NCC243198_FRO Submitted_20241025

Orange County Planning & Inspections Department
ORANGE COUNTY 131 W. Margaret Lane, Suite 200, Hillsborough, NC 27278
NORTH CAROLINA 919-245-2575 or [e-mail]
Land Disturbance Permit (LDP) Application
Please refer to instructions and checklist in completing the following application.
If completing by hand, please use black or blue ink.
* Please fill out all required fields
Date*: 10/11/2024 Case Number: LDP24-0058
Check all that apply*: ✓ Erosion Control Plan
❑ Stormwater Permit
❑ Stormwater Management Plan
General Submittal Information"
Name of Project: Carraway Village Enhanced Site Amenities
Parcel ID Number (PIN): 9880081129, 9880071995 Planning Jurisdiction: Chapel Hill
Size of Tract: 3.17 acres Area Disturbed 2.50 acres
Review Fee Payment* = To be completed by applicant
❑✓ Credit Card (additional 3% fee)E✓ Check
Note: A 2% technology fee will be applied to the permit fee as illustrated below.
Review Fee — To be completed by staff
Fee Amount
Erosion Control Plan Review
Required with Application $1,050.00
Land Disturbing Permit
Optional with Initial Application $2,100.00
Stormwater Management Plan Review
Orange County Planning Jurisdiction Only
Required with Application $N/A
Total $3,150.00
Technology fee (2%) $63.00
Credit Card fee (3%)
If applicable $
Total $3,213.00
Approximate date land disturbance will begin: October 2024
Contact Information*
Landowner(s) of Record* Use additional pages if necessary and attach to application
Name: NR Edge Property Owner LLC Name:
Street Address: Street Address:
3015 Carrington Mill Boulevard, Suite 460
Current Mailing Address: 3015 Carrington Mill Blvd Current Mailing Address:
Suite 460
City: Morrisville City:
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State: North Carolina Zip: 27560 State: _ Zip:
Phone: Phone:
Email: Email:
Contract Purchaser* (if applicable) (Use additional pages if necessary and attach to application):
Company/Organization: Company/Organization:
Contact Person: Contact Person:
Street Address: Street Address:
Current Mailing Address: Current Mailing Address:
City: City:
State: Zip: State: Zip:
Phone: Phone:
Email: Email:
Person(s) or Firm(s) Financially Responsible for this Land Disturbing Activity*
Company/Organization: NR Edge Property Ownera,Z..Company/Organization:
Contact Person: Jake Dinerman Contact Person:
Street Address: Street Address:
3015 Carrington Mill Boulevard, Suite 460
Current Mailing Address: Current Mailing Address:
City: Morrisville City:
State: North Carolina Zip: 27560 State: Zip:
Phone: [phone] Phone:
Email: [e-mail] Email:
Registered Agent (if any) for the Person(s) or Financially Responsible Party*
11111
- A North Carolina agent is required if the applicant is not a resident of North Carolina.
- All firms and companies shall complete and_identify agent.
Name: Corporation Service Company Name:
Street Address: 2626 Glenwood Ave Ste 550 Street Address:
Current Mailing Address: 2626 Glenwood Ave Ste Current Mailing Address:
City: Raleigh City:
State: NC Zip: 27608 State: Zip:
Phone: [phone] Phone:
Email: [e-mail] Email:
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Consent to Receive Electronic Communication
As the Financially Responsible Party, I consent to receiving notifications regarding this project through
electronic communication.
Email: •oev1/4s2-rr►ic..16)4.00,v01'(p.-'1 Initials:
;4_
I agree td-rovide any updated email addresses as necessary o ensure consistent communication is
maintained between myself and Orange County Sedimentation and Erosion Control. Electronic
notifications may include Plans Review Comments, Approvals and Disapprovals.
The Financial Responsible Party is responsible for the distribution of correspondence from Orange
County to other pertinent parties.
Additional Project Information'
Project Description* Detail the scope of the project and nature of land disturbance. Use additional pages if
necessary and attach to application.
Carraway Village Enhanced Site Amenities-grass seating lawn, dog park, volleyball court, pickleball courts, associated
grading, utilities, landscaping, and sidewalk.
Plans Prepared by*
Name of Person/Firm: The John R. McAdams Company
Contact Person: Z• Nathan Bales
License Number: 044862
Mailing Address: 621 Hillsborough Street, Suite 500
City: Raleigh State: North Carolina Zip: 27603
Phone: [phone] Email: [e-mail]
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Certification and Signatures' 11111.1111.11.0
Signature and Witness: The above information is true and correct to the best of my knowledge and
belief and was provided by me while under oath. `
pg E Arkiew,....)1,004. 4 4-4-
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Signature of Financially Responsible Party Type or Print Name Legibly
V cce Tres t.e * I'D /LP `ZO2 ,
Title or Authority Date
I, ` r` Z-(zIAAVAAA.r a Notary Public of the County of yvaY'`e..,-
hereby certify that 0`1 fAy personally before me this day and
under oath acknowledged that this Application for Erosion Control Plan Approval, Stormwater
Management Plan Approval, and Land Disturbing Permit/ Statement of Ownership and Financial
Responsibility was executed by him or her. �„, ��
Witness my hand and notarial seal, this\1 '
ay oft A.A-0 , L-'r '< ? 4--
Signature of Notary; m �•V\ J\ 7j
^ My Comm ssion Expires
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NOTAR
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SEAL �'
Property Owner Acknowledgement". _. . - �
I hereby acknowledge the abotte Fif�tegiti ,arid parties referenced herein have been granted
permission conduct idevelopmeritteiVIVon referenced property of which I own.
Jai QLv..�a,-GGL
<__� V c Ge 7 �le►..�` . .- -
Signature of Property Owners Type or Print Name Legibly
1,0/to i-, zL/
Date
I, 4-01,17 -- a Notary Public of the County of tA )#u -t-
hereby certify that \7V(L N�/ personally before me this day and
under oath acknowle ged that this Application for Erosion Control Plan Approval, Stormwater
Management Plan Approval, and Land Disturbing Permit/ Statement of Ownership and Financial
Responsibility was executed by him or her.
Witness my hand and notarial seal, this b 6 Day of ()(2}D '17"2-4-
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Signature of Notary . BREN'�,,�� My Commission Expires
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