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HomeMy WebLinkAboutCLE201800192 Application 2018-09-11APPRCl1/Pn ApplicationQi laance CLE GI�-1/5.E-©.A1LY PLEASE REVIEW ALL 3 SHEETS Check # 0—U Date: �7 ` Receipt # Staff: PARCEL INFORMATION Tax Map and Parcel: 7831 F Existing Zoning Planed Development Parcel Owner: PJP Building Two, LC Parcel Address: 630 Peter Jefferson Pkwy, STE 140 City Charlottesville State VA Zip 22911 (include suite or floor) PRIMARY CONTACT Who should we call/write concerning this project? Kenneth I Barron MD Address :630 Peter Jefferson Pkwy, STE 140E City Charlottesville State VA Zip 22911 OfficePhone:(434) 23404903 Cell#508-887-6896 Fax#434-234-4933 E-mail kenneth.barron@virginiagyn.con APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name x New business Business Name/Type: Center for Advanced Gynecology, PLLC / Medical Office Previous Business on this site Space is subleased from Eyelid & Facial Aesthetics (Dr Sara Kaltreider,MD) Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of vehicles, and any additional information that you can provide: Gyn@GG!Gg*G rnediGal PraGtiGQ with 3 arnployeas, 1 shift, 3 vehicles *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. 1 hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them. Signature Printed Kenneth I Barron APPROVAL INFORMATION [ ] Approved as proposed [ ] Approved with conditions [ ] Denied [ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117. [ ] 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 "7 � Other Official Date Uounty of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126 Revised I 1 /02/2015 Page 2 of 3 Intake to complete the following: Y/Q Is use in LI, HI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Y/ Willoere 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 or blic wat If private well, provide Health partment form. Zoning review can not begin until we receive approval from Health Dept. FAX DATE Circle the one that appli Is parcel on septic or ublic se 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: ?j xlN Permitted as: � Under Section: n Supplementary regulations section: Parking formula: Required spaces: Y / l� ItemWo be verified in the field: Inspector : Date: Notes: Vio�lons: Y �7Ifs ist: ffe If sn;'List: ZMA 101g0003 7 M � CGS I �D 15 Vari ce: Y / Ifs List: is: / N so, List: t� '�� �IA✓1 d Clearances: SDP's 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, application for zoning clearance [County application name and number] was provided to PJP Building Two, LC the owner of record of Tax Map [name(s) of the record owners of the parcel] and Parcel Number 7831F manner identified below: Hand delivering a copy of the application to 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 Date Mailing a copy of the application to Bernadette Coleman, Brandywine Realty Trust [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 8/23/2018 to the following address: Date 300 Arboretum Place, STE 330, Richmond, VA 23236 [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 Kenneth I Barron, MD Print Applicant Name 8/23/2018 Date c 0 vbalh6 <A f!3;)VW,pig' VWd ;, w O `C�'�H `�i3Cti�L'Ib?i W 5C Michael Dellinger From: Barron, Kenneth<kenneth.barron@virginiagyn.com> Sent: Wednesday, September 5, 2018 4:44 PM To: Michael Dellinger Subject: Re: zoning clearance question Dear Michael, We remodeled the space, but the exam rooms and procedure room were previously existing exam rooms. no additional exam rooms were added. I hope this answers your question? best, Kenny Kenneth I. Barron, MD Center for Advanced Gynecology, PLLC 630 Peter Jefferson Parkway, Suite 140B Charlottesville, VA 22911 www.virginiaGYN.com On Wed, Sep 5, 2018 at 1:59 PM Michael Dellinger <mdellinger@albemarle.org> wrote: Good afternoon, According to your zoning clearance you will be subleasing from Dr Kaltreider. Are the rooms you are planning on using existing offices or are they existing exam rooms? Thanks. Michael 1