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APPLICATION , ........;....;If .~...-' CITY OF BOYNTON BEACH, FLORIDA COMMUNITY APPEARANCE BOARD REVIEW APPLICATION PROJECT NAME: Boynton Amoco #60617 PROJECT ADDRESS: NE Corner of Winchester Park Boulevard and Boynton Beach BRIEF DESCRIPTION OF WORK: Constructi on of a convenience store with gas one-bay automatic car-wash. OWNER: Amoco 01 I Company "' AGENT: Kilday & Associates, Inc. APPLICATION TYPE (Xf Site Plan ( ) site Modification PLEASE PRINT OR TYPE ( ) Sign ( .) other CAB MEETING DATE: FILE NO.: <<"".5 RECEIPT NO.: RECEIVED BY: ~j) ~fP.Jt Boulevard. sales and a Phone Number: (4UI ) 743-9988 phone Number: (407) 689-5522 FAX NUMBER 407 689-2592 PRESENT THE PROJECT TO THE BOARD. A REPRESENTATIVE OF THE PROJECT MUST REPRESENTATIVE: Ki eran J. Kil day/Kil day & Assoc. Phone Number: (4QL) 689-5522 ADDRESS: 1551 Forum Place. Bldg.100A West Palm Beach. FL 33401 Street City state Zip Code - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - = = = = = = = = = = = Identify the type of architectural ~heme that is specified on the community Design District Boundary Map for your project location. Where compliance with the Community Design Plan is required, the building(s) and/or structure(s) proposed for the site shall be designed to comply with the appropriate architectural design theme. On-site and off-site landscaping shall comply with the Community Design plan landscape requirements. The requirements of the Boynton Beach community Design Plan are specified in Chapter 7.5, Article V of the Boynton Beach code of Ordinances. ARCHITECTURAL THEME CHECK ONE: [] COASTAL VILLAGE [~MEDITERRANEAN/SPANISH [] MODERN [] NOT APPLICABLE = = = = = = = = = - - = = = = = = = = = = = - - = = = = = = = = = = = = = = Complete the following information foT. the proposed project and ensure that the same information is identified on all plans submitted for the proposed project including colored elevation view drawings. Note: Color samples are required. EXTERIOR SURFACE c C ROOFING CANOPY CANOPY ;BEAMS CANOPY COLUMNS MECH. SCREENING FASCIA DECORATIVE MOLDING SOFFIT BEAMS COLUMN.S- TILE DECORATIVE MOLDING WALLS GLASS WALLS BANDS/RAISED BANDS/RECESSED VENEER TILE DECORATIVE TRIM SHUTTERS VENTS GUTTERS/LEADERS MECHANICAL EQUIP. DECORATIVE LIGHTS DOORS/OVERHEAD SWINGING DOOR TRIM DOOR FRAME rl, MATERIAL Spanish "s" Tile Spanish "5" Tile n/a Steel Tubing n/a n/a n/a n/a n/a n/a n/a n/a Smooth Stucco n/a . nfa n/a n/a n/a n/a n/a n/a n/il n Iii ni'a nfa Aluminum COLOR:NAME.NUMBER Terra Cotta (Ag-1) Gory Roof Tile Terra Cotta (AG-1) Gory Roof Tile Amoco Grey #26 (Glidden #79-48) L1ght Ian by Benjamin Moore #143 Grey E.S.P. Grey E.S.P. Aluminum Page 1 of 2 t - ,. - _pO"___ ~. vu. }Jll:,,';Ill mgnway system are such that overhead signs will have value at many locations. The factors justifying the erection of overhead sign displays are no ------~finable in specific nu,n"-:al terms, but the following condihvlls deserve consideration: 1. Traffic volume at or near capacity 2. Complex interchange design ... 3. Three or more lanes in each direction 4. Restricted sight distance S. Closely spaced interchanges 6. Multi-lane exits 7. Large percentage of trucks 8. Street lighting background 9. High speed traffic 10. Consistency of sign message location through a series of interchanges 11. Insufficient space for ground mounted signs 12. Junction of an Interstate route with another freeway 13. Left exit ramps The existence of anyone or more of the conditions listed does not automatically justify the use of overhead signs. Some of the elements listed above can be made less critical by close coordination between design and operation. 