NCC222616_FRO Submitted_20220725

�ancialsponsibility Ownership �►`• ENGINEERING
(Sedimentation Pollution Control Act) SERVICES
One Exchange Plaza, Suite 304
Raleigh, NC 27601
This section to be compl&
Submittal Date
Transaction Number
Effective Date
Permit Number LD-
The rernainlng sections to be com lefed by the A icant
SECTION 1: GENERAL INFORMATION & INSTRUCTIONS
This form is required to be completed, notarized and submitted with all Land Disturbing Permit applications. The
information provided herein becomes an enforceable part of the approved Erosion and Sediment Control Plan
and the Land Disturbing Permit listed above. Non-compliance may result in the assessment of civil penalties
and could potentially affect all permits, inspections and/or Certificates of Occupancy for this Project. Should any
of the information on this form change, a revised, executed form shall be submitted within thirty (30) days, said
submission shall include a copy of any documents recorded with the Register of Deeds.
The effective date of this form shall be the effective date as designated above by the City of Raleigh. No rights
and liabilities associated with any designation shall incur until the effective date, or the effective date of transfer
to any subsequent Party. Upon any delegation of an Applicant/Permittee or Financially Responsible Party, the
Owner shall continue to receive notice at the address provided.
A permit may not be transferred to a residential Home Owner's Association as the Applicant/Permittee or
Financially Responsible Party, until the issued Land Disturbing Permit for this project is administratively closed
by the Stormwater Management Division.
Raleigh City Code §14-1011 sets forth that it shall be unlawful and a violation of this code for any person to give
false information or misrepresentations in any application or permit required by this code. Failure to provide full
disclosure of the requested information may be grounds for denial or revocation of a Land Disturbing Permit.
Please complete all sections below. Type or print and, if information on the form is not applicable, place N/A in
the blank. All pages of this form must be completed and submitted or the form will be rejected and returned.
The property owner must initial each page of the form prior to submittal.
SECTION 2: PROJECT INFORMATION
PROJECT NAME FORESTVILLE STATION (F.K.A. PERRY FARM SUBDIVISION)!
PERMITTED PHASE(S) 2
PROJECT ADDRESS 2701 FORESTVILLE RD, RALEIGH NC 27587
COUNTYWAKE PARCEL ID
NUMBER(S) 1748638285
ANTICIPATED DATE OF
PROJECT INITIATION
EXPECTED DURATION OF
PROJECT
SUMMER 2022
6 MONTHS
ACREAGE DISTURBED F LAND TO BE 27 O
PROPERTY OWNER'S INITIALS:
Stormwater Inspections Form 111
08.01.16
Page I oj5

SECTION 3: PROPERTY OWNER INFORMATION
PERRY FARM LLC
PROPERTY OWNER OF RECORD
404 EMERSON DR 9 --4� q -;�- 5c, 5
MAILING ADDRESS (NO P.O. BOX) TELEPHONE NUMBER FAX NUMBER
RALEIGH, NC 27609
CITY, STATE, ZIP
E-MAIL ADDRI=SS
The undersigned acknowledges that he is the Owner, or holds the Owner's power of attorney, of the property
which is the subject of this application, and further states that the permitted land -disturbing activities are
authorized to be conducted on the subject property with the full knowledge, permission and consent of the
Owner.
The undersigned acknowledges that he is the Property Owner for permit implementation, compliance and
enforcement resulting under this Land Disturbing Permit and Unified Development Ordinance, Article 9.4. The
Owner of the property upon which the land -disturbing activity is to be undertaken states and affirms that he has
read and understands the statements and disclosures made in this form and that the information disclosed
herein is true and correct to the best of his knowledge and belief.
This form must be signed by the Owner of the property or by a person with authority to execute instruments, if
the Owner is not an individual.
This, the �7-4 day of FG R y a-- , 20 2/� 7-
� A- ►�►� !rr /Y► Chi � �✓{
PROPERTY OW ER SIGNATURE TITLE
IN WITNESS WHEREOF, the undersigned Notary Public has hereunto set his hand and seal, this
_day of , 20ell
2�
Notary Public (print name) Not03rPublic Signature
My Commission Expires: i Z3
Notary 119blic Title / Posi n
SARA JEAN BUNN
NOTARY PUBLIC
WAKE COUNTY, NC
MY COMMISSION EXPIRES SEPT, 15, 2023 (SEAL)
PROPERTY OWNER'S INMALS:
StormwalerInspections Form 111
08.13 16
Page 1 oj5

