Architectural Modification Request - General

Architectural Modification Request - General
Date of Request : 10/3/2022 AMR - GENERAL

Please submit only "One" modification or addition request per form.
Do not combine requests.
( * ) Denotes Field is Required.
Property & Owner Information
*Address Number: *     *Street: *
*Dwelling Type: *
*Owner's Name: *
*Owner's Phone: *
*Owner's Email: * 

Project Information - GENERAL
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.

*Project Starting Date: *
Note: Project must be completed within six (6) months of the Starting Date.
A new request is required in case more time is needed to complete your project.

*Summary of the Project:

Owner's Acknowledgement
Please input your initials in each box to acknowledge acceptance.

As owner of this property, I am authorized to make this request.    **

I understand and affirm that:
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 re-approval. **
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.


Supporting Documentation
  • For every supporting document (attached, dropped off, not needed) use the Attachment "BROWSE / CHOOSE FILE" button, located  at the bottom of this form.
  • If you specify "Dropped off" from the drop-down boxes below, you will be expected to provide "physical sample(s) of the materials to be used in your project".
    Those samples should be dropped off at the clubhouse (must include a hard-copy of this application).
    Your samples can be picked up after disposition of this request.
Property Plat : Project Diagram(s) :
Photo(s) : Color Sample(s) :
Other :

Covenants Committee Affirmation
It is the objective of the Covenants Committee (CC) to respond to home-owner 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.

***** Please create "ONE zip file" for multiple supporting documents *****

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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