HomeMy WebLinkAboutWPO201500022 Preconstruction Form 2014-07-10 01/23/2010 17:58 FAX 1Q 001
Request for Pre-construction Meeting and Grading Permit a-5240.2
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from Albemarle County '' •~
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Approved Plan Number: WPO-
Approved Plan Name: `a 4T P. ,. 1 K� e : �bc»--t 's, r(.. 5!wwe-04, PaArti4-
(Plans must be approved prior to a pre-construction meeting.)
Bond issued date: Bond Number:
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber:�
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Print Name: ('�y cY,�/Q l �
State Certification Number: 410ZtroS--
Daytime Phone OW) 9v-- )' 2 E-mail GOP 5/ '-:ET -4 t),4 •CC's-t'
Primary Contractor:
Print Name /
Address 7 ti-/1�s �.,q f3G P
City pkl State_MA zip 22ge e,
Daytime Phone ')4%r7�y-4.3, 77'-- E-mail 1.....143c-7-c,Z/ae C� r�� T t T
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 Duc at Grading Permit
Less than 1 $63.80
1 and less than 5 S594.00
5 and less than 10 $748.00
10 and less than 50 $990.00
50 and less than 100 51,342.00
100 and more -52,112 00
For plans exempt from VSMP,VESCP fees were paid with the application.
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01/23/2010 17:56 FAX 11002
Person(s)to attend the Pre-construction Meeting
Names(typeor print) Firm Contact Number or email
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L77-71.L.:
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The second part of the application fee is required to be paid with this request. This fee amount is.
POR OFFICE U5!ONLY Permit lintel Diu
By who?
71 1::14,Revised. 7110'14 Page 2 of 3