NCC221616_FRO Submitted_20220504

FINANCIAL RESPONSIBILITYIOWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Land
Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name 2217 S. Tryon
2. Location of land -disturbing activity: County Mecklenburg City or Township Charlotte
Highway/Street S. Tryon Latitude(decimal degrees) 35.2090 Longitude(decimal degrees)-80.867
3. Approximate date land -disturbing activity will commence: 5/2/22
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 1.13
6. Amount of fee enclosed: $ 200.00 . The application fee of $100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes M Enclosed 0 No O
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Matt Doerre E-mail Address [e-mail]
Phone: Office # 980-335-1502 Mobile # [phone]
V1
Landowner(s) of Record (attach accompanied page to list additional owners):
FHN 2217 South Tryon, LLC 704-904-0713 704-904-0713
Name Phone: Office # Mobile #
300 W Summit Ave Suite 250 300 W Summit Ave Suite 250
Current Mailing Address Current Street Address
Charlotte NC 28203 Charlotte NC
City
10. Deed Book
State Zip City
35649 Page No. 690-692
State
28203
OIL
Provide a copy of the most current deed.

Part B.
1. Company(ies) who are financially responsible for the land -disturbing activity (Provide a comprehensive list
of all responsible parties on accompanied page.) If the company is a sole proprietorship or if the landowner(s) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies).
Doerre Construction Co., LLC [e-mail]
Company Name E-mail Address
2459 Wilkinson Blvd. Suite 210 2459 Wilkinson Blvd. Suite 210
Current Mailing Address
Charlotte NC 28208
City State Zip
Phone: Office # 980-335-1502
Current Street Address
Charlotte NC 28208
City State
Mobile # [phone]
Zip
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Name of Registered Agent
Current Mailing Address
E-mail Address
Current Street Address
City State Zip City
Phone: Office #
Mobile #
Name of Individual to Contact (if Registered Agent is a company)
State Zip
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City
Phone: Office # Mobile #
Name of Individual to Contact (if Registered Agent is a company)
State Zip

(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath. (This form must be signed by the Financially Responsible Person if an individual(s)
or his attorney -in -fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Party). I agree to provide
corrected information should there be any change in the information provided herein.
M,lk-kk-t+CO (-::. 4r-lkw- �F SIo�.1r ,now Nr �nUa Ca.,c c L
Type or print name Title or Authority
Y -zz
Signature Date
a Notary Public of the County of
State of North Carolina, hereby certify that M n)ik e appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this _day of Aerd 20_ _
Notary
Seal
My commission expires 31 o
ULIE F KISER
AAecktenbu � i y. Norih Carolina
My Commission Expires
Jul 31, 2025

EATI
DOERRE I GGRANDRANDNG
CONSTRUCTION OPENINGS
April 18, 2022
Re: 2217S. Tryon
Charlotte, NC 28203
To Whom it may concern:
This is to confirm that as landowner of the above referenced address and project (2217 S. Tryon),
I authorize Doerre Construction Co., LLC to submit application for land disturbance and conduct
land disturbing activity per the City of Charlotte approved Land Development and Erosion Control
plans, as drawn by LanclDesign (NC Eng Firm License # C-0658) dated 11-19-21) and approved by
City of Charlotte 1-3-22. Reference Project Number LDUTOD-2021-00063.
Regards,
Freeman
iwner
HN 2217 South Tryon, LLC
2459 Wilkinson Blvd, #210, Charlotte, NC 28208 704-374-1440 0 704-374-1889 F doerreconstruction.com

For Registration
Fredrick Smith
Register of Deeds
Mecklenburg County, NC
Electronically Recorded
2021 Feb 08 03:29 PM RE Excise Tax, $ 0.00
Book:35649 Page: 690 - 692 Fee: $ 20-00
Instrument Number: 2021024442
�j -a ".
Excise Tax: J0.00 Tax Parcel ID #: 12104401
This instrument was prepared by Moore & Van Allen, I?tL C and after recording return to Grantee.
NO TITLE EXAM REQUESTEI)v NO TITLE OPINION GIVEN
Brief description for the Index: 1.1318 Acres South Tryon Street
THIS NORTH CAROLINA NON -WARRANTY DEED
is made as of this ft day of February, 2021, by and between
GUS KANOS and wife,
CHRISOULAKANOS
Address: 3112 Sunnybrook Drive.
Charlotte, NC 28210
FHN 2217 SOUTH TRYON, LLC,
a North Carolina limited liability company
Attention: Eric C. Nichols
Address: 300 W. Summit Avenue. Suite 250
Charlotte, NC 28ZO
The designation Grantor and Grantee as used herein shall include said parties, their heirs,
successors, and assigns, and shall include singular, plural, masculine, feminine or neater as required by
context.
WrINESSEM, that Grantor, for a valuable consideration paid by Grantee, the receipt of which
is hereby acknowledged, has and by these presents does grant, bargain, sell and convey unto Grantee mi
fee simple, all that certain lot or parcel of land described in Ex—M-bit "All attached hereto ("Property").
The Property was acquired by Grantor by instrument recorded in Book 28264, Page 241 in the
Mecklenburg County Public Registry.
ALL OR A PORTION OF THE PROPERTY BEREIN CONVEYED DOES NOT INCLUDE TBE
PRIMARY RESIDENCE OF GRANTOR.
TO HAVE AND TO HOLD the Property and all privileges and appurtenances thereto belonging
to Grantee in fee simple.
And Grantor makes no warranties, express or implied, with respect to the Property.
W M 0
0 * At
rt 0
rt
0 W
J.
rt
0-3
M 0
of et rt
M �
=00
< a
rt M IV
JU
M-1 r-
0
0-3
0
C
rt n
toff
to . 1A ft
"
rA
0
M
M
C.
W
CHAR212382559vt

