HomeMy WebLinkAbout03-10 Verizon Wireless - Telecommun. Tower Izaak Walton - Shawnee - BackfileSITE PLAN TRACKING SKEET
Comment Sheets:
GIS `, VDOT ✓
Sanitation Authority X Winchester
Inspections ✓ Stephens City
Public Works X Middletown
Parks & Rec �. _ Airport V
Health Dept. File_
One copy of Site Plan application form
—� Payment of site plan review fee
One reproducible copy of Site Plan
OPEN FILE:
O File Opened
D Reference Manual updated/number assigned
q4L)0—
D-base updated
, d pplication Action Summary updated
CLOSE FILE:
—/ D Approved (or denied) letter mailed to applicant/copy to file and cc's
VA/ // O File stamped "approved", "denied" or "withdrawn"
0 Reference Manual updated
D-base updated
p Application Action Summary updated
Sys lD-9
U
DATE
RECEIVED FROM
ADDRESS
.JFOR RENT
JJ FOR
NO. 3935
DOLLARS S ____
AMT OF CASH '
ACCOUNT
AMT PAID - CHECK
PAI ANCE %inliry - BY
F
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46
April 7, 2010
Mr. Brian Silverling, PE
Morris & Ritchie Associates, Inc.
1220-C East Joppa Road, Suite 505
Towson, Maryland 21288
Department of Planning and Development
540/665-5651
RE: Approval of Site Plan #03-10; Verizon Wireless — Izaalc Walton Park
Property Identification Number (PIN): 77-A-68
Dear Mr. Silverling:
The Prederick County Department of Planning and Development administratively approved the
above -referenced site plan on April 7, 2010. The site plan is approved for an expansion of an
existing telecommunication tower site located at 3101 Millwood Pike in the Shawnee Magisterial
District. This expansion includes some of the following:
• Twelve (12) antennas mounted on the existing tower (does not increase height).
• New 1 P-7" x 30' equipment shelter and a new ice bridge.
The site plan meets all regUlremcuts for development in the RA (Rural Areas) Zoning District.
All relevant review agencies have approved the project at this time. I am providing you with
three (3) copies of the approved site plan. Please forward these copies to the appropriate
representative(s). Furthermore, advise the owner(s) that a copy should be kept for future
reference, and an approved copy must be kept on the construction site throughout the
development process. Once site development is complete, the owner(s) should contact this office
to schedule an on -site inspection. Do not hesitate to contact me should you have any questions or
concerns.
Sincerely,
;Jz—
Caridice � f
E. Perkins, AICP
Senior Planner
Enclosures
CEP/bad
cc: Jane Anderson, Real Estate
Gene Fisher, Shawnee Magisterial District Supervisor
Lawrence Ambrogi and 1-I. Paige Manuel, Shawnee District Planning Commissioners
Commissioner of Revenue
SCE for Verizon Wireless, c/o Andrew Martin, 9000 Junction Drive, Annapolis Junction,
MD 20701
107 North Kent Street, Suite 202 • Winchester, Virginia 22601-5000
0
Verizon Wireless
9000 Junction Drive
Annapolis Junction, MD 20701
301.512.2000
April 6, 2010
Department of Planning and Development
Attn: Candice Perkins, Senior Plamier
107 North Kent Street
Suite 200
Winchester, VA 22601
Via Hand Delivery
Re: Site Plan #03-10; Verizon Site Names: Izaak Walton Park
Property Identification Number (PIN): 77-A-68
Revised Site Plan for Approval
we"n (wireless
Andrew Martin
Real Estate/Zoning
Cell: 410.474.9081
Fax: 410.286.8355
Candice, we have revised the site plan per your comment letter dated February 22, 2010. Find enclosed
five (5) sets of site plans for your final approval. Also, find enclosed comment sheets from the Frederick
County Inspections Department, the Frederick County Fire Marshall, VDOT and the Winchester
Regional Airport Authority. All of the agencies have recommended approval for our site plan.
Please process accordingly. If you should any questions please contact me.
Sincerely,
Verizon Wireless
Andrew Martin
Real Estate/Zoning
APR 2010
I.
•
1
2
3
0
J
SITE PLAN APPLICATION
Department of Plannin j and Development lJse only.
Date application received: Application
Fees received: L-�': Initials:
Project Title: VC C I Z. 61Y) (Ui Kr / /_--S_S— ---T7-A4)kVIA Z-XlN ef0,<'
Location of Property 31 7 S l ! )LL Gy 00 0 � � � C
(street address) I Nc/-/F-S � yA_
Property Owner: � _�Kr? �Ir . I C�i `Ila 1�, fir/ %nir7
Address: _L/� ��JCI'C%f�� (/�� //e co/ye
br � ( btj Z 5
Telephone: 302-
Applicant/Agent C E-7 -Co r VzT1200 kl"/clo 144�%/e
Address 9 00Q J C l / 6-,7 br r ve cl,^6;2
Telephone: ///O-1-/71-- ` %U
Designer: Mc, -,-/ S J/�17��/P, 4z.c)cicc Zo J��C
Address: 22.C) - C EC?S Au 2,?t %\ 0q
S u� & 5-0 5
7owscyi , N/) 212E
Telephone: /-//o - 82/ - /l� 9 0
Contact: 13ci a !Q S /v k"'/, ///9 P
ro
•
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6s.
