NCC222953_FRO Submitted_20220818

T j
LiIiFVtiliit•
FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM c-�
Soil Erosion and Sedimentation Control Ordinance mue
PART B — Sections 1, 2 and 4 are required
Person(s) or firm(s) who are financially responsible for this land -disturbing activity. Note: Ifthe Financially
Responsible Persons) or Firms) has an out-of-state address, a North Carolina agent must be designated in
item Z, below.
Person or Firm
Paragon Site Solutions, 7C
I Cone Orr y or Finn, list na►ne as listed on AC Secretary o State business re isiry
Mailing Address
City: State: Zip: 8030 England Street, Ste 8
Street Address
City-: c�rlo+le State; NC Zip: 28273
Required if PO Box listed as _ failing Address
Contact Name
Stephen McCarthy
Email
[e-mail]
Phone: Office
Phone: Mobile
803-280-9206
2. If the Financially Responsible Parry is not a resident of North Carolina, proside the information of the
designated North Carolina agent who is registered on the NC Secretary of State business registry.
Registered Agent Name Nevne as listed on _VC Secretary of State business registry
Mailing Address City: State: Zip:
Street Address City: State: Zip:
I PO Box listed above
Email I Phone
I (Optional) Additional contact familiar with the site, understands the plans, and ma_v represent the company
Site Contact's Name Stephen McCarthy
Phone: Office
Email smccarthy(§paragonsitesolutions.coi
Phone: Mobile [phone]
4. The above information is true and correct to the best of my UoNvledge and belief and was provided by me under
oath. (This form must be signed by the Financially Responsible Person, if an individual, or his attorrier•-in-fact. If
the Financially Responsible Owner is not an individual, this form must be signed by an officer, director, partner, or
registered agent with the authority to execute instruments for the Financially Responsible Pam,)- I agree to provide
corrected information should there be any change in the information provided herein.
Printed Name Stephen McCarthy
Title or Authority Managing Member
0 L C,, A
aV t `"► �C.L_. a Notary Public of7he County of State
of �a
YtA hereby certify that S ersonally appeared
before me this dory and being duly sworn acknowledged that the above four! was executed gy him'her.
Witness my hand and notarial seal. this
SAVI
Nary Pdit 8t*dSMffi C'/a�ralh�
* C� E"�� 2/27120'V •F
day of_� -
Notary Signature a
My Commission Expires 0 )-1 ill 50%.0
Rev. 6/2022 Page 2 of 2

11
FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM I tnVl1 �,t.
mHe
Soil Erosion and Sedimentation Control Ordinance i l
1 1 .'+ 1. I IN .l
Instructions: No person shall initiate any land -disturbing activity on one or more acres, as covered in the Town of
Huntersville Soil Erosion and Sedimentation Control Ordinance, before this form and an acceptable erosion and
sedimentation control plan have been completed and approved by the Town of Huntersville. The Financially
Responsible Party i6ll be on record as the party to accept any Notices of Violation or related documents for any non-
compliance of the Town of Huntersville Soil Erosion and Sedimentation Control Ordinance. lithe Financially
Responsible Party resides out of state, a North Carolina agent must be assigned. All relevant items on this form
must be filled out accurately and completely.
PART A - Complete All Fillable Fields
1• Projectname Bryton 5FR - Phase 3
2. Address of land -disturbing activity (number, street) 13547 Roderick Drive
3. Approximate date land -disturbing activity will begin AugusL JAi 2022
4. Purpose of development Single Family ResiOther:
5. Total acreage of land to be disturbed or uncovered 25.8
6. Total site acreage 32.9
7. Landowner (s) of Record. Names listed must match the deed(s). Attach list of additional oiAmers, if applicable.
Note: If the landowner of record is not the person(s) or frrm(s) Financially Responsible Party, as listed in Part
B, item 1, a separate letter of consent, signed and dated by the landowner of record, or their authorized agent,
is required
Name
Northbridge, LLC
Mailing
7Address
8030 England Street, Ste 8
Contact Name
Stephen McCarthy
City: Charlotte
Title
Managing Member
State: NC Zip: 28273
Phone: Office/Main
Street
Address
NS( oorfilisted above
Mailing
Address
Phone: Mobiile
803-280-9206
City:
Email
Name
smccarthy@paragonsitesolu
State: Zip:
Contact Name
City:
Title
State: Zip:
Phone: Office/Main
Street
Address
1fP0 Box listed above
Phone: Mobik
City:
Email
State: Zip:
8. Indicate Book and Page number where the deed or instrument is filed .attach list ofaddi.. 7 deeds if applicable
Deed Book 3752,
I►�#:.1a Iq
Page s29-e33
Page
Deed Book 37621 page 934-938
Deed Book Page
Rev. 612022 TOH Staff Reviewer Ownership Agent: Verified at Pre -Can Meetnig By: Page 1 of 2