HomeMy WebLinkAboutWPO201600083 Preconstruction Form WPO VSMP 2017-06-16 f rzu,.n CMIa
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Request for Pre-construction Meeting and Grading Permit
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from Albemarle County jeW
Approved Plan Number: WPO- 2 016 —oc2ocg3
Approved Plan Name: ( L Vti VG' 4` ( 0Ci a
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date: 5A3f t7
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber: `` n/
Print Name: g'004.14" ' )(t4V4mc)1 Dim tcGopli411
State Certification Number: 310 773
Address 26'Iq. pinscady, `Fc_
City J11)4t5 State VA Zip 23G'Y
Daytime Phone(S`4)) 412. Stas E-mail /�Vookyr►++�Q,ywil-'h5IZc e�Yt)4;1.Con-,
Primary Contractor: J f
Print Name (. Ftvcsa Cois\rtuatov 1 Mk& nag
Address Q.0 . c$0.), 4c60
City Keil 126 be State V A Zip '239`0
Daytime Phone(0) 616-4221 E-mail I" t 13040"se Kt brioCt. corn
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 59 .
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
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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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Dri'6 6er-1-ay. 441. 45e_ CokskrvAit, -Lci, 6410- j- 105
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 who?
7/1/14,Revised: 8/29/14 Page 2 of 3