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HomeMy WebLinkAboutNCC220787_FRO Submitted_20220216JCN Durham City/County (Office Use Only) Sedimentation and Erosion Control FINANCIAL RESPONSIBILITY/OWNERSHIP FORM WITH LANDOWNER CONSENT FORM No person may initiate any land -disturbing activity covered by the Durham City -County Unified Development Ordinance before a Land Disturbing Permit is issued by the Sedimentation and Erosion Control Office. Issuance of a Land Disturbing Permit does not relieve the permittee of the obligation to obtain any other licenses, permits and approvals as may be required by Federal, State, County or Municipal governments. This office must be notified in writing of any change to the information on this form. PLEASE TYPE OR PRINT 1. Project name: 120 Broadway Street 2. Road location of land -disturbing activity: 118 - 120 Broadway St., 706-710 North St. Tax Map - Block - Parcel: PIN: 0831-05-09-2383 3. Square footage of land to be disturbed or uncovered: 54,928 4. List below the landowner of record. Each landowner must complete Item 8. (If there are multiple owners, please list on a separate page): Broadway Townhomes, LLC Name 2201 Wisconsin Ave NW, Suite 226 Address Washington DC 20007 City State Zip 202-922-6540 N/A Telephone Fax Email 5. List the person or entity financially responsible for this land -disturbing activity: The financially responsible party shall be (1) the developer or other person who has or holds themselves as having financial or operational control over the land - disturbing activity and/or (2) the land owner or person in possession or control of the land when they have directly or indirectly allowed the land -disturbing activity or have benefited from it and (3) the named party on the Land Disturbing Permit. David Gorman Name 2201 Wisconsin Ave NW, Suite 226 Street Address Washington DC 20007 City State Zip 202-922-6540 david@lock7.com Telephone Fax Email The Sedimentation and Pollution Control Act (Act) and the Durham City -County Unified Development Ordinance (Ordinance) includes, but is not limited to, the following legal obligations of the financially responsible party: ■ Maintain a set of approved sedimentation and erosion control plans, if required, on site. ■ Display permit on site. ■ Understand and implement any required plan, including the construction sequence and details. ■ Inspect, maintain and repair sedimentation and erosion control measures, especially after rainfall events. ■ Provided adequate ground cover or otherwise stabilize all areas that have not been actively graded within 21 calendar days. ■ Plan and conduct all land -disturbing activity so as to prevent off -site sedimentation. 201 E. Main St, 51h Floor, Durham, N.C. 27701 e (919) 560-0735 . Fax (919) 560-0740 www.co.durham.nc.us/ceng 6. For business applicants, list below the North Carolina registered agent for the financially responsible entity: _Chappell Name _910 Tryon Hill Drive, Suite 100 Street Address Raleigh NC_ 27603 City State Zip 919.737.2247 hello@chappellres.com Telephone Fax Email 7. The above information is true and correct to the best of my knowledge and belief and was provided by me while under oath. I understand that the person or entity listed on Line 5 above will be: (1) the owner of the Land Disturbing Permit when issued; (2) responsible for ensuring compliance with the Act and Ordinance; and, (3) will be the only person or entity with standing to appeal any action taken or decision made by the Sedimentation and Erosion Control Office. _9/13/21 David Gorman Date Type or Print Name 202-922-6540 Principal Telephone Fax Title or Authority _David@lock7.com / Email Signature Business Anulicant (Provide corporate resolution on signatory authority) I, 1 a Notary Public of the County of State of hereby certify that personally came before me this day and acknowledged that he is of Witness my hand and official seal, this My commission expires and acknowledged, on behalf of , the due execution of the foregoing instrument. 20 day of Notary Public Individual Annlicant I, , a Notary Public of the County of State o hereby certify that 20 personally appeared before me this date and under oath acknowledged that the above form was executed by them. Witness my hand and official seal, this day of 120. My commission expires 20 Notary Public LAND DISTURBING PERMITS ARE NON -TRANSFERABLE Provide a Notarized Item H for each landowner listed in Item 4. !i. Land Dnner Consent. As a landowner. I provide my consent for land -disturbing activities to occur on the property listed in Item 2 by the person or entity listed in Item 5, 9113121 Broadway Townhomes, LLC Deft Type or Print tame Managing Member Telephone Fax Tile or uthorisy d1tr1d@Otk7A*W !_ / Email signafure rsskewwrrwrrskwwwrs+wrwrwrrwerwkwsskkrrwsrsisesssskskrsssssiwesssrsskkkwsswswkwwwrsrkrwwwsrkwewwwwrrkwkwrrrrrwrwwrrrrrprrrlrprrrr Business Landowner {tmvidc comoeate resolution on sigaMM audwrity) 1, fir: n GIC w .r a Notary Public of the County of �►�lad•l �-r , State of hereby certify that personally came before me this day and acknowledged that be is _ 0(?JV -Cy of ) 2 O and acknowledgLii, on behalf of paw +_(fit Gf T .n h C �►►-C 5 LtL �^ ��titttlt?r�e■ the due execution of the forcgoing instrument,aL Witness my hand and official seal, this 1 3 day of 55 si .i..a 20 ►` A : _ •.�r. Notary Public G f ' E U My commission expires 11� , 2p ';. z 0. 1 e ' rwwwwtkkkkkkasrrwrsi.......•........•.. ..................... ►rrrrrr►��krr►rrgre�x��akksaks��karua�i.•...:a... di,ddual LandoK arr ,•'rr"i r i F t %tt"��•,, State of a Notary Public of the County of hereby certify that personally appeared Wore me this date and under oath acknov.lcdgcd that the above form was executed by them. Witness my hand anti official seal, this .. day of Nularn Public My commission expirrs 20 20