SECTION 4: OWNER'S APPOINTED AGENT INFORMATION
The Owner of the property upon which land -disturbing activities will be undertaken is required to either reside in
or appoint an agent for service with business and residence addresses within Wake County, North Carolina.
Section 4 must be completed if the Property Owner listed in Section 3 does not reside in Wake County,
North Carolina and is optional for all others.
The Owner of the subject property hereby appoints the following person as an agent to receive service of any
notice, process, or pleading in any action or legal proceeding arising out of any matter relating to Unified
Development Ordinance, Article 9.4. The Owner agrees that any notice, process, or pleading may be served by
and through the undersigned appointed agent and such service shall have the same force and effect as if
service was accomplished upon the Owner.
NAME
COMPANY, IF APPLICABLE
STREET ADDRESS (NO P.O. BOX)
CITY, STATE, ZIP
TITLE
TELEPHONE NUMBER
FAX NUMBER
E-MAIL ADDRESS
The undersigned acknowledges that he/she is the Owner's appointed agent.
This, the day of
APPOINTED AGENT SIGNATURE
20
TITLE
IN WITNESS WHEREOF, the undersigned Notary Public has hereunto set his/her hand and seal, this
day of
Notary Public (print name)
My Commission Expires:
,20
Notary Public Signature
Notary Public Title / Position
A 9 (SEAL)
NoT w L I e A Ib 1e
PROPERTY OWNER'S INITIALS: 2-
Stormwater Inspections Form 112
08.23 16
Page 3 oj5

SECTION 5: FINANCIALLY RESPONSIBLE PARTY INFORMATION
The Owner of the subject property authorizes the following person or firm as the Financially Responsible Party
for this Land Disturbing Permit. The Financial Responsible Party shall receive service of any notice, process,
civil assessment or pleading in any action or legal proceeding arising out of any matter relating to the Land
Disturbing Permit issued under this permit application and Unified Development Ordinance, Article 9.4.
FINANCIALLY RESPONSIBLE PARTY TITLE
4�r 1►.4rF lu f d 41--.111-24j ' +� /YL '%- i O / - / 2-r 2-
COMPANY, IF APPLICABLE TELEPHONE NUMBER
l.ss'v
STREET ADDRESS (NO P.O. BOX) FAX NUMBER
C. C4 j / /C - Z-7 s l �_ A' 4/"4 4 � arm M
CRATE, ZIP E-MAIL ADDRESS
The undersigned acknowledges that he is the Financially Responsible Party for permit impl9mentation,
compliance and enforcement resulting under this Land Disturbing Permit and Unified Development Ordinance,
Article 9.4. He has read and understands the statements and disclosures made in this form, that the information
disclosed herein is true and correct to the best of his knowledge and belief.
This form must be signed by the person or firm financially responsible for the land developing activity or other
person with authority to execute instruments for the financially responsible party, if not an individual.
This, the Z7 day of
2-V2%-
FINANCIALLY RESPONSIBLE PARTY SIGNATURE
20
v %
TITLE
IN WITNESS WHEREOF, the undersigned Notary Public has hereunto set his hand and seal, this
:2 Ttfdav of _ )rcIn op-, .20 Z Z
Notary P blic (print name) Ni7tar P lic Signature
My Commission Expires I `1 Z, _ �<Ss 01-- -0flC r
Notary Public Title I Position
PROPERTY O ER'S INITIALS. 74'0
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Stormwaterinspeclions Form Ill
0813.16
Page 4 oj5

SECTION 6: APPLICANT I PERMrrTEE
The Owner of the subject property authorizes the following person or firm as the Applicant/Permittee to receive
service of any notice, process, civil assessment or pleading in any action or legal proceeding arising out of any
matter relating to the Land Disturbing Permit issued under this permit application and Raleigh Unified
Development Ordinance, Article 9.4. The Applicant/Permittee designated below is the person responsible for
implementation of permit conditions and violation under Article 9.4 of the Raleigh Unified Development
Ordinance.
The Applicant/Permittee may be the landowner or another party who acknowledges that he is the Contractor
responsible for completion of the project as approved.
MARK ALTMAN VP, LAND DEVELOPMENT
APPLICANT/PERMITTEE TITLE
TAYLOR MORRISON OF CAROLINAS, INC. 919-407-1232
COMPANY, IF APPLICABLE TELEPHONE NUMBER
15501 WESTON PKWY STE 100
STREET ADDRESS (NO P.O. BOX) FAX NUMBER
CARY, NC 27513 [e-mail]
CITY, STATE, ZIP E-MAIL ADDRESS
The undersigned acknowledges that he is the Applicant/Permittee for permit implementation, compliance and
enforcement resulting under the Land Disturbing Permit listed above and Unified Development Ordinance,
Article 9.4. He has read and understands the statements and disclosures made in this form and that the
information disclosed herein is true and correct to the best of his knowledge and belief.
This form must be signed by the person or firm responsible for the permit or by a person with authority to
execute instruments for the Applicant/Permittee, if not an individual.
This, the day of 2, 20
-APPLICANT/PERMITTEE SIGNATURE TITLE
IN WITNESS WHEREOF, the undersigned Notary Public has hereunto set his hand and seal, this
-day of
/1111,z 0 I . • 6
Notary Public (print name)
My Commission Expires: 11I Z3
PERTY OWNER'S INITIALS: V/47
20 2 Z
otaryP ic Signature J
ASS,-54a,,'1- Oe,,1 tale-o
Notary Public Title / Position
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(SEAL)
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,,,,++ .+,+,+i' Stormwater Inspections Form 111
08.13.16
Page 5 of 5