6b.
7a.
7b.
8.
a)
b)
c)
d)
e)
g)
Is this a standard or'minor' site plan?
Is this an original or revised site plan?
Total acreage of parcel to be developed:
Total acreage of parcel:
Property Information:
Property Identification Number:
Current Zoning:
Present Use:
Proposed Use:
Adjoining Property Use(s)
Adjoining Property Identification Number(s)
Magisterial District(s)
Standard Minor r�
Original ti Revised
10 3, 07 aCTes
T7 -4-Ca
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,T-C C ors M C 'e 0?,
e leC Omm U4/ Ccr 6pY1
s� - /cc >7
See S/
Shac��vr�e
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: 2 15—h 0
•
•
Request For Site Plan Comments
Department of Planning and Development
Mail to:
Department of Planning and Development
Attn: County Planner
107 North Kent Street
Winchester, VA 22601
(540) 665-5651
Hand deliver to:
107 N. Kent Street
North Building, 2n' Floor
Winchester, VA
(540) 665-5651
Please fill out the information as accurately as possible in order to assist the agency with their
review. Please attach two (2)) copies of the site plan with this sheet. 1
Applicant's Name: VeIIZU� (N1���CS1' cZo �✓����Gv ��Q�l/Ji7 SCE
Address:
Phone Number:
Name of .development and/or description of the request:
erne 3o x 2 n 0 C cvo (?� _ r/ H
Location of property:
:�)�% 5
Planning and Development's Comments:
Planning and Development Ilse only
Date received
Incomplete
Date reviewed
Signature and Date
Signature and Date (revision)
Date revision received
Incomplete
Date reviewed
15
Date approved
•
0
`GY� ' o oCi
Special Limited Power of Attorney
County of Frederick, Virginia
Frederick Planning Web Site: ti4wt►.co.freclerielc.va.us
Depiu•( inent of Planning & 1)eve Iopill ent, County of Frederick, Virginia,
107 North Kent Strect, Suite 202, Winchester, Virginia 22601
Phone 5,10-665-5651 Facsimile 5,10-665-6395
Know All Men 13), Thosc Present: That I OV0
30y-- 28 3--z/C)0
(Address) W l 1do1en V011e1 CQve.�j ep�l�c�t' owo . WV zS"yy3
the owner(s) of all those tracts or parcels of land ("Property") conveyed to nae (us), by deed recorded in the
Clerk's Office of the Circuit Court of the County of Frederick, Virginia, by
Instrument No. y/ RJ on Page , and is described as
Parcel: Lot: 65 Block: — Section: — Subdivision. T,,>,, Alqrp 77 A C&
cto hereby make, constitute and appoint:
(Nanae)_Andr-et,,, Mil/[its) Vey)Zw1 WILe J'S (Phone) �Z/0'/'72/-900/
(Address) '-/000 juoc.�icn Dt'lye 3 y000p d LJ, Ilol ) ND 2070/
To act as nay true and lawful attorney -in -fact (m and in my (our) name, place, and stead with full power and
authority 1 (we) would have if acting personally to file planning applications for nay (our) above described
Property, including:
❑ Rezoning (including proffers)
V Conditional Use Permits
❑ IViaster Development Plan (Preliminary and Final)
❑ Subdivision
14, Site Plan
i\,/Iy attorney -in -fact shall have the authority to offer proffcrccl conditions and to make amendments to
previously approved proffcrccl conditions except as follows:
This authorization shall expire one year from the clay it is signed, or until it is othenvise rescinded of -
modified. l�
In witness thereof, I 'c have her o ct n )(ou - 'hand a ad seal this Z/ clay of 0 J , 200 ,
Signatures)
Sf ttcvH�irgrlrrt C—tt)C—of+a�lt� jilt(�[uj], 1-t� To -wit:
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a Notary Public in and For the jurisclietion
aforesaid, certify that the person(s) who signed to the foregoing instrument personally al„ tired before me
an, has acknowl(-" )ed the san e before nae in the jurisdiction aforesaid this 5 clay of 200_q_.
My Commission 1: NANETTE JONES-POTTS
NRO!iY-PUBL-IC—DIS-TRIeT-6FCOLt1MBIA
Notary Public My Commissir, Expires biav 14, 2012
0
Candice Perkins
From: Funkhouser, Rhonda [Rhonda.Funkhouser@VDOT.Virginia.gov]
Sent: Monday, April 05, 2010 9:58 AM
To: Candice Perkins
Cc: Ingram, Lloyd
Subject: RE: Approval - Verizon Wireless - 50/17, Frederick Co
It is approved with the issuance of the land use permit.
From: Candice Perkins[ma iIto: cperkins@co.frederick.va.us]
Sent: Monday, April 05, 2010 9:58 AM
To: Funkhouser, Rhonda
Subject: Approval - Verizon Wireless - 50/17, Frederick Co
Rhonda,
I received the emails regarding the approved Land Use Permit for the Verizon Wireless Tower, however I haven't seen an
approval for the actual site plan. Do you know if Lloyd has issued the site plan approval yet or what the status of it is?
