section: Parking formule:---I Required spaces: Y/N Items to be verified in the field: Inspector: Notes: Date: Violations: Y / If so, L t: Prof e : Y / N If so, List: Variance: 0 / N If so, List: —7b � y SP's: 0/N If so, List: Clearances: SDP's 9Y-y4 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 or Appeals, 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: 1� 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 AM1L.; 2S , 2C17 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 I16Z 6. sio2� Print Applicant Name �- 25— 7 Date LEASE AGREEMENT This agreement of Land Lease is made this day of AP2T-c- , 12017 between CrlEAU ,(LESSOR) and -SEAsoas OF CH,`tA-bf ,(LESSEE) for the Property described as an area at the front of I IofS SemitiJoL -1 A, L , more specifically Described on the attached site plan. LESSOR and LESSEE agree that for and in consideration of the sum ofTtto -rHgiv-wb -- Vi 4yq) �ZISa4CO) 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 6 -► D Two 7-1010 2o),*7 -- LESSEE agrees to obtain the necessary permits from C©✓Arri( or- kum4e[:i� for the purpose of selling CLASS C. VA • Ml°a1&►� Ft&iVdZt5 during this period. LESSEE agrees to provide a certificate of insurance to the LESSOR providing coverage during the above dates, naming CCU i C H[-A) as additionally insured. LESSEE agrees to remove all stands, merchandise and refuse from the leased area by IS ZD 1 And shall restore the area to the same condition it was before the lease began. In addition, LESSEE agrees to hold 6 0.1 C H &.k) 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: 61u I CHE.AJ SIGNED—. WITNESS: 43Z DATE: LESSEE: 1-)'-yUYEL 51M0'Vb SIGNED: ,.v-- WITNESS: �i i DATE: y /J-/ 7 . O CERTIFICATE OF LIABILITY INSURANCEL4111/2017 DATE WYY" 1. 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 lieu of such endorsemen s . PRODUCER Britton -Gallagher and Associates, Inc. One Cleveland Center, Floor 30 1375 East 9th Street NCONTACT AME: PHONE FAX - - ACNo - ADDRESS Cleveland OH 44114 INSURERS AFFORDING COVERAGE NAIL t INSURER A:EVereSt Indemnity Insurance Co- 0851 INSURED 18166 INSURER B Fireworks Over America of South Carolina, Inc. 916 Rosewood Drive INSURER C Columbia SC 29201 INSURER D INSURER E INSURER F %.Cn I IrILIM 1 C NUM[SCFS' 917094r.79 4 Dcilneinu KI runn. 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 AD' INSR SUBR WVD POLICY NUMBER MMADD EFF MPOLICYM/DD/ EXP LIMA A I GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY S18GLOO655-161 12/1/2016 12/1/2017 EACH OCCURRENCE $1,000,000 PRE M SES Ea occurrence $ MED EXP (Any one person) $ CLAIMS -MADE OCCUR X $2500 Deductible PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: POLICY JFCTPRO LOC PRODUCTS - COMP/OP AGG $2,000,000 $ AUTOMOBILE LIABILITY COMBINED-9MI-t: LIMIT Ea accident ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per t $ UMBRELLA LIAB EXCESS LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? ❑ WC STATU- OTH- $ N/A E.L.EACH ACCIDENT $ (Mandatory in NH) If Yes, describe under E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. Property Owner: Gui Chen as well as Seasons of Change, LLC/Dan Simone Location: 1195 Seminole Trail, Charlottesville, VA 22901 Seasons of Change/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 y ACORD 25 (2010/05) I, 1985-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • " �rmP �••1 frtr i�� - xam Lm - x4uwLlw „Y .. • !'.... ;ice. tC ova— Q n c nr M ja g —wi ry n rr -PLAT IMM. . Clyy Qn:grk."Cltc - llb •�, �'�� L,_ e, g .ram L� ,� � . . File � � �� ••++ `'4Yy ��r r �e p tit. Y� ' •r�' m � •-^ wj�Z��n��L 4' SL n 0; t t t - • -';:_=ty ZAP•• :. �:f�•Y, '4i.:• " :eg - Be - H+761 CUE : A'T LurcH. LIW r ~ '•}r �•.',. � �r, A '•�•' It f '. � 126t f :ld vq 19. ' o� � • � _ � � � get Certificate of Flame Resistance REGISTERED ISSUED BY pate of Manufacture FABRIC JOHNSON OUTDOORS INC. NUMBER BINGHAMTON, NEW YORK 13902 JAN 2004 F-140.01 Manufacturers of the Finest Tent Products Described Herein This is to certify that the products herein have been manufactured from material inherently flame retardant as here after specified by the material supplier. NAME: GIBSON RENTALS CITY: BARBOURSVILLE STATE: VA Certification is hereby made that: The articles described on this certificate have been manufactured with an approved flame retardant chemical in compliance with California State Fire Marshal Code, NFPA-701-, Underwriters laboratory of Canada, and have been tested in accordance with the Federal Test Method Specifications 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 FT- ec K o 0 —T- T E � Z 17 H 71