IN WITNESS WI1EREOF, Grantor has caused this instrument to be signed as of the day
and year first above written.
FA
V, % dr1a
STATE OF NORTH CAROLINA )
COUNTY OF ME(k14-A�
Notary Public, do hereby certify that the following individual
I
personally appfaced b6fore, me this day and acknowledged the due execution of the foregoing
instrument: Gus Kanos.
Date: 7/1 + u
No PAU
tary
[Notarial Sea
NotaryPublic
Mecklenburg
County Print Name
1� MAc QE 9T My commission expires:
9,
STATE OF NORTH -CAR'OTLINA
COUNTYOFW &6Att
I a&& boon , Notary Public, do hereby certify that the following individual
personally appt aied efore me this day and acknowledged the due execution of the foregoing
instrument: Chrisoula Kanos.
Date: I 1 +1 -u
[Notarial Sea, IIIINI/,
C) Notary Public
:z Mecklenburg
County
S my M E
C 0
o
�ub
j
I qwiff�a I
Ni7'"PP
rPrint Name
My commission expires:- 110
CHAR212382558v1

EXHIBIT A
LEGAL DESCRIPTION
All that certain parcel of land located in the City of Charlotte, Mecklenburg County, North Carolina and
being more particularly described as follows:
BEGINNING at a new 1/2" iron rod on the northerly margin of Dunavant Street (50' public right-of-way),
said point of beginning marking a northwesterly corner of the RRPIV 2250 Hawkins JV LLC Property as
described in Deed Book 32094, Page 771; thence from said point of beginning and running with the
aforesaid Dunavant Street right-of-way North 43-27-05 West 57.49 feet to a new nail; thence with the arc
of a circular curve turning to the right having a radius of 32.00 feet and an arc length of 11.91 feet (chord:
North 14-34-53 West 11.84 feet) to a new nail in the easterly margin of South Tryon Street (6ty public
right-of-way); thence leaving the aforesaid Dunavant Street right-of-way and running with the aforesaid
South Tryon Street right-of-way the following three (3) courses and distances: 1) with the arc of a circular
curve turning to the left having a radius of 966AO feet and an arc length of 21.6.82 feet (chord: North 15-
16-48 East 216.37 feet) to a new 112" iron rod; 2) North 08-51-10 East 93.55 feet to a new 1/2" iron rod,
3) with the arc of a circular curve turning to the right having a radius of 30.00 feet and an arc length of
66.82 feet (chord. North 72-39-40 East 53.84 feet) to a new 1/2' iron rod in the southerly margin of
Rampart Street (50'public right-of-way); thence leaving the aforesaid South Tryon Street right-of-way and
running with the aforesaid Rampart Street right-of-way South 43-31-40 East 182.16 feet to; a new 1/2'
iron rod; thence with the arc of a circular curve turning to the left having a radius of 290.35 feet and an
arc length of 16.97 feet (chord:'South 45-10-31 East 16.96 feet) to an existing r iron pipe in a
northeasterly corner of the aforesaid RRPIV 2250 Hawkins JV LLC Property, thence leaving the aforesaid
Rampart Street right-of-way and running with the aforesaid RRPIV 2250 Hawkins JV LLC Property the
following three (3) courses and distances: 1) North 80-41-16 West 8.97 feet to an existing I' iron pipe; 2)
South 42-19-06 East 21.33 feet to a new 1/2" iron rod; 3) South 46-28-44 West 307.92 feet to the point
and place of BEGINNING, containing 49,302 square feet or 1.1318 acres of land according to a survey by
R.B. Pharr and Associates, P.A. dated September 23, 2020. Job No. 91989.
CHAR2\2383405v2