SECTION 4: OWNER'S APPOINTED AGENT INFORMATION
The Owner of the property upon which land -disturbing activities will be undertaken is required to either reside in
or appoint an agent for service with business and residence addresses within Wake County, North Carolina.
Section 4 must be completed if the Property Owner listed in Section 3 does not reside in Wake County,
North Carolina and is optional for all others.
The Owner of the subject property hereby appoints the following person as an agent to receive service of any
notice, process, or pleading in any action or legal proceeding arising out of any matter relating to Unified
Development Ordinance, Article 9.4. The Owner agrees that any notice, process, or pleading may be served by
and through the undersigned appointed agent and such service shall have the same force and effect as if
service was accomplished upon the Owner.
NAME
COMPANY, IF APPLICABLE
STREET ADDRESS (NO P.O. BOX)
CITY, STATE, ZIP
TITLE
TELEPHONE NUMBER
FAX NUMBER
E-MAIL ADDRESS
The undersigned acknowledges that he/she is the Owner's appointed agent.
This, the day of
APPOINTED AGENT SIGNATURE
20
TITLE
IN WITNESS WHEREOF, the undersigned Notary Public has hereunto set his/her hand and seal, this
day of
Notary Public (print name)
My Commission Expires:
PROPERTY OWNER'S INITIALS:
20
Notary Public Signature
Notary Public Title / Position
(SEAL)
Stormwater Inspections Form 112
08.23.16
Page 3 of S

SECTION 5: FINANCIALLY RESPONSIBLE PARTY INFORMATION
The Owner of the subject property authorizes the following person or firm as the Financially Responsible Party
for this Land Disturbing Permit. The Financial Responsible Party shall receive service of any notice, process,
civil assessment or pleading in any action or legal proceeding arising out of any matter relating to the Land
Disturbing Permit issued under this permit application and Unified Development Ordinance, Article 9.4.
Y'�4�1�- ��T�tQ�I V Y" �� �C�s�r�✓Ke.'�t
FINANCIALLY RESPONSIBLE PARTY TITLE
COMPANY, IF APPLICABLE TELEPHONE NUMBER
15S-ol Werisn
STREET ADDRESS (NO P.O. BOX) FAX NUMBER
Cacse *VC— 2`-? /44 /�-n ra C��. ,14� .tie ofrr ror! Ea„r�
CITY, ZIP E-MAIL ADDRESS
The undersigned acknowledges that he is the Financially Responsible Party for permit implementation,
compliance and enforcement resulting under this Land Disturbing Permit and Unified Development Ordinance,
Article 9.4. He has read and understands the statements and disclosures made in this form, that the information
disclosed herein is true and correct to the best of his knowledge and belief.
This form must be signed by the person or firm financially responsible for the land developing activity or other
person with authority to execute instruments for the financially responsible party, if not an individual.
This, the 2,7 f4 day of Zo 2 7- , 20
FINANCIALLY RESPONSIBLE PARTY SIGNATURE TITLE
IN WITNESS WHEREOF, the undersigned Notary Public has hereunto set his hand and seal, this
7 day of `J,i.�n L)O-;-" 20 Z Z
LA
Notary P blic (print name) *ta, Signature qq
My Commission Expires:
Notary Public Title / Position
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•••••"Cheryl P
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(SEA- -
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PROPERTY OWNER'S INITIALS: �rrr�,e� +++++++ Stormwater Inspections Form 112
08.23.16
Page 4 of 5

