NCC231007_FRO Submitted_20230418

DURHAM JCN
COUNTY Durham City/County (Office Use Only)
Sedimentation and Erosion Control
O FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
NC WITH LANDOWNER CONSENT FORM
1881
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: WASHINGTON STREET MIXED USE
2. Road location of land-disturbing activity:_501 & 703 WASHINGTON ST. & 706 W. CORPORATION ST.
Tax Map- Block- Parcel:_0821-89-39-9536, 0822-20-80-5323.L02, 0822-80-66-0253, 0822-80-67-3387
PIN:_105148, 105153, 105156, 105157
3. Square footage of land to be disturbed or uncovered: 4.15 AC/ 180,639 SF
4. List below the landowner of record. Each landowner must complete Item 8.
(If there are multiple owners,please list on a separate page):
(see Exhibit"A" attached hereto and by reference incorporated herein)
Name
Address
City State Zip
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.
RRPVI Washington Durham LP [CONTRACT PURCHASER FOR PARCEL 1 AND LAND OWNER
FOR PARCELS 2,3,AND 4 ON THE ATTACHED EXHIBIT "Al
Name
4801 PGA Boulevard
Street Address
Palm Beach Gardens, FL 33418
City State Zip
561 630 6110 561 282 4806 ikurtz[a�ramrealestate.com and [e-mail]
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.
201 E. Main St,5th Floor,Durham,N.C.27701 •[phone]• Fax[phone]
www.co.durham.nc.usiceng

• 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.
6. For business applicants,list below the North Carolina registered agent for the financially responsible entity:
Ram Realty Advisors LLC
Name
2100 Tryon Street,Suite 203
Street Address
Charlotte,NC 28203
City State Zip
704 377 6735 561 282 4806 [e-mail]
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.
10/5/2022 Karen D. Geller,VP/Jennifer S. Stull,VP
Date Type or Print Name
561 630 6110 561 282 4806 Vice Presidents of Ram Realty Associates VI LLC, as
Manager of RRPVI Washington Durham GP LLC,as General Partner or ' ' 'VI Washington Durham LP
Telephone Fax q1APAA � i, A thoV a �� '[e-mail] (5• r 11 /%
Email Signatu
Business Applicant(Provide corporate resolution on signatory authority)
I, 4Vl4/ HOPS /1 16'((S ,a Notary Public of the County of Palm Beach, State of Florida,hereby certify that
Karen D. Geller and Jennifer S. Stull,Vice Presidents,respectively,of Ram Realty Associates VI LLC,as Manager of RRPVI
Washington Durham GP LLC,as General Partner of RRPVI Washington Durham LP personally came before me this day and
acknowledged,on behalf of RRPVI Washington Durham LP,the due execution of the foregoing instrument.
Witness my hand and official seal,this 5th day of October,2022.
/hie S•,
; v" .; AMY HOPE HARRIS• :*: MY COMMISSION#HH 036871 Notary P b l is
My commission s k' a` EXPIR Notary Public
26,2024 20
•FOFFL P• Bonded ni Notary!'[fub&Undent itp,
*********************4*****-*.**+fs4i*1i+Fp s+F##f..-...,..*•..—A ob********************************************************************
Individual Applicant
I, ,a Notary Public of the County of
State of ,hereby certify that
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 ,20
Notary Public
My commission expires 20
LAND DISTURBING PERMITS ARE NON-TRANSFERABLE
Provide a Notarized Item 8 for each landowner listed in Item 4.

8. Land Owner 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. (FOR PARCEL I ON EXHIBIT"A" ATTACHED HERETO(
OC14d' /el „.1.04 --- .j 719 , I /V)5' l of Magnolia Fire Tower Place,LLC
Date Type or Print Name
M/4) 9-1 - a7d- I t�
Telephone Fax Titg or Authority
Email Signature
Business Landowner(Provide corporate resolution on signatory authority)
I, 14 k nett Q VJi• bot t\ ,a Notary Public of the County of N Q, 5 k
State of N @ Y'c i n[4 ,hereby certify that 51-e. C n r. \ t r1 S O rl
personally came before me this day and acknowledged that he is WI q r el 0j-P r'"
of Magnolia Fire Tower Place,LLC and acknowledged,on behalf of Magnolia Fire Tower Place, LLC,the due execution
of the foregoing instrument.
Wit is 1 A day of October,2022.
KE //�� n� � �
Notary Public, North Carolina
Nash County PALE—tlia, W. A au,l ,My Commission Expires Notablic JUG
My ommission � ,20 "I .
*********************************************************************************************************************************
Individual Landowner
I, , a Notary Public of the County of
State of ,hereby certify that
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 ,20
Notary Public
My commission expires 20
SE-03 Rcv.07/06

EXHIBIT"A"TO FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
WITH LANDOWNER CONSENT FORM
Washington Street Mixed Use- Landowner of Record
Parcel 1:
Site Address: 501 Washington Street&706 W. Corporation Street, Durham, NC 27701
Owner: Magnolia Fire Tower Place, LLC
Parcel ID: 105157
PIN: 0821-89-39-9536
Parcel Area: 2.79+Acres
Overlay Districts: Foster and West Geer Streets National Historic District City Garage and Fire Drill
Tower
Local Historic Landmark
Parcel 2:
Site Address: 701/703 Washington Street, Durham, NC 27701
Owner: RRPVI Washington Durham LP
Parcel ID: 105156
PIN: 0822-20-80-5323.L02
Parcel Area: 2.21+Acres
Overlay Districts: Foster and West Geer Streets National Historic District
Parcel 3:
Site Address: 705 W.Trinity Avenue, Durham, NC 27701
Owner: RRPVI Washington Durham LP
Parcel ID: 105153
PIN: 0822-80-66-0253
Parcel Area: 0.21+Acres
Parcel 4:
Site Address: 707 W.Trinity Avenue, Durham, NC 27701
Owner: RRPVI Washington Durham LP
Parcel ID: 105148
PIN: 0822-80-67-3387
Parcel Area: 0.03+Acre