Thanks,
Candice
Candice Perkins, AICP
Senior Planner
Frederick County Department of
Planning & Development
107 North Kent Street
Winchester, Virginia 22601
(540) 665-5651
(540) 665-6395 (fax)
coerkinsl@co.frederick.va.us
www.co.frederick.va.us
MORRIS & RITC& ASSOCIATES, INC.
■. W i V. A
'M Engineers, A /itects, Planners,
��� Surveyors and Landscape Architects
1220-C East Joppa Road, Suite 505, Towson, MD 21286
Phone 410-821-1690 - FAX 410-821-1748
TO: Department of Planning and Development
107 North Kent Street, Suite 202
Winchester, Virginia 22601-5000
Phone: (540) 665-5651
WE ARE SENDING YOU ❑ Attached ❑ Via
❑ Shop drawings ❑ Prints Plans
❑ Copy of letter ❑ Change order ❑
LArER OF TRANSMITTAL
DATE: February 25, 2010
1JOB NO.: 10427.733
ATTN: Candice E. Perkins, AICP
RE: Izaak Walton
Fed EX THE FOLLOWING ITEMS:
❑ Specifications
COPIES DATE NO. DESCRIPTION
1 s/s ZD's
THESE ARE TRANSMITTED AS CHECKED BELOW:
❑
For approval
❑ Approved as submitted ❑ Resubmit copies for approval
For your use
❑ Approved as noted ❑ Submit copies for distribution
As requested
❑ Returned for corrections ❑ Return corrected prints
❑
For review and comment
❑
❑
For Bids Due
REMARKS:
COPY TO: SIGNED:
Jake lldroney,IP.E.
r i 2 6 2010
L _1 If enclosures are not as noted, kindly notify us at once.
.- i r F�1•
•l� '
COAy of FR��bERIC��
Department of Planning and Development
540/665-5651
FAX: 540/ 665-6395
February 22, 2010
Mr. Brian Silverling, PE
Morris & Ritchie Associates, Inc.
1220-C East Joppa Road, Suite 505
Towson, Maryland 21288
Re: Review Comments for Site Plan 903-10; Vel-izon Wifeless — Izaalc Walton Park
Property Identification Number (PIN): 77-A-68
Dear Mr. Silverling:
Planning Staff has reviewed the above -referenced site plan to determine if administrative approval can be
granted. At this time, administrative approval cannot be granted. This site plan is denied until tile n e issues i
this letter, as well as all issues of the other review agencies, have been adequately addressed. Please review
Staff's comments listed below and then prepare a revised site plan which adequately addresses each concern.
Review Comments:
Site Information. On the coversheet, revise the owner t(
property owner information fi•om sheet 2 on the coversheet.
tower was originally constructed.
Existiniz Site Elements. Many of the symbols shown in
shoxvn.
Equipment Building. Indicate if any building -mounted
building,
show the tower owner and provide the
On the coversheet, provide the year the
the existing site elements legend are not
lighting is proposed on the equipment
After you have revised the site plan, please resubmit one copy so that I may verify the information contained
on the plan. I will need all approved review agency comment sheets and at least five copies of the final plan
for approval. Comment sheets are required from the following agencies: the Frederick Colmly h1q)ections
Department, the Frederick Cozmf)y Fire Alarshal, and the 14'777chester Regional Airport Authorit}�.
Do not hesitate to contact me if you have any questions or concerns regarding this letter.
Sincerely,
Candice E. Perkins, AICP
Senior Planner
Attachment
CEP/bad
cc: SCE for Verizon Wireless, c/o Andrew Martin, 9000 .function Drive, Annapolis Junction, MD 20701
107 North Kent Street, Suite 202 • Winchester, Virginia 22601-5000
Verizon Wireless
9000 Junction Drive
Annapolis Junction, MD 20701
301.512.2000
February 5, 2010
•
F
7-L-
Frederick County Virginia
Department of Planning and Development
107 North Kent Street
Suite 202
Winchester, VA 22601
Via Hand Delivery
Re: Application for Site Plan
Proposed Antennae Placement and Shelter
3175 Millwood Pike, Winchester, VA
Verizon Site Names: Izaak Walton Park
I
gnin
YW'lZMwireless
Andrew Martin
Real Estate/Zoning
Cell: 410.474.9081
Fax: 410.286.8355
Verizon Wireless is proposing to attach our antennas at the height of 145' and will place an unmanned 12'
x 30' shelter at the base of the tower. The tower is located at 3175 Millwood Pike in Winchester. The
Frederick County Zoning Ordinance requires Verizon Wireless to obtain certain state and local agency
comments before we can submit our application. To assist your agency in completing the "Site Plan"
comments form, we have attached the following:
1. Application For Site Plan
2. Application Fee of $500
3. Site Plan
4. Special Limited Power of Attorney
If you should have any questions please contact me.
