NCC240053_FRO Submitted_20240109

,, HOLLY
eCIVIL CONSTRUCTION
���, SPRINGS DRAWING APPLICATION
�����J/ North Carolina
Submittal Requirements
All items listed are required for a complete submittal. Incomplete submittals will be rejected and
delay the process.
Beginning the week of April 3, 2023, all applications submitted by NOON on Friday will be routed
the following week for review:
Submit the following items via the Portal (Construction & UDO Permits -> Apply for a Permit):
• Complete Application
• One complete, combined set of PDF Civil Construction Drawings
• Calculations and Reports as needed
• Action Notice from Preliminary Plan Review
• Environmental Agency Documentation (NCDEQ 401/USACE 404 Permitting Status)
• Copies of USGS and Wake County Soil Survey stream information for the project location.
Once your submittal is deemed complete and accepted, staff will send you a confirmation and
advise that submittal fees (if applicable) are available for payment in the Portal.
Visit our website for a current fee schedule:
https://www.hollyspringsnc.us/335/Forms-Review-Schedules-Fee-Sheet
For questions about your submittal, please reach out to dsintakes_`hollvspringsnc.gov
This application is for Construction Drawing Plan Approval, Erosion & Sedimentation Control Plan
Approval, NPDES Stormwater Review, Land Disturbance Permit Issuance and Statement of
Ownership and Financial Responsibility. Check all that apply:
❑Construction Drawing Plan Review 0 Erosion & Sedimentation Control Plan Review
0 NPDES Stormwater Review
PROJECT INFORMATION
Project Name Amgen Project FleX Batch Phase 1
Total LF Streets 8310
Disturbed Acres 46.03
LF of Sidewalk 5062 LF Sewer Line 2171
LF of Water Line 9350 LF Stormwater 8685
# SCMs < 5AC 0 # SCMs > 5AC 1
Latitude 35°40'31.64"N Longitude 78°54'28.86"W
FEMA/FIRM Map # 3720072000K Panel # 0720
Effective Date: 07/19/2022 PIN # 720700500
Total Post Development Impervious Surface(FT2): 744,876 SF(17.10AC
Approximate Date Land Disturbance will begin: November2021
Description of Construction or Land Disturbance:
The project consists of the development of approximately 269,585 square feet of life science facilities over the course of two phases.The
proposed Phase 1 will construct 141,895 square feet and the proposed Phase 2 will construct 127,690 square feet.Parking has been designed
to meet the requirements set forth by the Town of Holly Springs Planning Department.Additionally,the site will have loading docks.new
utilities,sidewalks,and other infrastructure to service the new buildings.There will be future development in addition to Phases 1 and 2.
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}1 HOLLY CIVIL CONSTRUCTION
SPRINGS DRAWING APPLICATION
��J/ North Carolina
CONTACTNT INFORMATION (Attach additional sheets if needed)
Applicant and Financially Responsible Party will need to register for an account on the Portal
Landowner(s) of Record
Name: Paul Lewus Company: Amgen
Mailing Address: 4130 Friendship Road
City, State, Zip: Apex, NC 27539
Mobile Phone: [phone] E-Mail: plewus@amgen corn
Landowner(s) of Record
Name: Company:
Mailing Address:
City, State, Zip: _
Mobile Phone: E-Mail:
FUTURE Landowner(s) if applicable
Name: Company:
Mailing Address:
City, State, Zip:
Mobile Phone: E-Mail:
FUTURE Landowner(s) if applicable
• If Landowner will be different at time of plan approval, provide documentation that the FRP has
permission to apply on their behalf.
Name: Company:
Mailing Address:
City, State, Zip:
Mobile Phone: E-Mail:
Book 8 Page where Deed or Instrument is Filed in Wake County:
Location Description: Property along Friendship Road
Parcel Identification Number (PIN): 0720702658
Tax Map, Block and Lot Number:
Book: 018844 Page: 267 ; Book: BM2021 Page: 2063
Person or Firm Financially Responsible for Land-Disturbing Activity
Name: Company:Amgen
Mailing Address: 4130 Friendship Road
City, State, Zip: Apex,NC 27539
Mobile Phone: E-Mail:
Registered Agent for Person or Firm Financially Responsible for Land-Disturbing Activity
Name:Paul Lewus Company: Amgen,Inc
Mailing Address: 4130 Friendship Road
City, State, Zip:Apex,NC 27539
Mobile Phone: [phone] E-Mail: [e-mail]
Plans Prepared By:
Name:Jordan Brewer,P. Company: Kimley-Horn and Associates,Inc.
Mailing Address: 300 S.Main Street,Suite 212
City, State, Zip: Holly Springs,NC 27540
Mobile Phone: [phone] E-Mail: lordan.brewerckimley-hom.com
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eHOLLY CIVIL CONSTRUCTION
SPRINGS DRAWING APPLICATION
North Carolina
CERTIFICATE OF COMPLETION
The above information is true and correct to the best of my knowledge and belief and was
provided by me while under oath. (This form must be signed by the Financially Responsible
Person if an individual(s) or their 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.
Signature of Financially Responsible Party:
Print Name: 1 AFL LEL.00S
Title: Vice President, Site Operations Date: oe
I, Ke&f Pk. L 1� , a Notary Public of the County of l�1 VC,
State of North Carolina, hereby certify that l DGV) \ LIA9 Lk
appeared personally before me this day and being duly sworn acknowledged that the
above form was executed by them.
Signature of Notary Public: L.iT► p
Print Name: 11111,./ A.
Bail/
My Commission Expires: fi//C 7pg1 ?dab
KELLY A BEATY
SEAL NOTARY PUBLIC
( Wake County
North Carolina
My Commission Expires Mar. 09,2028
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