HomeMy WebLinkAbout002-95 F & M Bank County Park Plaza - Backfile* STAFF SITE PLAN CHECKLIST *
This application is not complete if the following are not included:
1. One set of comment sheets from the following agencies along with any marked
copies of the plan;
VDOT
Sanitation Authority
Inspections Dept.
}� Fire Marshal
- / -/ County Engineer
Airport Authority
11136k5 2. One copy of the Site Plan application.
Date
3. Five copies of the Site Plan.
City of Winchester
Town of Stephens City
Town of Middletown
Health Dept.
Parks & Recreation
\ Soil & Water Conservation Dist.
4. One reproducible copy of the Site Plan (if required).
5. One 35mm. slide of the Site Plan (if required).
TRACKING
Application received.
All necessary agency comments received.
Fee Paid (amount $ ` ).
Site Plan to Planning Commission via bi-monthly.
— Site Plan heard by Planning Commission (if required).
Revisions received (if required).
Date of approval.
�� Info added to d Sus z.
RECEIPT
N2 024367
AMOUNT DUE
A NT PAID
--
$ia
BALACE DUE
$0
PAID BY
,CASH
14
CHECK
10?)A
❑ OTHER
FREDL.PICK COUNTY DEPT. Of PLANNING AND DEVELOPMENT
P.O. BOX 601, 9 NORTH LOUDON ST.
WINCHESTER, VIRGINIA 22601
RECEIVED FROM
ADDRESS
I I \Do - THE SUM OF�Ly'1\l_- G MARS + - --
FO:-�QAYTV - �1&(I' G- \-
COUNTY of FREDERICK
Department of Planning and Development
703/665-5651
FAX 703/678-0682
August 21, 1995
Mr. Tom Glass
847 Lake St. Claire Drive
Winchester, Virginia 22603
RE: Proposed F&M Bank with Drive -In
Country Park Plaza
Site Plan #002-95
Dear Mr. Glass:
This letter is to inform you that the Frederick County Planning Department administratively approved
revised site plan 4002-95 for the Country Park Plaza on August 17, 1995. This site plan involves the
construction of two drive-in lanes on the east side of the existing Country Park Plaza building. This
revised site plan includes the renovation of 2,800 square feet of the existing structure to
accommodate a bank with two drive-in lanes, a landscaped parking island, 154 standard parking
spaces and 1 handicapped parking space and ramp.
Attached are two copies of the approved site plan. This will enable you to maintain approved copies
in your records.
107 North Kent Street
Winchester, VA 22601
P.O. Box 601
Winchester, VA 22604
Page 2
Mr. Tom Glass
August 21, 1995
Please contact me if I may answer any questions regarding this letter.
Sincerely,
Eric R. Lawrence
Planner I
ERL\bah
Enclosure
cc: Steve Gyurisin, Gilbert W. Clifford and Associates
COUNTY of FREDERICK
Department of Planning and Development
703/665-5651
FAX 703/678-0682
February 22, 1995
Mr. Tom Glass
847 Lake St. Claire Drive
Winchester, Virginia 22603
RE: Proposed F&M Bank with Drive -In
Country Park Plaza
Site Plan #002-95
PIN SS-A-194
Dear Mr. Glass:
This letter is to inform you that the Frederick County Planning Department administratively
approved revised site plan #002-95 for the Country Park Plaza on February 22, 1995. This
site plan involves the construction of two drive-in lanes on the east side of the existing
Country Park Plaza building. This revised site plan includes the renovation of 2,800 square
feet of the existing structure to accommodate a bank with two drive-in lanes, 154 standard
parking spaces and 1 handicapped parking space.
Attached are two copies of the approved site plan. This will enable you to provide the
contractor with an approved copy and for you to maintain an approved copy for your
records. Please have the contractor contact this office to schedule an on -site inspection once
all improvements are complete.