Sincerely,
Verizon Wireless
Andrew Martin
Real Estate/Zoning
•
•
Document Approval Form
PLEASE REVIEW THE ATTACHED DOCUMENT. IF THIS DOCUMENT MEETS YOUR
APPROVAL PLEASE INITIAL AND PROVIDE THE DATE AND TIlVIE OF YOUR
APPROVAL.
IF THIS DOCUMENT DOES NOT MEET YOUR APPROVAL PLEASE PROVIDE
COMMENTS AS TO WHAT YOU WOULD LIKE TO HAVE COMPLETED.
C Candice ; \
Mark
Dana
Eric
Mike
John
COMMENTS:
INITIALS DATE & TIME
.� K'I
i
Received by Clerical Staff (Date & Time): ?- , D
U:\Pam\Common\Document Approval Form.wpd
,�,)j� I(()
•
0
Request For Site Plan Comment
Frederick County Inspections Department
Mail to:
Frederick County Inspections Dept.
Attn: Building Official
107 North Kent Street �� 'hJr)
Winchester, VA 22601 �
(540) 665-5650
Hand deliver to:
107 N. Kent Street, Suite 200
North Building, 2"d Floor
Winchester, VA
(540) 665-5650
Please fill out the information as accurately as possible in order to assist the agency with their
review. Please attach one (1) copy of the site plan with this sheet.
Applicant's Name: vQ xo� %1/i c G 1'
Address:
Phone Number:
y/D--y7y--9Ob/ -
Name of evelopmentLPnd/or description of the request: erl� rN 0) cJf -ra Pcr h r�rk
,� 7�-iv or1 eaU
Location of property: 3) 7
Inspections Department's Comments:
...Inspections Dept. use only+'
:;Date received
Incomplete
Date:reviewed
- Signtiture'and Datc _
Siunature and Date (revision)
Date revisi
Incomplete
Date revi4
16
i0 39dd
Z890OL900S 6Z:5Z 0Z0Z/bZ/Z0
Structure shall comply with The Virginia Uniform Statewide Building Code and Section 312, use
group U (Utility and Miscellaneous) of The International Building Code 2006. Site plans shows
an antenna to existing tower and a new shelter.
Structural plans submitted for permit application shall he sealed by a Va. Licensed Design
Professional for antenna attachment. Please note the requirements in Chapter 17 Special
Inspections for this type structure, soils, concrete, bolts, etc.
7,0 39VJ Z8908L90b5 6Z:9i 0Z0Z/GZ/Z0
From:LIFESAFE
•
03�/2010 10:58
#483 P.001/001
Control number Date received Date reviewed Dale Revised
S P 10-0002 2/9/2010 2/12/2010
Project Name
Verizon wireless / Izaak Walton
Address
9000 Junction Drive
Type Application
Site Plan
Current Zoning
RA
Automatic Sprinkler System
No
Other recommendation
Emergency Vehicle Access
Not Identified
Siamese Location
Not Identified
Emergency Vehicle Access Comments
Access Comments
Additional Comments
Plan Approval Recommended
Yes
Applicant
SCE for Verizon Wireless C/O Andrew Martin
City Stale Zip Applicant Phone
Annapolis Junction MD 20701 410-474-9081
Tax ID Number Fire District Rescue District
77-A-68 21 21
Election District
Recommendations Shawnee
Automatic Fire Alarm System Residential Sprinkler System
No No
`�'� c� z�' re t'i'i e n t'::.
Hydrant Location Fire Lane Required
Not Identified No
Roadway/Aisleway Width Special Hazards
Adequate No
PLANS .
PFROVE
g�-�+ GG rt��-� 'a�1 }{','y, (� t y��.. �.' i�j (s nj y)
C 1 7.,., lkdt^g�t�M7� A., �i��Y t' b+�"�.,F•c����. l.J �i`'�Jt7 Y: fir';•
Reviewed By Signature
S. Mark Showers
Title�t.�,�L------�-
VDOT Land Use Permit 98 9193 - Approval - Verizon Wireless Private Entrance - 50/... Page I of 1
From: Funkhouser, Rhonda <Rhonda.Funkhouser@VDOT.Virginia.gov>
To: Andrew Martin <amartin@sceeng.com>, Melissa Reese <mmreese@comcast.net>
Cc: Hoffman, Gregory <Gregory.Hoffman@VDOT.VirginIa. gov>, Ingram,
Lloyd <Lloyd.Ingram@VDOT.virginia.gov>,
cperkins@co.frederick.va.us
Date: Friday, April 02, 2010 01:55 pm
Subject: VDOT Land Use Permit #855-9193 - Approval - Verizon Wireless Private Entrance - 50/17, Frederick Co.
Attachments: V
1n 855-9193.pdf (1MB)
U 2010.3.17_Izaccwalton_ZDs_with_Entrance.pdf (2MB)
Attached is your approved Land Use Permit #855-9193 and plans to the installation of a
private entrance at the subject location.
«855-9193.pdf>> <<2010.3.17_Izaccwalton_Ms_with_Entrance.pdf>>
Please ensure a copy of the approved permit assembly is kept at the job site whenever
working within the right-of-way. I would also like to remind you of the need to erect and
maintain proper traffic control in accordance with our Virginia Work Area Protection
Manual and the Manual of Uniform Traffic Control Devices.