2A-23 Height Signs erected at the side of the road in rural districts shall be mounted at a height of at least 5 feet. measured from the bottom of the sign to the near edge of the pavement. In business. commercial and residential districts where parking and/or pedestrian movement is likely to occur or where there are other obstructions to view, the clearance to the bottom of the sign shall be at least 7 feet. The height to the bottom of a secondary sign mounted below another sign may be 1 foot less than the appropriate height specified above. The height requirements for ground installations on expressways vary somewhat from those on conventional streets and highways. Directional signs on expressways shall be erected with a minimum height of 7 feet (from the level of the near edge of the pavement to the bottom of the sign). If. however, a secondary sign is mounted below another sign, the major sign shall be at least 8 feet and the secondary sign at least 5 feet above the level of the pavement edge. All route markers and warning and regulatory signs on expressways shall be at least 6 feet above the level of the pavement 2A-9 , '~~~~~~ ~~~:~ ~~~:! ~~~" ": ~..::, ,', , " " ", "',,"; " ?k'(;:T~;,;~',\:,'l. ,/;J'~:;:~;;~~~~r~0~!~1 A parcel of I a-n.d lying in' S.ect j on 30. Townsh j p45 South, Ran'ge 4.3 :'~a.st,.~';Pa I.mc':',;.:';:~;r".'';;/'~: Beach County, F lor j d a. S a'J d parcel be j n g a portion of Tracts A a n dB;' . al. 0 c k: 3. .:.. ,-(;~"" of "PALM BEACH FARMS COMPANY PLAT NO.8 OF SECTION 30, .TOWNSHIP 45 SOUTH,' RANGE 43 EASP, according to the plat thereof as recorded in Plat Book 5, at rage 73, of the Publ ic Records of Palm Beach County, Florida. Said land being more particularly described as follows: Commencing at the Northeast corner 'of Section 30, Township 45 South, Ran~e 43 East; Thence with a bearing of S. 87032' 4rW., along the North I ine of said Section 30, a distance of 60.00 feet to a point on the West Right-of-Way.1 ine of Congress Avenue; Thence continue along the aforementioned course extended a distance of 733.74 feet to a point; Thence with a bearing of S.01018'43DE., along a I ine lying 120 feet West of and parallel with the East I ine of sa.id Tracts A and B, Block 3, of the above described Plat of "PALM BEACH FARMS COM PAN Y P L A T NO.8", a d i s tan ceo f 25. 00 fee t tot h e Poi n t 0 f 8 e gin n i n g crf Parce I of I and here i nafter to be descr i bed: Thence cant i nue a long the afare- men t ion e d par a I I e I I i n e , a d i s tan ceo f 1 91. 04 fee t to a poi n t 0 fin' t e r s e c t ion with the North Right-at-Way I ine of Boynton Beach Boulevard (now known as Ne~ Boynton West Road - State Road No. 804); Thence with a bearing of S.8r32'47IW., along the North Right-of-Way I ine of Boynton Beach Boulevard. a distance Qf 168.43 feet; Thence with a bearing of N. 46052'58"W., a distance of 35.71 feet to a point of intersection with the East Right-of-Way I ine of Winchester Park Boulevard; Thence with a bearing of N.OP18'43DW., along the Easterly Right-of- Way I ine of Winchester Park Boulevard, a distance of 165.54 feet to a point; Thence with a bearing of N.87032'47DE., along a line lying 25.00 feet South of and parallel with the North I ine of said Section 30, a distance of 193! 94 feet to the Point of Beginning. Lying and being situated in Palm Beach County,.! Florida. (2BVI>~Y ,J PrPPii{/>cfID . " ,..,,,,,,,. ",', CITY OF BOYNTON BEACH, FLORIDA PLANNING & ZONING DEPARTMENT SITE PLAN 1\PPROVAL 1\PPLICATION Site Plan - Major Modification to Existing Site Application Accept~nce Date: Fee Amount Paid: ~ 57JO. 1/27 Receipt Number: 2> () 1- ' aj)o This application must be filled out completely and accurately and submitte in one (1) copy to the Planning Department. Incomplete applications will be processed. I I Please print legibly or type all information. I . GENERAL INFORMATION 1. Project Name: Boynton Amoco #60617 2. Applicant's name (person or business entity in whose name this application is made): Amoco Oi 1 1254 Holly Cove Drive Address: Jupiter FL 33458 (Zip Code) Phone: FAX: 3. Agent's Name (person, if any, representing applicant): Kilday & Associates Address: 1551 Forum Place, Building 100A West Palm Beach, FL 33401 407-689-5522 (Zip Code) FAX: 407-689-2592 Phone: 4. Property Owner's (or Trustee's) Name: Winchester, Winchester, Zeiher & Schroeder. c/o Schroeder & Larche, P.A. One Boca Place, Suite 319 Atrium 2255 Glades Road Boca Raton FL 3343J-7313 FAX: (Zip Code) Address: 5. Correspondence address (if different than applicant or agent)*: * This is the address to which all agendas, letters, and other materials will be mailed. PLANNING & ZONING DEPARTMENT - November, 1991 A:SitePlan Revised and Re-submitted May 15, 1992 (2 ) . . 6. What is applicant's interest in the premises affected? (OWner, buyer, lessee, builder, developer, contract purchaser, etc.) Buyer 7. street address or location of site: Northeast corner of Boynton Beach Boulevard & Winchester Par~ Boulevard. 8. Property control #: Legal description of site: I I See Attached Exhibit'A' 9. Intended use(s) of site: Food Store and Gasoline Sales with Automatic Carwash. 10. Developer or Builder: Amoco Oil Company 11. Architect: Madison Industries, Inc. 12. Landscape Architect: Kilday & Associates 13. Site Planner: Kilday & Associates 14. Engineer: M D M Engineering 15. Surveyor: J.H. Manucy, Inc. 16. Traffic Engineer: 17. Has a site plan been previously approved by the City Commission for this property? No, N/A 18. Estimated construction costs of proposed improvements shown on this site plan: $900,000.00 PLANNING & ZONING DEPARTMENT - November, 1991 A:SitePlan . . (3 ) II. SITE DATA The following information must be filled out below and must appear, where applicable, on all copies of the site plan. 1. 2. 3. Land Use Category shown in the Comprehensive Plan LRC Zoning District C3 Area of site 0.844 acres 36768.03 sq. ft. 4. Land Use -- Acreage Breakdown a. Residential, including -0- surrounding lot area of grounds Recreation Areas * -0- (excluding water area) acres '% of si' acres % of si b. c. Water Area -0- acres % of si1 d. 0.844 -0- acres % of si1 Commercial 100 % of si1 acres e. Industrial f. Public/Institutional -0- acres % of si1 g. Public, private and Canal rights-of-way Other (specify) acres % of sit -0- acres % of sit -0- h. i. Other (specify) -0- acres % of sit j . Total area of site 0.844 acres 100 % of sit * including open space suitable for outdoor recreation, and having a minimum dimension of 50 ft. by 50 ft. 5. Surface Cover a. acres b. * c. Ground floor building 0.047 area ("building footprint") 5.6 % of sit Water area -0- % of sit -0- acres Other impervious areas, including paved area of public & private streets, paved area of parking lots & driveways (ex- Cluding landscaped areas), and sidewalks, patios, decks, and athletic courts. *0.57 -8,:68:1:- *67.5 -H-;zu acres % of sit 3f< d. % of sit *0 . 617 Total impervious area -8,:648-- acres *72 . 8 -7'6-;8- *- e. *~054 Landscaped area -9:-929- acres inside of parking lots (20 sq. ft. per interior parking space required - see Sec. 7.5-35(g) of Landscape Code). *6.3 -2:-4- % of sit 'A.:SitePlan PLANNING & ZONING DEPARTMENT - November, 1991 *INDICATES ITEMS THAT HAVE CHANGED PER CITY STAFF COMMENTS 5-13-92 ( ~ ) f. Other landscaped areas, 0.176 acres 20.8 % of sit g. other pervious areas, including golf courses, natural areas, yards, and swales, but excluding -0- -0- water areas acres % of sit *0.227 *27.2 "* h. Total pervious areas ~:-l-%- acres -l3?'l % of sit i. Total area of site 0.844 acres 100 % of sit I I 6. Floor Area a. Residential -0- sq. ft. b. Commercial/Office 1248 sq. ft. c. Industrial/Warehouse -0- sq. ft. d. Recreational -0- sq. ft. e. Public/Institutional -0- sq. ft. f. other (specify) 792 sq. ft. Car Wash g. Other (specify) sq. ft. h. Total floor area 2040 sq. ft. 7. Number of Residential Dwelling units a. Single-family detached Duplex Multi-Family (3 + attached dwelling units) (1) Efficiency (2) 1 Bedroom (3) 2 Bedroom (4) 3+ Bedroom N/A sq. ft. sq. ft. b. c. dwelling units dwelling units dwelling units dwelling units d. Total multi-family dwelling units e. Total number of dwelling units 8. 9. Gross Density N/A dwelling units per acre Maximum height of structures on site 16 feet 1 storie 10. Required off-street parking a. Calculation of required number of off-street parking spaces 1 space per 20a s.f. of retail b. Off-street parking spaces provided on site plan 7 spaces 1248/200 = 6.24 = 7 spaces PLANNING & ZONING DEPARTMENT - November, 1991 *INDICATES ITEMS THAT HAVE CHANGED PER CITY STAFF COMMENTS 5-13- 92 A:SitePlan III. CERTIFICATION (5 ) (I) (We) understand that this application and all papers and plans submitted herewith become a part of the permanent records of the Planning and Zoning Board. (I) (We) hereby certify that the above statements and any statements or showings in any papers or plans submitted herewith are true to the best of (my) (our) knowledge and belief. This application will not be accepted unless signed according to the instructions below. M~JL~~:tJ . Signature of OWner(s) or Trustee, of Authorized Principal if property is owned by a corporation or other business entity. IV. AUTHORIZATION OF AGENT ~/~~ ~.~ /~~____;r ~/2.. ,"/P"~ ~ ."ll-bAt Signature?6f Authorized Agent :e:-..;e.. ~ 7 d::... , Date ..:J";;J J. .:;;:z 7 I I Cj" "i .:z..- Date (I) (We) hereby designate the above signed person as (my) (our) authorized agent in regard to this application. AffJt' A/"~LI:; Signature of OWner(s) or Trustee, or Authorized Principal if property is owned by a corporation or other business entity. SPACE BELOW THIS LINE FOR OFFICE USE ONLY Review Schedule: z. ~ ~ ?-2.. t7 Date Date Received Technical Review Board Planning & Zoning Board Community Appearance Board City Commission Stipulations of Final Approval: Date Date Date Date Other Government Agencies/Persons to be contacted: Additional Remarks: PLANNING & ZONING DEPARTMENT -'November, 1991 A:SitePlan .' . E.X',HIB,IT.IIAII:.. ..:.':i~\;_:'., ".:,,' ",,:'''''!/~::;i-'li~'(;:~~1W~' ~:;' ~ .~::" ., r ~. , . f .;~ ~r. :r::: {'-;~li"~~~~ ~ . ~ LE.GA'L DESCR I PT ION'. " ':"',.' ...,-.,... "i':)"''1,?1<' ~~'" , .' " kl { ., ...f! · .~P1-.;r:iJ-' ,~ =============.m= . '. ". ...~.;.,Ai:?~~~~~ A parce I of I.an.d I y i ng inSect i on 3D, Townsh i p 45 South, ,Range' 43 .~asJ, ";;'P~l~',-'~;}: Beach County, Florida. Said parcel being a portion of Tracts A and 'S,';;,:Sl'oCk';:3> of M PALM BEACH FARMS COMPANY PLAT NO. 8 OF SECT I ON 3D, TOWNSH I P 45 SOUTH, RANGI 43 EASP, accord i ng to the p I at thereo f as recorded in P I at Book 5. at Page 73, of the Public Records of Palm.Beach County, Florida. Said land being more particularly described as follows: Commencing at the Northeast carner of Section 3D. Township 45 South. Range 43 East; Thence with a bearing of S.B7032'4rW., along the North line of said. Section 30, a distance of 60.00 feet to a point on the West Right-of-Way line of Congress Avenue; Thence continue along the aforementioned course extended a distance of 733.74 feet to a point; Thence with a bearing of S.01018'43-E.,' along a line lying 120 feet West of and parallel with the East line of said Tracts A and B, Block 3, of the above described Plat of "PALM BEACH FARMS COMPANY PLAT NO. Bn, a distance of 25.00 feet to the Point of Beginning of Parcel of land hereinafter to be described: Thence continue ~Iong the afore- mentioned parallel I ine, a distance of 191. 