107 Nortli Kent Street P.O. Box 601
Winchester, VA 22601 Winclester, VA 22604
f
orb ifairfax i"JCnimiltq :431i5trict Colltlitl54;i0t1
"Serving the Northern Shenandoah Volley"
Local Technical Assistance * Economic Development Network
Map & Data Center * Regional Programs
103 E. Sixth St. Front Royal, VA 22630-3499
Phone: (703) 636-8800 Fax: (703) 635-4147
Area Code (703) becomes (540) on Jul), 1. 1995.
NOTES
..I � —c--
DATE
zzG c)
TRIP Rideshare - Northern Shenandoah Valley
Please Recycle �
Page 2
Mr. Tom Glass
February 22, 1995
Please contact me if I may answer any questions regarding this letter.
Sincerely,
Eric R. Lawrence
Planner I
ERL\bah
Enclosure
cc: W. Harrington Smith Jr., Shawnee District Supervisor
Steve Gyurisin, Gilbert W. Clifford and Associates
T. Roy Jennings, Frederick County Real Estate
Betty Carroll, President F & M Bank
1 �I
-' REQUEST FOR SITE PLAN COMMENTS
Virginia Department of Transportation
ATTN: William H. Bushman, Resident Engineer
P.O. Box 278, Edinburg, Virginia 22824-0278
(703) 984-4133
RECEIVED
EDINBURG RESIDENCY
JAN 26 1995
KCO JAC O WLS O KDW
❑ KSH ❑ KDC O RLF
Copies to
The local office of the Transportation Department is located at
1550 Commerce Street, if you prefer to hand deliver this review
form.
Applicant Is name, address and phone number:
Country Park Plaza - F & M Bank
GILBERT W. CLIFFORD & ASSOC., INC 200 N. Cameron St.
Winchester Va 22601 C/O Stephen M. Gvurisin (703) 667-2139
Name of development and/or description of the request:
COUNTRY PARK PLAZA - F&M BANK DRIVE-IN
Location: SENSENY ROAD AND GREENWOOD ROAD. NORTHWEST CORNER.
Transportation Department Comments:
No objections to site plan. Existin entrances are adequate for proposed
improvements. Our minimum storage requirements of 150' are met to allow
for the two lane teller window.
VDOT Signature and Date:
Z7 3�
(NOTICE TO VDOT -PLEASE RETURN THIS FORM TO THE AGENT.)
NOTICE TO APPLICANT
It is your responsibility to complete this form as accurately as
possible in order to assist the agency with their review. Also,
please attach THREE copies of your plans and/or application form.
AMENDMENT
FREDERICK COUNTY ZONING ORDINANCE
Planning Commission April 6, 1994 - Recommended Denial
Board of Supervisors May 11, 1994 - APPROVED
AN ORDINANCE AMENDING
THE ZONING DISTRICT MAP
#f002-94 of THOMAS C. GLASS
WHEREAS, Rezoning application ##002-94 of Thomas C. Glass was submitted to rezone 2.38
acres, located east of Winchester, at the intersection of Senseny Road and Greenwood Road, in
the Shawnee District, and designated by PIN 55-A-194, from B1 (Neighborhood Business
District) to B2 (General Business District); and,
WHEREAS, the Planning Commission held a public hearing on this application on April 6,
1994; and,
WHEREAS, the Board of Supervisors held a public hearing on this application on May 11,
1994; and,
WHEREAS, the Frederick County Board of Supervisors finds this rezoning to be in the best
interest of the public health, safety, welfare, convenience, and in good zoning practice;
NOW, THEREFORE, BE IT ORDAINED by the Frederick County Board of Supervisors,
That Chapter 165 of the Frederick County Code, Zoning Ordinance, is amended to revise the
Zoning District Map to change 2.38 acres, designated as PIN ##55-A-194, from B 1
(Neighborhood Business District) to B2 (General Business District) as described by the
application and plat submitted, subject to the following conditions voluntarily proffered in
writing by the applicant and property owner:
•i •
REZONING REQUEST PROFFER
Re: Thomas C. Glass Property
Thomas C. Glass - Owner and Applicant
Rezoning Case No. 002-94
The undersigned Applicant, being the sole owner of the
property to be rezoned under the above referenced Rezoning Case
Number, hereby voluntarily proffers that if the Board of
Supervisors for the County of Frederick, Virginia approves the
rezoning application of.the undersigned for 2.382 Acres, more or
less, (being the Northwest corner of the intersection of Senseny
Road and Greenwood Road in Shawnee Magisterial District of
Frederick County, Virginia) from B-1 to B-2, the development of
the subject property shall be done in accordance with the
following terms:
1. The subject property to be rezoned shall not be used for
the following:
A. Communication facilities and offices.
B. Electric, gas and other utility facilities.
C. Retail nurseries.
D. Automotive dealers.
Bt, Hotels and motels.
i
F. Organizational hotels and lodging.
G. Car washes.
H. Golf driving ranges and miniature golf courses.
I. Model home sales offices.
J. Self-service storage facilities.
K. Public utility distribution facilities.
2. The subject property to be rezoned shall be used
primarily for retail and personal service uses. This proffer
does not intend to prohibit the use of the subject property for
an electric supply business.
3. The subject property shall be subject to the dimension
requirements, including the floor to area ratio and the lot
coverage requirements of the B-1 Zoning Districts of Frederick
County, Virginia. In addition, the maximum floor area for this
site shall be 31,100 Square Feet (the existing building is
approximately 30,000 Square Feet).
4. The conditions proffered above shall be binding upon the
heirs, executors, administrators, assigns and successors in
interest of the Applicant and Owner. In the event the Frederick
County Board of Supervisors grant said rezoning and accepts these
conditions, the proffered conditions shall apply to the land
rezoned in addition to other requirements set forth in the
Frederick County Code.
Respectfully submitted,
Cn
Thomas C. Glass
(Owner and Applicant)
•
This resolution was approved by the following recorded vote:
Richard G. Dick Aye Jimmie K. Ellington
W. Harrington Smith, Jr. Aye James J. Longerbeam
Charles W. Orndoff, Sr. Ave Robert M. Sager
This ordinance shall be in effect upon its passage.
Passed this 11th day of May, 1994.
A Copy Attest
John "iley,Jr.
Frederick County Administrator
Aye
Aye
&ye
gilbert w. clifford &
200 N.Cameron
Winchester, Virginia
703-667-2139 Fax:
TO:
WE ARE SENDING YOU
ElHAND DELIVERED
ElSHOP DRAWINGS
ElCOPY OF LETTER
0
associates, inc.
Street
22601
703-665-0493
X1ATTACHED
CHANGE ORDER
aPRINTS
l l PLATS
0
LETTER OF TRANSMITTAL
PRESENT DATE JOB NO.
2/21/95
ATTENTION Eric Lawrence
RE: C minfry Park Pla7.a
UNDER SEPARATE THE FOLLOWING ITEMS
SAMPLES SPECIFICATIONS
X❑ PLANS OTHER El
T
COPIES
DATE
DESCRIPTION
5
Jan. '95
Site Plan 1`.ID
`R �` �l I• �A �? '
X❑
ARE TRANSMITTED
XAI
FOR APPROVAL
FOR YOUR USE
AS REQUESTED
APPROVED/SUBMITTED
APPROVED/AS NOTED
El RETURN/CORRECTIONS
LJ FOR REVIEW or COMMENT
FOR BIDS DUE ----- 19___
REMARKS
COPY TO:
RESUBMITFOR APPROVAL
El SUBMIT___ FOR DISTRIBUTION
RETURNED_ CORRECTED PRINTS
El LOAN PRINT/RETURN
RETURN/WITH SIGNATURES
7
SIGNED Stephen M. G urisin
/ REV. 2.0
li"�
t•
COUNTY OF FREDERICK VIRGINIA
FIRE MARSHAL'S OFFICE �.. `\ • ,_ �' ;,�r
LAND DEVELOPMENT COMMENTS
Control No. 0213952111 Date Received 020195 Date Reviewed'-0213'95'
Applicant Name G. W. Clifford & Assoc.
