Architectural Modification Request - Tree

Architectural Modification Request - Tree
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 - TREE
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 as described below.
Please submit only one removal or addition request per form.
Removal & Planting may be combined if occurring at the same time.

*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.

Criteria for Tree Removal Details/Agreement
1-1. Diameter, in inches, at 2 feet above the ground. (If less than 4 inches at 2 feet above the ground, an AMR is not required for removal). D=circumference/3.14
1-2. Contained entirely within property line and does not extend onto common or my neighbor's property.
1-3. Agree to grind the stump to the natural topography of the surrounding terrain.
1-4. Justification (Choose at least 1):
     a. Diseased or Damaged as assessed by a qualified Arborist.
     b. Potential damage to people or property that cannot be corrected by trimming or pruning as assessed by a qualified Arborist.
     c. Detrimental effect on other desirable plants and trees.
     d. Blockage of paths or vehicular sight lines that cannot be corrected by trimming or pruning.
     e. Overgrown to the extent that the Tree cannot be corrected by trimming or pruning.
     f. Too large for space.
Insert letter(s)  

Criteria for Tree Planting Details/Agreement
2-1. Contained entirely within property line and does not extend onto common or my neighbor's property.
2-2. Does not prevent or impair the free and unencumbered use of streets or sidewalks for pedestrian traffic, encroach on neighboring property, or obstruct sight lines for vehicular and pedestrian traffic.
2-3a. I will choose a specimen from the approved list (see the Guidelines for the recommended species)
2-3b. Specimen chosen
2-4. Approximate size of new specimen (height and diameter) 

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. Other supporting document(s) provided (list in 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 Tree. *

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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