Green Building Proffer Verification Form

Green Building Proffer Verification Form

Rezoning Case and Proffer Information

Rezoning Case #*

AS SHOWN IN THE PLANNING & LAND USE SYSTEM (PLUS).

District*

Select

Proffer #*

Trigger*

Site Plan Approval

Building Plan Approval

RUP/NON-RUP

Bond Release

GB Project Name*

AS SHOWN IN THE ONLINE RATING SYSTEM PROGRAM.

GB Rating System*

Earthcraft

ECLC

EnergyStar

LEED

NGBS

Soft Commitment

Other Program

Has online access been granted to DPZEDRB@fairfaxcounty.gov (LEED ONLY)?*

YES

N/A

Has a green building escrow been posted? (LEED AND SOFT COMMITMENTS ONLY)*

YES

N/A

Are you submitting the EnergyStar certificate, in addition to the NGBS certificate today? (Both are required for the NGBS Program.)*

YES

N/A

Project Information

Site Plan Name*

AS SHOWN IN THE PLANNING & LAND USE SYSTEM (PLUS).

Site Plan #*

AS SHOWN IN THE PLANNING & LAND USE SYSTEM (PLUS).

Use (Select ALL that apply)*

ALF

CCF

CONCRETE

CORE & SHELL

GARAGE

HEALTHCARE

HOTEL

ILF

MFD (CONDO)

MFD (2-OVER-2)

OFFICE

PUBLIC USE

RESTAURANT

RETAIL

SFA (TOWNHOME)

SFD

STORAGE

TELECOM

TRIPLEX

WAREHOUSE

WORSHIP

# of Units*

RESIDENTIAL USE: ONLY 1 DWELLING UNIT PER SUBMISSION FORM.

MFD & COMMERCIAL USES: INPUT THE TOTAL # OF UNITS ASSOCIATED WITH THIS SUBMISSION.

Building Permit #*

INPUT N/A IF THE BUILDING PLAN HAS NOT BEEN SUBMITTED YET.

Lot #*

4-DIGIT FORMAT. FOR EXAMPLE, INPUT 0001 TO INDICATE LOT 1.

Street Address*

DO NOT INPUT THE CITY, STATE, OR ZIP CODE.

Projected Settlement Date*

Applicant Name*

Applicant Email*

Applicant PH #*

Phone

File Upload*

A SEPARATE SUBMISSION IS REQUIRED FOR EACH RESIDENTIAL DWELLING.

EXCEPTION: CORE & SHELL RELATED PERMITS.

Drag and drop files here or

Almost Finished!

LDS Technical Bulletin #22-03

I have read LDS Technical Bulletin #22-03 dated 6/21/2022 and titled, "Verification of Green Building Proffer Commitments".*

Review Time

I understand that EDRB and LDS requires five (5) business days to review the submission for proffer compliance.*

I understand that EDRB must approve my submission prior to requesting a Residential or Non-Residential Use Permit (RUP or NON-RUP).*

Submission Status

I understand that I will need to add automation@app.smartsheet.com as an email contact to be notified when my submission is approved or disapproved.*

Send me a copy of my responses

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