Address 200 N. Cameron Street
Winchester, VA 22601
Project Name F & M Bank
Phone No. 703-667-2139
Type of Application Site Plan Current Zoning
1st Due Fire Co. 18 1st Due Rescue Co. 18
Election District Stonewall
RECOMMENDATIONS
Automatic Sprinkler System X Residential Sprinkler System
Automatic Fire Alarm System X Other
Emergency Vehicle Access;
Adequate X Inadequate Not Identified
Fire Lanes Required; Yes X No
Comments Fire lane required to existing fire hydrant on
site and existing fire lane on rear side must be maintained.
Roadway/Aisleway Widths;
Adequate X Inadequate
Special Hazards Noted; Yes
Comments
Not Identified
No X
- Continued -
REQUEST FOR SITE PLAN COMMENTS
Frederick County Inspections Department
P.O. Box 601, Winchester, Virginia 22601
(703) 665-5650
The Frederick County Inspections Department is located at 9 North
Loudoun St, 2nd floor of the Hammon Building in Winchester, if you
prefer to hand deliver this review form.
Applicant's name, address and phone number:
Country Park Plaza - F & M Bank
GILBERT W. CLIFFORD & ASSOC., INC 200 N. Cameron St.
Winchester Va 22601 C/O Stephen M. Gyurisin (703) 667-2139
Name of development and/or description of the request:
COUNTRY PARK PLAZA - F&M BANK DRIVE-IN
Location: SENSENY ROAD AND GREENWOOD ROAD. NORTHWEST CORNER.
INSPECTIONS Department Comments:
Building shall comply with Virginia Uniform Statewide Building Code and
Section 304, Use Group B (Business) of the BOCA National Building Code/1993.
Other codes that apply are title 24 Code of Federal Regulation, Part 36
Nondiscrimination on the Basis of Dis ilia I)y PuK
in Commercial Facilities.
Inspect. Signature & Date:
(NOTICE TO INSPECTIONS -,A ASE RETURN THIS,
lccommodations and
TO AGENT.)
NOTICE TO APPLICANT
It is your responsibility to complete this form as accurately as
possible in order to assist the agency with their review. Also,
please attach a copy of your plans and/or application form.
REQUEST FOR SITE PLAN COMMENTS 0A,
ffe�
Frederick County Engineering Depar
Attn: Director of Engineerin
P.O. Box 601
Winchester, Virginia 22601
(703) 665-5643
The Frederick County Engineering Department is located at 9,,;North
Loudoun St. , 2nd Floor of the Hammon Building in Winchester, i'firyqu;:�:,,
prefer to hand deliver this review.
Applicant's name, address and phone number:
( 13 U r 7;N-j Pkn K PLAZA - F 4 YA
Name of development and/or description of the request:
Location:
S!CNsENy Ao4a 4��
Engineers Comments:
1 vV ars ° f.4 tvy
o YA4L UJ-t, 4L
Engineers Signature & Date: - � C%-k , Z -yt.,6,V2.I
(NOTICE TO ENGINEERING DEPT. *PLEASE RETURN THIS FORMUTO PPLICANTT
NOTICE TO APPLICANT
It is your responsibility to complete this form as accurately as
possible in order to assist the agency with their review. Also,
please attach two copies of your plans and/or application form.
-13-
COUNTY of FREDERICK
Department of Planning and Development
703/665-5651
FAX 703/678-0682
January 31, 1995
Mr. Stephen M. Gyurisin
Gilbert W. Clifford & Associates
200 North Cameron Street
Winchester, VA 22601
RE: Preliminary Site Plan Review - Country Park Plaza
Dear Steve:
I have had an opportunity to review the above referenced site plan. The following comments will
need to be addressed prior to final approval of this revised site plan. Please:
1) Provide the name and address of the owner and developer.