04 feet to a point of intersection with the North Right-of-Way I ine of Boynton Beach Boulevard (now known as New Boynton West Road - State Road No. 804); Thence with a bearing of S.87032'47.W. along the North Right-of-Way I ine of Bcynton Beach Boulevard. a distance of 168.43 feet; Thence with a bearing of r:. 46052'58uW., a distance of 35.71 feet 1 a point of intersection with the East Right-of-Way I ine of Winchester Park Boulevard; Thence with a bearing of N. 01018' 431111., along the Easterly night-of- Way I ine of Winchester Park. Boulevard, a distance of 165.54 feet to a point; Thence with a bearing of N. 87032' 4rE.. fllong a I ine lying 25.00 feet South of and parallel with the North I ine of said Section 30, a distance of 193. 94 feet to the Point of Beginning. Lying and being situated 1n Palm Beach County, Florida. winchester, Winchester, Zeiher & Schroeder, Partnership I, Elsie Winchester, General Partner, hereby authorize Bill R. Winchester, General Partner, to sign all documents pertaining to Annexation, Land Use Amendment, Rezoning, Site Plan Approval, and Variance to Zoning Code applications for property described on attached Exhibit "A". ~/; , --J-- 11 - ( ~ C~ . . /~1L~/L:' 'IUW l TiJJc..) Elsie Winchester, 'General Partner STATE OF: COUNTY OF: I HEREBY CERTIFY THAT ON THIS ...?;:: da;;~' 199 1, before me personally appeare~~ './ {l, . to me known to be the person(s) described in and who executed the foregoing instrument. WITNESS my hand and official seal in the State and County the day and year last aforesaid. (NOTARIAL SEAL) ~~lf~f'G ,/ "- ~--/ ~Of: My Commission Expires: Notary Publit, Stote of Florida My Commission Expirl!s Od. 1, 1993 . Bonded Thru Troy Fain. Insurance Inc. ' winchester. winchester. Zeiher & Schroeder. Partnership I, MICHAEL A. SCHROEDER and LESLIE C. SCHROEDER, General Partner, hereby authorize Bill R. Winchester, General Partner, to sign all documents pertaining to Annexation, Land Use Amendment, site Plan Approval, and Variance to zoning Code property described on attached Exhibit "A". M' hael A. Soeder, Ge Partner ,'~(!~AliPLk . ~eslie C. Schroeder, General Partner STATE OF FLORIDA ) )ss: COUNTY OF PALM BEACH) The foregoing instrument was acknowledged before me this~ ~ day of r~~, , 19~(LDy MICHAEL A. SCHROEDER and LESLIE C. SCHROEDER, who are personally known to me/or have produced "-as identification and did not take an oath. _. " c-- --- Printed Name of Notary Notary Public State of Florida My Commission Expires: My Commission Number: ...~;;:;%;.. OfF~C!,''',l SEAL .. of' ..~ ". 'j r'........, , YN'" Joel"" . ~(:r . ".,..,,oj 'n.. '''' .;:) f ~t~to1..'.. i f;h11....,r'l n ,{.'!i~ ;:;tl'l~e of Florida \. ... : ''',.! C,)rf'["':';<i'cn No. CC 125028 ...:~-~.~~t~..,:::~/' t~~~r.,'~fJ)1J ,"'bg~st 27. 1995 (Winchest\Authoriz) ....I!~ I I ! I I I I I i I I I , 1 i -' HI ,~'::~;:J~ ':::1,,- .l.b: 40 I U: Li~L',1 Ur r 1 '-1::.,-, JAt'~-2121-'92 MOt~ 17:26 ID:KILDAH 4, A:-50C:IA-TES It:.L li'-';-")I-,--Il~,I,-,W I ~ ~ _ TEL NO:407-689-2592 - ~l,;Jb,,- t~ ''-'~ NOO9 Pt)3 ~ , ~ \ . v ~;nchester. winchester, Zeih~r , Sohroeder, Partnarahi~ I, William A. Zeiher, General partner, hereby autho~ize Sill R. Winohester, General Partner, to sign all documents pertaining to Annexation, Land use Amendment, Rezoning, Site Plan Approval, and Variance to Zoning Code applications for property descKbed on attach~d Exhibit HA". STATE OF& FLORIDA COUNTY OF. BROWARD I HEREBY CERTIFY THAT ON THIS 23rd day of, Jan~ I 1992, before me personally appeared. WILLIAM a. ZEIH~F to me known to be the person'.) described in and who executed the foregoing instrument. WI~BSS my hand and off1cial seal in the State and county the day and year last aforesaid. (NOTARIAL' SEAL) ,~\'" - ~--'~-~ "')~, , St(/,~) /r. /. /~ ;, ( *l) ... /.