You are required to contact Greg Hoffman at (540) 535-1824 at least 48 hours in advance
of the start of construction to arrange for any necessary inspections.
Once the work has been completed, please advise this office so a final inspection can be
performed.
If you have any questions concerning the permit requirements or during construction, do
not hesitate to call/email.
P.noAda FbwJzko�(ser
virgiv,. ,2 DeportmeAt of TrciAsportati,ovL
bawd DevelopmeAt
1.4031 odd Va[l.eU PC' 6
EdI o,burq, VLygq v,,41 22224
PnoAe 1/ (540) 904-5<02
FnX # (540) 924-560z-
littp://mail.sceeiig.com/e(lgcclesk/cgi-bin/vicwmail.exe?icl=0 10383cc9bde4c0825dfa8c7cc8a... 4/5/2010
0
Commonwealth of Virginia
Department of Transportation
Land Use Permit
•
Permit No. 855-9193
Revision No. 1
:J Status Active
Application No. Payment Method Check Total Payment Amount $100.00
Effective Date April 2, 2010 Expiration Date September 29, 2010
Reinstatement Date Revision Date April 02, 2010
Permittee Information
Owner E886598-1-1, Herman Ashby
Duke
Address Herman Ashby Duke
41 Hidden Valley Cove
Shepherdstown, WV 25443
Contact Ashby Duke
Phone # (304)876-6758
Your Job # Verizon Wireless Private Entrance
Agent 521170360-1-1, D & H Builders
Address D & H Builders
7001 Van Dusen Road
Laurel, MD 20707
Contact Melissa M. Reese
Phone # (301)317-5777
Fax # (301)953-2749
24 Hr. # (301)814-0132
Surety & Account Receivable Information:
Name Cash
Surety Type
Cash
Surety Acet.
43871
Amount
5,000.00
Obligation Amt.
5,000.00
Surety Holder
Agent
Acct. Recv. #
AUTHORIZATION: In compliance with your application, permission is hereby given insofar as the Commonwealth Transportation Board has the right,
power, and authority under sections 33.1 - 12(3); 33.1 - 197; 33.1 - 198 of the Code of Virginia as amended, to grant by Special Agreement and/or by Land
Use Permit for you to perform the work and or activity(s) described below:
County/City/Town Frederick Co.
Highway Route(s) 50/17
From Route 644, East Parkins Mill Road
To Route -, Capon Valley Road
Installation of a Daved PE-1 entrance Der attached Dlans and soeclal Drovisions.
Fee Description
New Fee
Existing Fee
Total
Regular
$0.00
$100.00
$100.00
Totals
Applicant has complied with Section Code 56-265.15 affidavit is attached. D YES 7 Not Applicable
TERMS: Applicable as stated within the Land Use Permit Manual (current edition) and/or as per approved plan(s) and/or regulatory instructions and/or
agreements attached hereto. THIS PERMIT IS NOT VALID WITHOUT THE FOLLOWING ATTACHMENTS:
Approved Site Plans, Special Provisions - General
COMMONWEALTH TRANSPORTATION BOARD
�i Call before you dig
Greg A. Whiney, Acting Commissioner,
Allow the required time for marking`
By. —�"�"`
_ 4.1212010 (D Respect and protect the marks/flags
Lloyd A. Ingram
Excavate
Call Miss Utility
carefully
811
Final Inspection Requirements: Upon completion of the work
described under this permit, the permittee shall contact the following office in writing to
request inspection.
Edinburg Residency (540)984-5600
14031 Old Valley Pike
Edinburg, VA 22824
Permit No.: 855-9193, Revsion No.: 1
Land Use Permit
VD07's Web Site: ww11.vdot.virginia.gov
u
Commonwealth of Virginia
Department of Transportation
6/2008
i4 :j ;? l
, r
�a
LUP-A
LAND USE PERNUT
Application
APPLICATION is hereby nude for permit as shown on the accompanying plan or sketch and as described below. Said activity(s) will be done under and in accor&nec with die rides and
xgulatioris of de COrmnonwCtlth Transportation Board of Vir,^�;, in so far as said rules arc applicable thertro and any agreement bmwen the parties berein before referred to. Where
applieible agreements may be aaacbed and made a port of the permit numbly including any cost responsibilities covering work under permit. Applicant agrccs to maintain work in a
manner as approved upon is completion. Applicant also hereby agrees and is bound and held responsible to rite owner for any and all damages to any other insmIlatioru already in place as a
nstdt of work covered by resWting permit Applicants to whom permits aro issued shall at all times indertu fy and save harmless the Commonwealth Tmnspomdon Board members of the
Board, the Commonwealth and all Commonwealth employees, agents, and ofL•ecs, from rmWnsbility, damage, or liabilityarising from die exercise of the privikgcs granted in such permit
to t' e extern allowed by law. In consideration of the issuanoc of a permit the applicant agre s to waivo for itself, successors in interest or assigns any cntidcmtents it may otherwise have or
have herraRer under the [inform Relocation and Assistant Act of 1972 as amended in event the Department or its successor, chooses to e xcrcise its acwowlcdgai right to demand or eauso
the removal of gay or all fixaues, pemoartity of whatever kind or d 'cripdon dut may herea ler be located should this application be approved.