2) Provide a space labeled "approved by the Zoning Administrator" for the approval
signature and date of approval.
3) Provide the magisterial district.
4) Provide the zoning of this site, and the use and zoning of adjoining properties.
5) Provide the surveyed boundaries for the site.
6) Change the 'setback required' summary to reflect accurate information. The setbacks are
35, 15, 50 feet for the front, side, and rear, respectively. Place the setback lines at the
appropriate location within the site plan.
7) Provide the ground floor area and the total floor area for the building.
8) Provide the height of the building.
9) Provide the location and dimension of any existing and proposed signs.
10) Provide the location of outdoor trash receptacles and storage areas.
11) Provide the calculations describing the required number of parking and loading spaces.
The submitted site plan contains existing and required figures; please provide the
calculations which were used to arrive at these figures. Note: The number of required
parking spaces under existing conditions is 150. Please change the plan to reflect this.
As the proposed bank drive-in lanes will replace 13 existing parking spaces, lines delineating these
spaces should be removed from the site plan. Additionally, the approved site plan for the gas
pump island has expired. Please remove the gas island from the current site plan.
107 North Kent Street
Winchester, VA 22601
P.O. Box 601
Winchester, VA 22604
r
Page 2
Country Park Plaza
January 31, 1995
The submitted site plan is a revision to an existing site plan. As you are aware, parking
requirement calculations are based on the uses within the site. Therefore it is important to include
the entire site on the revised site plan.
Please revise this site plan to address the above comments, in addition to any other comments
which have been provided to you. As discussed, we will present the submitted site plan to the
Planning Commission on February 1, 1995, and seek administrative approval authority. It is
necessary that we receive all approved review agency comments and five copies of this site plan in
order to proceed with approval of this project.
Please contact me if I may answer any questions regarding this letter, or, if I may be of further
assistance.
Sincerely,
Eric R. Lawrence
Planner I
Site Plan Application
Complete the following application:
DATE: January 20, 1995 Application #:�^-r
Complete the following application:
1. Development: Country Park Plaza - F&M Bank
2. Location of Property: Sensenv Road & Greenwood Road
3. Property Owner: Mr. Tom Glass
Address: 847 Lake St Clair Dr
Winchester Virginia 22603
Telephone: 703-662-2188
4. Applicant: Gilbert W. Clifford & Assoc., Inc
Address:
Telephone:
5. Agent/Designer: Gilbert W Clifford & Assoc., Inc
Address: 200 N. Cameron Street - Forth Floor
Winchester Va 22601
Telephone: (703) 667-2139
Contact: Stephen M. yurisin
6. Is this an original or revised Site Plan?
Original Revised XX
7. Total Area of Parcel to be developed: 2.382 acres
E
0
8. Property Information:
a) Property ID # :
c) Present Use:
55-((A))-194
t
0�
Existina Shoppina Center
d) Proposed Use: Bank with Drive -up window
e) Adjoining Property Zoning: RP
f) Adjoining Property Use: Residential
g) Magisterial District: Shawnee
I have read the material included in this package and understand
what is required by the Frederick County Planning Department. I
also understand that all required material will be complete prior
to the submission of my site plan.
Signature:
Date:
I I
• .-1 J 1kClryl•�� •
b
COMMONWEALTH of VIRGINIA
DEPARTMENT OF TRANSPORTATION
14031 OLD VALLEY PIKF
DAVID R. GEHR PO BOX 278
COMMISSIONER EDINBURG, 22824-0278
January 24, 1995
Mr. Steve Gyurisin
C/O G. W. Clifford & Associates. Inc
200 North Cameron Street
Winchester, VA 22601
Dear Steve:
WILLIAM H. BUSHMAN, P.E.