-(I.~-t: It.."'. _ ,..\ tL 2 IJ-ti rctf-...L- Ji~tary Public ~ Jearune Barbanoa~ State of: My Commission ,;, .,,~,. -. . ~,."o . ~ -"'.: c~ ,-, J : \..~ '-11' ..' Expires .NOTARY PUBLIC STATE OF FLORIDA ~y COMMISSION EXP. MAY 4,1993 BONDED THRU GENERAL IUS. UND. C' ,~ .- ( -;. '" . File No.: -11. - . t . CO{TlJ'l1"'n~.ty' Appearance BOc..L-l ~ Page 2 WINDOW GLASS WINDOW FRAME WINDOW TRIM SCREEN ENCLOSURE FRAME RAILINGS AWNING SUPPORT(S) WALL SIGN FRAME FACE COpy SITE WALL TRIM FENCE DUMPSTER ENCLOSURE FREE STANDING SIGN SUPPORT FRAME FACE COPY DECORATIVE SITE LIGHTING POLE/FIXTURE DECORATIVE SITE PEDESTRIAN LIGHTING n/a DECORATIVE DRIVING SURFACE DECORATIVE WALKING SURFACE OTHER Aluminum Grey E.S.P. n/a n/a n/a n/a 8" CBS Stucco Finish Light Tan bY Beniamin Moore #143 Light Tan by Benjamin Moore #143 Block Wall with Stucco Aluminum ilLS!" Heritaqe Series n/a n/a SUBMITTAL REQUIREMENTS: The following shall De incorporated as part of the Community Appearance Board application submittal: 1. Application form filled out completely and legibly. 2. Application fee of $50.00 (payable to City of Boynton Beach) 3. Submit a scaled locator map that identifies the location and perimeter boundary of the site and the surrounding roads and current zoning districts including the district of the subject property. The map shall show and identify by name the roads surrounding the site and the roadway path that links the site to the closest arterial road with the names of the roads and arterial road(s) identified. The map shall show the zoning district line and the title of the zoning districts that abut the perimeter of the zoning district where the subject property is located. The map shall have the North compass direction and scale identified. Haximum size of locator mnp is 8 1/2" by 14". 4. Submit color photographs of the buildings on the site that are to remain in their existing condition and photos of existing buildings that are located on the sites that abut the perimeter of the subject property. The minimum size is 8" by 10". Each photograph shall be labeled to identify the location of the e:<isting structures with respect to the location of the proposed project. 5. Submit a 8-1/2" x 11" transparency of the landscape site plan drawing to be used on an overhead projector at board meetings. 6. Submit colored elevation view drawings - a colored duplicate copy of all drawings of the elevation views of each side of all buildings and signage associated with the pt'oject. The colot'ed elevation views shall match the elevations shown in the documents that where submitted for site plan review. The applicable exterior surfaces as identified above shall be colored with the color name and associated color reference number identified. The type of exterior surface material shall be identified next to the associated color. The colored elevation drawings shall have compass direction or title of the side of the building identified. Th,~ title block of the o.~iginal drawing shall be shown. The maximum size is 24" by 3(,". Do no submit on board of any kind. 7 Submit color samples as an example of the proposed colors. E8~h sample shall have attached a label that identi~les the color by name and numeri~al/letter code from an established color chart. 8. Where a specific exterior surface is not applicable to the project, signify by placing a "N/A" on the appropriate line. 9. Submit a copy of the legal description of the subject property on an 8 1/2" by 11" sheet. of paper. COMMUNITY APPEARANCE BOARD Kieran J. Kilday/Kilday & Associate Name of Applicant Signa CAB Chairperson/Acting Chairperson A:CABAPP.SDD 2/92 S/~z. ate Approved/Denied Name Date