NCC232957_FRO Submitted_20231002

PLAN REVIEW/FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
CATAWBA COUNTY CODE OF ORDINANCES, CHAPTER 16 ARTICLE V
SOIL EROSION AND SEDIMENTATION CONTROL
No person may initiate any land-disturbing activity on one or more acres as covered by the Ordinance before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Catawba County
Utilities and Engineering Department. (Please type or print, and if question is not applicable,please N/A in the blank)
PART A
1. Job Name ,Flower's Ridge
2. PIN or 911 Address f3714-15-62-4958
3. Purpose of development (residential, commercial, industrial, institutional,etc.) Residentail
4. Approximate soil disturbance date IJune 1,2023
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) I26 Acres
6. Has an erosion and sedimentation control been filed? r Yes r No 17 Attached
7. If you have an Erosion Control billing account, would you like this to be billed? E Yes fl No
Account Number
PEOPLE
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity
Name !Dillon O'Connor E-mail address [e-mail]
Telephone [phone] Cell# 770-570-7831 Fax#
9. Landowner(s) of Record(attach accompanied page to list additional owners)
Name IMCP Flowers Ridge, LP Telephone [phone] Fax#
Current Mailing Address 140 W.57th St.STE 1420
City lNew '0rk State INY Zip Iiooi9
Current Street Address 140 W.57th St.STE 1420
City 'New York State INY Zip jiooi9
10. Deed Book No. 13782 Page No. 11118
PART B
1. Person(s) or firm(s)who are financially responsible for the land-disturbing activity (Provide a comprehensive list
of all responsible parties on attached sheet):
Name MCP Flowers Ridge,LP E-mail address [e-mail]
Current Mailing Address 12626 Glenwood Ave Ste 550
City (Raleigh State NC Zip 127608

Current Street Address 140 W.57th St.STE 1420
City New York State INY Zip 110019
Telephone [phone] Fax# I
2. (a) If the financially responsible party is not a resident of North Carolina, give name and street address of the
designated North Carolina Agent:
Name I E-mail address I
Current Mailing Address I
City I State Zip I
Current Street Address
City I State Zip I
Telephone Fax#
2. (b) If the financially responsible party is a Partnership or other person engaging in business under assumed name,
attach a copy of the Certificate of Assumed Name. If the financially responsible party is a Corporation, give name
and street address of the Registered Agent:
Name E-mail address I
Current Mailing Address
City I State Zip
Current Street Address
City I State Zip
Telephone I Fax# I
The above infonnation 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 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 person). I agree to
provide corrected information should there be any change in the information provided herein.
Michael Kavourias COO
Type o
l r Print Na Title of Autho 7 211 /13
Date /
Signatur S(s��N Atomism 1/
'l_ 7
WK
1, mism - � 1 T ,a Notary Public of the County of s {l1'0(� State h
£aielina, hereby certify that ,14l ctff , L , ewafie 4s appeared personally before me this day and being duly
sworn acknowledge that the above form was executed by him.
Witness my hand and notary seal,this 2-40 day of JuL y . 2023
Seal G a/kTad".
SISILYN S.HUTCHINSON ty j�D f�
NOTARY PUBLIC,STATE OF NEW YORK My Commission expires / D/
Registration No.01HU6430994
Qualified in Suffolk County
Commission Expires March 28,20 Z(i Print Form