RESIDENT ENGINEER
TELE1703I984 5600
FAX (703) 984 5607
Ref: Proposed F & M Bank Drive -In Facility
Country Park Plaza
Routes 656 & 657
Frederick County
We have reviewed your draft plan of the referenced project.
It appears our minimum storage requirements our met to allow the drive-thru teller window
if two lanes are provided.
Once a final site plan is available please submit for review.
RBC/rf
Enclosure
xc: Mr. S A. Melnikoff
Mr R W. Watkins
Sincerely,
William H. Bushman
Trans. Resident Engineer
( �'�=�-/� AZ /�
By Robert B. Childress
Trans. Permits & Subdivision
Specialist Supervisor
TRANSPORTATION FOR THE 21 ST CENTURY
REQUEST FOP S TE PLAN COMMENTS
Frederick County Sanitation Authority
ATTN:Engineer/Director
P.O. Box 618, Winchester, Virginia 22601
(703) 665-5690
The Frederick County Sanitation Authority is located on Route 522
South of Winchester, if you prefer to hand deliver this review
form.
Applicant's name, address and phone number:
Country Park Plaza - F & M_Bank
GILBERT W. CLIFFORD & ASSOC., INC 200 N. Cameron St.
Winchester, Va 22601 C/0 Stephen M. Gvurisin (703) 667-2139
Name of development and/or description of the request:
COUNTRY PARK PLAZA - F&M BANK DRIVE-IN
Location: SENSENY ROAD AND GREENWOOD ROAD. NORTHWEST CORNER.
Sanitation Authority Comments:
Sanit . Signature & Date: �� • /� /1,l/
(NOTICE TO SANITATION LEASE RETURN THIS FORM T`Q AGENT.)
NOTICE TO APPLICANT
It is your responsibility to complete this form as accurately as
possible in order to assist the agency with their review. Also,
please attach Two copies of your plans and/or application form.
• 0
gilbert w. clif ford & associates, inc.
200 North Cameron Street • Winchester, Virginia 22601
703-667-2139 • Fax: 703-665-0493
January 30, 1995
Mr. Eric R. Lawrence, Planner I
Frederick County Planning Department
P.O. Box 601
Winchester, Virginia 22601
RE: Country Park Plaza - F&M Bank Branch
Revised Site Development Plan
Dear Eric:
CcIlk
Attached for your approval are five (5) copies of the above referenced site plan.
The plan has been revised to reflect your comments noted on January 26, 1995.
Based upon your comments and the Technical Review Committee (TRC),
parking spaces have been added to increase total parking to 152 spaces. Also
attached for submittal is a check for $1,238.00, your required application form and
comments from both VDOT an FCSA.
As you know, F&M Bank is awaiting your approval of this plan so that they may
proceed with building permits and improvements.
Sincerely,
gilbe w. clifford & associates, inc.
Step M. Gy ris'
SMG/cls
attachments
cc: Mr. Tom Glass
Ms. Betty Carroll
0
•
gilbert w. clif ford & associates, inc.
200 North Cameron Street • Witichester, Virginia 22601
703-667-2139 9 Fax: 703-665-0493
January 17, 1995
TO.
Mr. Childress, - Virginia Dept. of Transportation f
Mr. Whitacre - Frederick County Sanitation Authority
Mr. Keller - Greenwood Fire Company
Mr. Kiracofe - Frederick County Fire Marshal
L-Mr. Miller - Frederick County Zoning
FROM: Stephen M. Gyurisin
SUBJECT: Country Park Plaza, F & M Bank Drive-in facility addition
LOCATION: Senseny Road and Greenwood Road
Attached for your review and comment is the site planning comment sheet for
the above referenced project. We are currently revising the attached site
development plan to show the planned bank drive -up window, canopy, and
access lanes. We have been advised that there are no planned utility changes
and there are no planned site entrance changes planned.
Your comments on the enclosed "draft" plan are requested to help facilitate site
planning revisions and approvals by Frederick County.
