HomeMy WebLinkAboutWPO201800011 Preconstruction Form WPO VSMP 2014-08-29 �ornr^i
•
Request for Pre-construction Meeting and Grading Permit
® l
from Albemarle County 11,ffit7
Approved Plan Number: WPO- .2 0/7 (90 0 7 9
Approved Plan Name: W'./Yon R-Ps;Qlo„
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date:
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber:
Print Name: /L10n4-{ &170 (on3rzC4- Ser✓,ceS lLL^
State Certification Number: 270 5/5- 03/8
Address 3 002 Q2 rk mgr Or;vee
City C-44. tie v,iL[ State L12 Zip -24p)
Daytime Phone('131-/) 2 Li 2 - G 0 .7E-mail rbi`��/ �, ,�n.,Gtis _ r1.QJ�
Primary Contractor:
Print Name ;1,30 r7 "45er>t';e/q� Eifc/;
Address //41 Z Cosa 1-1L54 Sir I-
City C4 r/n.}.}.eJ y;)/.. State 17-4- Zip 2 2g o2
Daytime Phone(4)3L/) g `p- z)7b E-mail j)o,,✓,L/1 GAa bti I�PrS .C�"►
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 $594.00
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 of 3
Person(s)to attend the Pre-construction Meeting:
Names(type or print) Firm Contact Number or email
Rob ,Qrr,S i /'7 0„4,0 bo//0 3L)) 2 412 - G 02 7
'Sash 4 Io1,;6e /1-7 or,4-I Po ' D ' ' - 0/2.
b of 13>uet GSE rz-i3z1) 560— 0-71.
1S LQ NPno GA -13=-1)/33i) —
7:41 -,G er- ';e4,/ 6A C ('i 3z-i) 53/ - 4/4311
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