TYPE OR PRINT CLEARLY
Driver's license or Tax ID number: qi � L �`` Contact Name: r
Owner Name: '4 -C�r / ) \ E-mail Address: I �C CHtJ CCG
Address: ��',.' U '�- Phone Number: ()-
/�
City: _1Stat Zip Code% 1 Emergency Number: ( )
Fax Number: ( ) -
Driver's license or TaxLLID number: - cc� _(p O Contact Name: /--fAf . � _ S —
Agent Name: 4t E-mail Address: LJ,,?J9 e•
III
Addre/ss:t /�) Vi1 r.� -DS 4SEh� OtD Phone Number :(,2 >L) 3/7 -5-7z1`;7
City: Stag tp_Zip Code Emergency Numbcr:( b)
Fax Number: ( OL) 9'
Permit Term Requested FeesEnclosedS Ul b, CheckNumber419-7_Coupon Number(s)
hfoney Order Other E 'mated cost of work to be performed on VDOT Right of Way S
Suretv Information: Company dame ' r
The Surety posted by Owner ( ) or Agent (xf
[S'urety
Amount of Surety S :) D-6 0 • ~ Obligation Amount S 5 �� .
4
Check m Bond # II C #
Surety Refunds paid to Owner () or Agent ((
" IF SURETY IS BY CHECK OR MONEY ORDER -
[ j Corporate Surety [ ] Resolution [ ] Ordinance [ ] Waived
THEN SS# OR TAX ID# IS REQUIRED "
Applicant has provided proof of the fnlloein_ requirements in necordance as defined in Code of Vir-inia acctinn 23-1151.14
(1) The utility company has registered as an operator with the appropriate notification center.
Attached is a notarized affidavit, that du utility owner Iris notified the cornmerci.•rl and residcntint developer• owner of commercial or multifamily real estate, or local
govcrtment entities with a property interest in any parcel of land located adjacent to the property over which the lard use is being requested, dut application for the permit
has been made.
Location: Tax Map Number '77-,4 - ,� F
Geographically" Cty/Town/ City oflj
Between Route St. Name Ita,
And Route — - St. Name a c^
(VDoT�
/ 7S-
as per attached plans.
Applicant Job No.
On Highway Route and/or Name (/S 50//7
70.1/ Latitude 37. !O2y Longitudes
=rd Latitude -,9 _ /35"/ Longitude-
2
[ ] IF APPLICABLE, I AGREE TVPAYfTHF FULL AL RY/1_ND EXPENSES OF A STATE ASSIGNED D�SPECTOR LN
CONJUNCTION WITH TIIIS.PROC • IACCOUNT RECEIVABLE NUMBER.
i
Signature of applicant Title U- Y\-4;-(- Date 1
Signature of agent ITitle erc,StD<4`4T Date 3-210-o'Zo�p
(IF BOTH APPLI AN 8 AGEN ARE I% ED ABOVE -THEN SIGNATURE -TITLE -DATE OF BOTH ARE REQUIRED)
Ail applicable items on this form must be completed before your request can be considered. Recheck information furnished to avoid delay. Prepayment
Required - make Remittance payable to Treasuxer of Viroginia.
VDOT USE ONLY
Receipt is hereby acktrowledged of CHECKVCOUPON M.O.
In The Ampunt of S '�, DD. ,.(
Permit ee S C Cash Surety S 5� . ^ VDOT Ref rencC Number
Signed I 1 tt II (N (`A \ f 1 %_VDOT. % , 7J)I I O
L UP -CB
Revised 1110212009
(COMMONWEALTH of VIRCjINIA
DEPARTMENT OF TRANSPORTATION
14031 Old Valley Pike
Edinburg, Virginia 22824
NOTICE TO PERMITTEE PLACING A CASH SURETY
Ref: Project Na e: 1 60 Zo Id V IJ I ~SAG Wt--iz)t'l -
Route 5Q ' l —c-j �.. County
I understand if I should owe the IRS or the Commonwealth of Virginia money
for any reason, that I may not receive a refund of the cash guarantee placed
for land use permit surety unless the amount owed is less than the amount
posted.
Failure to complete the work described in the land use permit to VDOT's
satisfaction may result in the fo 'ture of the cash surety.
zl-iL�
S' natu of Person S plying Ca h Surety (or company's representative)
1-i- H 4?UILV --Lq c—
�1 amen of Person/Business as it appears on check being provided for cash surety.
Complete Mailing Address (Surety to be returned to address on check.)