A self-addressed, stamped envelope is attached for your use of return comments.
Should you require more information or should you wish to meet to discuss this
plan request, please call.
Your comments returned by January 25, 1995 is greatly appreciated for Planning
Commission review on February 1, 1995. Thank you.
Sincerely.
gilbe w. if ford iffid a sociates, inc.
Stephen urisin
COUNTY OF FREDERICK, VIRGINIA
DEPARTMENT OF INSPECTIONS
Caller 1)A�JA �iu _ Time Called 3:CO in,
_
Phone No. ";k.5 — 3z S Time Requested ASAi�
Received By EYA*3 A • W Ym_
PERMIT HOLDER NAME 410CVC' 1 061%PATJY
Date Called 8 / / L % `7Sr
Date Requested 8I%/95
Date of Inspection _�1-7 215
RT. NO. s S 1 Lot No. SEC. No. SUBDIVISION
STREET NAME E
DIRECTIONS CexW, ST"zi�T s►�aa<• S- BUILDING NO. (.3S ^ 95
5 +rMuJ Q_�-a rD CAI w&J ti PLUMBING NO.
pAQ,e_ ELECTRICAL NO.
ApJA<ENT -rn ,Q77E2SeZ.n(YI) MECHANICAL NO.
fit= S SAY aftn &W_-T),J3uD erA- SIGN NO.
DISTRICT 5 t.+A,J*JEJ --
PERMIT FOR: F f M, &+Ji<
Type of Inspection
Residential Commercial
Footers ___ ______
Setbacks: FIR
BK L
R
Slab
Draintile
Gas Fire -up
Final Electrical
Water
Service
Framing
Final Mechanical
Sewer
Rough Electric
Final _
Site Plan
Rough Plumbing
Rough Mechanical
Final Building
Fire Marshall
Groundworks
Gas Pininn/Test
Final Plumbinq
Special/Complaint
Other: _0
U
Time In: 124 Temperature `�� is Cut in No.
Time Out: 2 • Weather
Results: Approved C �? Rejected
Comments:
.— —{}-- - Signature Date
L1 n-�+^� �(�
COUNTY OF FREDERICK, VIRGINIA
DEPARTMENT OF INSPECTIONS
Caller L1 t l _j MW R �, Time Called 10 : 56 Date Called
Phone No. la 3,_$15' Time Requested k5A-!'-__ Date Requested AShfl
Received By CVA*3 WYa7-1`— Date of Inspection
PERMIT HOLDER NAMEY_-
RT. NO. a % Lot No. SEC. No. SUBDIVISION
STREET NAME SC.N��—N� Rnrkn
DIRECTIONS 51u •a3 CniZK �M��T Rc/c.c5' BUILDING NO. ��JS 7�
•-
=' PLUMBING NO.
t*z,�a�k SET s L-�y n Apreox ELECTRICAL NO.
Z ram- T-iaJ MECHANICAL NO. _
OF <;cTj5EW 2 L. r C•ICca;�73ubc tz> SIGN NO.
DISTRICT �F+r�w►.�r--- - -- - — -
PERMIT FOR: F
Type of -Inspection
Residential
Commercial
Footers
Setbacks: FR
- BK L
__ R
Slab _
Draintile
Gas Fire -up
Final Electrical
Water _
_ Service
Framing
Final Mechanical
Sewer
Rough Electric
Final
Site Plan
Rough Plumbing _ -_
Rough Mechanical
Final Building
Fire Marshall
Groundworks
Gas Piping/Test
Final Plumbing
Special/Complaint
Other:Time
In: Z= OZ PM
Temperature
+ F Cut in No.
Time Out: Z • b
E4 Weather
SlilJ �v
Results: Approved
Rejected
(
Dieu, r Az,
Comments: MPLL--TZ-
A:�eh i,T t
r1]4 H ---A
PC
A
Signature
TON(31 t_.t p >,c, r
Date A / I+%q s