Architectural Modification Request - Patio

Architectural Modification Request - Patio
Date: 10/3/2022

* Denotes a Required field.
Property Information
Street Address: *Number: * *Street: *
*Dwelling Type: *

Owner Information
*Owner's Name: *
*Owner's Email: *
*Owner's Phone: *

Project Information - PATIO
In accordance with the Declaration of Covenants and Restrictions referred to in the Deed covering the property described in the Property Information section, I hereby apply for written consent to make the following modification or addition as described below.
Please submit only one modification or addition request per form.
Do not combine requests.

*Projected project start date: *;
Note: Project must be completed within six (6) months or a new request is required.

*Short Summary of the Project:

The Island Creek Community Association (ICCA) Architectural Guidelines (as approved by the Board of Directors (BOD)) provide pre-approved criteria that are listed in the checklist below. Please acknowledge each item showing agreement or describe each request for deviation.
Approved Criteria for PATIOS *Agreed
1. Located in rear yard *
2. Built entirely within the property line *
3. No grading change required *

4. Construction (Select all that apply)
- Brick (provide color sample) *
- Stone (provide color sample) *
- Commercial Pavers (provide color sample) *

-- Mortared *
-- Non-Mortared (Dry fit) *

- Poured concrete (provide color sample) *

- Other (describe in Project Comments) *

Supporting Documentation (included to support your request).
If you are dropping off physical samples to the clubhouse, they must include a hardcopy of this application.
The "Upload Attachment" button can be found at the bottom of this form.
A. Property Plat is provided
To obtain a copy of your plat, call the Department of Planning and Zoning at 703-222-1082 OR check your loan closing documents
B. Diagram(s) of the project provided
C. Photo(s) provided
D. Color Sample(s) provided (if not wooden/composite)
E. Other supporting document(s) provided (list in Project Comments)

PROJECT COMMENTS; include Criteria or Supporting Documents #:

Owner's Acknowledgement
*Please initial each box to acknowledge acceptance.
I am the owner of this property and, therefore, authorized to make this request. Initials: *
I understand and affirm that: Initials:
a. This request represents alterations that comply with the zoning and building codes of Fairfax County and the State of Virginia. I am responsible for obtaining all the necessary building permits prior to commencement of construction and schedule all required inspections during and after construction. *
b. This request is also subject to restrictions contained in the Island Creek Architectural Guidelines and Architectural Modification Request (AMR) review process as established by the Covenants Committee (CC), and approved by the Board of Directors (BOD). Therefore, I agree to let members of the CC, the Management Agent, or the BOD make inspections during the construction phases. *
c. Nothing in this document, or committee statements, shall be construed as a waiver or modification of the above referenced ordinances and guidelines. *
d. No work shall commence until I have received written approval from the Management Agent. Any construction or exterior alteration made before the approval of this application is not authorized. If alterations are made, and this application is rejected, I may be required to return the property to its former condition at my own expense and I may be required to pay any legal expenses incurred. *
e. Any variation from the originally approved application must be resubmitted for review and reapproval. *
f. I am responsible for ensuring any contractors hired to complete the work do so in a professional manner and adhere to all safety, zoning, and building codes. *
g. I am solely liable for any claims, including without limitation, claims for property damage or personal injury, which result from the requested addition or modification. *
h. I am responsible for all maintenance, repair, and upkeep of said addition or modification. *

Covenants Committee Affirmation
It is the objective of the Covenants Committee (CC) to respond to homeowner Architectural Modification Requests (AMRs) in a timely manner. Each case is considered on its own merit using current Island Creek Community Association (ICCA) Bylaws, Architectural Guidelines, and historical precedence. Therefore, the process can take up to six (6) weeks. Please plan accordingly.

A copy of this request will be returned to the owner after review by the Covenants Committee (CC). Possible outcomes: approved, approved with comments/modifications, returned for additional information and/or clarification, or denied.

For multiple files, please create a "zip" file containing all of them before attaching.

File must be less than 5 MB in size
File must be less than 5 MB in size
File must be less than 5 MB in size
File must be less than 5 MB in size
File must be less than 5 MB in size
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