Q�3pI 317-j�77
Phone #
301- 3�:7 - 5777
Fax #
//702 6
Social Security # or Tax I.D.#
Date
**Required** - Driver's License # not adequate.
For VDOT Use
Land Use Imit ' ^'� ' �`�i? i( a71
Check Amount 5 —
DEPARTMENT OF TRANSPORTATION
'�9 � 4TSi RY'FP S-n�F•
VDOT Erosion & Sediment Control Contractor Certification
In accordance with the Virginia Department of Transportation (VDOT) Road and Bridge Specification
107.14 (a), Special Provision 107D, all contractors perfonning regulated land disturbing activities
within VD01' right-of-way must have an employee that has successfully completed the VDOT Erasion
& Sediment Control Contractor Certification training. Regulated land disturbing activities are defined
as those activities that disturb 2,500 square feet or greater in Tidewater, Virginia (as defined in § 10.1-
2101 of the Code of Virginia) or 10,000 square feet or greater in all other areas of the State, The
Department will require evidence of this certification with any Land Use Permit application that
involves utility and/or commercial right of way improvement.
NON-COA,fPLIANCE MAY RESULT IN PERMIT SUSPENSION &/OR A STOP WORK ORDER
A ppi I cant/P roj ect N=c: �/ l _1—C-�"t��
Contractor:[ —
Route Number: �� County: Residency- Residency:,}
As the Conrractor fur this project, Y , herebv acknowledge that an emplo�.ee of this conipanY has
successfidly completed the YDOT Erosion &Sediment Control Contractor Certification training and
will be responsible jor insuring compliance with all applicable local, state and federal erosion and
sediment control regulations during all land clisturbance activities.
_ Fl,ork on this project involves less that �,500 square feet of land disturbance activities and
lhercfore is exe7ptlfron: this requi en nl
/(
Datc
THIS DOCUMENT MUST ACCOMPANY THE VDOT LArVD USE PERMIT APPLICATION
•
rsi'C i-b.,
Commonwealth or Virginia F' `. 1.t;P-WZTC V
Department of Transpoi-tation LA\'I) USE 1'E1ZNI1T
03120I0 Special Provision
VDOT Work Zone Traffic Control Certification Verification
In accordance with the Virginia Department of Transportation (VDOT) Road and Bridge Specification,
Special Provision 105.14, beginning July 1. 2009, all activities performed tinder the auspices of
VDOT Land Use Permit involving the installation, maintenance and removal of work zone traffic
control devices must have at least one (1) person on -site who, at a minimum, is verified by VDOT in
Basic Work Zone Traffic Control. A person verified by VDOT in Intermediate Work Zone Traffic
Control must be on -site to provide supervision during work zone adjustments or changes to traffic
control due to field conditions. These persons must have their verification card with them while on the
project site.
NON-COMPLIANCE MAY RESULT IiY PERRIIT SUSPENSIOtl' &,IOR A STOP WORK ORDER
Applicant: .� & ��- w
Project Name: V7, " - ZaiA G �
Route Number:_ County: C-i Residency:
11 , state that 1 tivill have at least are (1) person that is
verified by VDOT in Basic 6frork Zone Traffic Control who tivill be responsible for the placement.
irraintenance and removal of work zone traffic control devices within the project limits in compliance
with the pc:rinit requirements and conditions, the approved plans, specifications, the Virginia Work
Area Protection Xfanual and the Manual of Uniform Traffic Control Devices. iI person verified by
VDOT in Intermediate Work Zane Traffic Control will be on -site to provide supervision during ivork
zone adittstmenis or change, to traffic control due to field conditions. These persons will provide
evidence of these verifications upon request front VDOT personnel.
The requested Cltivity does not,'rvo ve the installation, maintenance and removal of work
tare traffic i� I devices anA there is exempt froin Ihis requirement.
S
Date
THIS DOCUMENT ttiIUSTACCOMPANY THE YDOT LAND USE PERAHTAPPLICATION
•
Commonwealth of V bginin F-1
LUP-SP
Department of Transportation LAND USE PE nT
3/2010Special Provisions
NOTICE OF PEE LTA.BTLM
Permitter Agreement for Land Use Permit Lsaance
I the uadersiped applicant hereby acknowledge that I am fully co niznnt of 0 of the following requirements
associated with the ismancc of a VDOT Land Usc Permit
Applica
Applim
Project
Rome Nmnber-.Comity: F106 Y C,K`. Itcsid ency :_�G�]
Any of the following provisions that may apply, shall apply.
1. Pmrattce acccp incc and use of a 'Virginia Department of Trmtsportadan (VDOT) Land Use Permit is prima
facie evidence that the pernvttec has read and is fully cognizant of all required p,-rrwt provisioas, applicable
traffic control pl:ems and associated coastraction standards to be employed- ALL applicants to whom permiu
are issued shall at all times indemnify and save harm]= the Commonwealth Transportation .board, members
of the Board, the Commonwealth, and all Commonwealth employecs, agents, and officers, from responsibility,
damage, or liability arising from the exercise of the privileges granted in such permit to the extent allowed by
law.
2 Inc permitter agrees to sccurc and arty insarancc against liability for personal injury and property damage that
may arise from the work performed under permit and/or from the operadoa of pamitted actirity-up to one
million dollars (S 1,000.000) each oca trcacc to protect the Board members and the Dcparvncnfs agents or
employes see-nty five thoasaad dollars (S75,000) each occ=mcc to protect theBoard, the De-partmeni, or
the Commonwealth in event of suit
3. The pamittcc assumes full .rtsot onsibility far any and all (downstream flooding, erosion, siltation, etc.) damages
that may occar as a result of the work perfocmcd under this pcmait. Furthermore, the Department will in no
way be responsible for any dariige to the, facility being placed as a result of futurc maintenance or coustrucron
activzdes performed by the Department.
4. Tec permittce agrees to move, remove, alter, or change any immstallalioa that interferes with the uldruotc
cousa ction of tLr highway in alignment er grade at NO cost to the. Department unl= otbcmisc stipulated and
agreed to by the Department.
5. The pamiitteo shall irnraodiately car_ect any siti<adon than may arise as a result of these activities that the
)'strict Adminis=or's designer deems hazardous to the traveling public.
6. Any and all highway signs, right-of-nny markers, etc., dstur od as a result of work performed under this permit
shall be accurately reset by the parnrittce immediately foDowin- the work in the vicinity of the disturbed
EieJity. The scr&cc of a ccrtif ed land stcveycr v. th experience in route surveying may be regnired.
7. It shall be th a p=zuttec s responmibiLay to obzain AN-V and ALL neecss;r:y permits thatmnay be requirrd by any
other governmcnt agcncm , i-e., 64 Army Corp- of Engineem, .Departrnent of Environmental Quality,
Department of Conservation and Recreation, etc.
i�
J
Mail to:
Winchester Regional Airport
Attn: Executive Director
491 Airport Road
Winchester, VA 22602
(540) 869-2422
Request For Site Plan Comments
Winchester Regional Airport
Hand deliver to:
491 Airport Road
(Route 645, off of Route 522 South)
(540) 869-2422
Please fill out the information as accurately as possible in order to assist the agency with their
review. Please attach one (1) copy of the site plan with this sheet.
Applicant's Name:
Address:
Phone Number:
Name of develop ent and/or description of the request: ve 1 0rl 0) W
a N)e -- 9</P
<f nC4 77OWfl"
Location of property: 3/7 6 _nd l tl o ad Pl ke
Winchester Regional Airport Comments : "'
c E oonnm
Winchester Regional Airport use only
Date received oZ 5 10
Incomplete
Date reviewed 31 1t o
Signature and Date
Signature and Date (revi
Date revision received
Incomplete
Date reviewed
24
Date approved�t2j// 0
0
0
WINCHESTER REGIONAL AIRPORT
:�•r� o-=
1p of VIRGWA
March 24, 2010
491 AIRPORT ROAD
WINCHESTER, VIRGINIA 22602
(540) 662-5786
Andrew Martin
Virginia 10 RSA Ltd, Partnership
d/b/a/ Verizon Wireless
9000 Junction Drive
Annapolis, Maryland 20701
Re: Site Plan Comment
Co -Locate Antennas at 145'
Izaak Walton Park Site — Route 50
Winchester, Virginia — Shawnee Magisterial District
Dear Mr. Martin:
We have reviewed your request for site plan comments to place antennas at 145'
on an existing antenna tower (816323) located at 3175 Millwood Pike, Izaak
Walton Park Site, owned by Crown Castle.
Since the existing tower Is the immediate controlling obstruction and your
proposed frequencies are within the ranges of the FAA pre -approved bands for
co -location, you will not be required to file with the Federal Avlatlon
Administration or the Virginia Department of Aviation for an aeronautical airspace
study. However, your company must still meet any other local, State or Federal
requirements.
Thank you for allowing us the opportunity to review these plans.
Should you have questions, please do not hesitate to contact me.
Sincerely,
QC� �
Serena R. Manuel
Executive Director
•
0
Candice Perkins
From: Funkhouser, Rhonda [Rhonda.Funkhouser@VDOT.Virginia.gov]
Sent: Friday, April 02, 2010 1:56 PM
To: Andrew Martin; Melissa Reese
Cc: Hoffman, Gregory; Ingram, Lloyd; Candice Perkins
Subject: VDOT Land Use Permit #855-9193 - Approval - Verizon Wireless Private Entrance - 50/17,
Frederick Co.
Attachments: 855-9193.pdf; 2010.3.17_IzaccwaIto n_ZDs with_Entrance.pdf
Attached is your approved Land Use Permit #855-9193 and plans to the installation of a private
entrance at the subject location.
«855-9193.pdf>> <<2010.3.17_lzaccwalton_ZDs with_Entrance.pdf>>
Please ensure a copy of the approved permit assembly is kept at the job site whenever working
within the right-of-way. I would also like to remind you of the need to erect and maintain proper
traffic control in accordance with our Virginia Work Area Protection Manua/and the Manual of
Uniform Traffic Control Devices
You are required to contact Greg Hoffman at (540) 535-1824 at least 48 hours in advance of the start
of construction to arrange for any necessary inspections.
Once the work has been completed, please advise this office so a final inspection can be performed.
If you have any questions concerning the permit requirements or during construction, do not hesitate
to call/email.
Rhonda Funkhouser
Virginia Department of Transportation
Land Development
14031 01(1 Valley Pike
Edinburg, Virginia 22824
Phone #(540) 984-5602
Fax #(540) 984-5607