SECTION 6: APPLICANT / PERMITTEE
The Owner of the subject property authorizes the following person or firm as the Applicant/Permittee to receive
service of any notice, process, civil assessment or pleading in any action or legal proceeding arising out of any
matter relating to the Land Disturbing Permit issued under this permit application and Raleigh Unified
Development Ordinance, Article 9.4. The Applicant/Permittee designated below is the person responsible for
implementation of permit conditions and violation under Article 9.4 of the Raleigh Unified Development
Ordinance.
The Applicant/Permittee may be the landowner or another party who acknowledges that he is the Contractor
responsible for completion of the project as approved.
MARK ALTMAN VP, LAND DEVELOPMENT
APPLICANT/PERMITTEE TITLE
TAYLOR MORRISON OF CAROLINAS, INC. 919-407-1232
COMPANY, IF APPLICABLE TELEPHONE NUMBER
15501 WESTON PKWY STE 100
STREET ADDRESS (NO P.O. BOX) FAX NUMBER
CARY, NC 27513 [e-mail]
CITY, STATE, ZIP E-MAIL ADDRESS
The undersigned acknowledges that he is the Applicant/Permittee for permit implementation, compliance and
enforcement resulting under the Land Disturbing Permit listed above and Unified Development Ordinance,
Article 9.4. He has read and understands the statements and disclosures made in this form and that the
information disclosed herein is true and correct to the best of his knowledge and belief.
This form must be signed by the person or firm responsible for the permit or by a person with authority to
execute instruments for the Applicant/Permittee, if not an individual.
This, the Z7 day of Z O Z 20
� � �� ���� j��or•ea..f
APPLICANT/PERMITTEE SIGNATURE TITLE
IN WITNESS WHEREOF, the undersigned Notary Public has hereunto set his hand and seal, this
day of
o b
Notary ublic (print name)
My Commission Expires: 2//1JZ3
PROPERTY OWNER'S INITIALS:
20"�tary
Z�
isSignature
Notary Public Title / Position
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(SEAL) '
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�fr•�fe+r�+fC fli„y�•��`�1�`,StormwaterInspections Form lll
08.23.16
Page 5 of 5

DEVELOPMENT SERVICES •;%00
7 No"
0
Non -Residential Plot Plan Checklist 'low
Development Services Customer Service Center • One Exchange Plaza, Suite 400 i Raleigh, NC 27601 i 919-996-2495 Raleigh
This checklist is for non-residential/commercial site plans or plot plans.
PLAN REVIEW TYPE
Building Permitting -1 Site Permitting
❑ Addition ❑ Interior Completion ❑ Addition ✓❑ Mass Grading Only
❑ Alteration ❑ New Building/Shell ❑ Change of Use ❑ New Building/Shell
❑ Change of Use
Notes about Land Disturbance/Grading Office Use Only
• If there is > 12,000 sq. ft. of disturbed area with no improvements, grading Transaction #:
and other permits, and an alternative review process may be required.
• If there is < 12,000 sq. ft. of disturbed area with no improvements, a Site Plan: ❑
grading permit is not required, but other permits may be needed. Plot Plan: ❑
If your project has been through Preliminary Subdivision Review or Administrative Site Review, provide the
Provide all previous transaction numbers for Sketch Plan Reviews or Pre -Submittal Conferences:
GENERAL INFORMATION
Project address:2701 FORESTVILLE RD, RALEIGH NC 27587
Suite:
Subdivision/tenant/shopping center: FORESTVILLE STATION (F.K.A. PERRY FARM SUBDIVISION) Lot:
Property owner: PERRY FARM LLC Phone #:
Property owner email:
Project contact: MARK ALTMAN
Fax #:
Phone #: [phone]
Project contact email: [e-mail]
Fax #:
Owner/agent signature:
Provide a detailed description of the project scope:
Mass Grading Only for 27.00 acres.
Page 1 of 4 REVISION 06.07.19
raleighnc.gov

To be completed by Applicant APPLICANT I CITY
Yes JSheet#J Yes No
GENERAL REQUIREMENTS FOR PERMITTING
1. Cover sheet with project name, transaction #, plan review type, and a
site data summary table with existing and proposed information as it
✓❑
C0.00
❑
❑
relates to land use (UDO Ch. 6) and parking calculations (Article 7.1)
2. Sheet index
✓❑
C0.00
❑
❑
3. Approved concurrent site plans (if required)
✓❑
C0.00
❑
❑
4. Completed 2018 NC Building Code Summary Sheet must be printed
on the plans. Include decision diagram if using 2018 Existing Building
❑
❑
❑
Code.
5. Four sets of bound and rolled proposed plans (minimum size 18"x24"
and not to exceed size 36"x24") and drawn to engineering scale (1"=20",
1 "= 100", etc.) including:
❑
❑
a) Date of preparation (SIGNED)
b) All revision dates (resubmittals only)
c) Sealed AND SIGNED by design professional
6. One extra set of plans if project requires approval by Wake County
Health Department. Must include Wake County Food Service
❑
❑
❑
Application and Wake County Environmental Services Review Guide
(Appendix S, equipment specs, and menu).
7. Refer to the Development Services Fee Schedule for fees.
❑✓
❑
El
8. Completed Shell Variable Form for each shell building
❑
❑
❑
❑
❑
❑
9. Two copies of proposed suite layout for all new multi -tenant buildings,
or approved suite layout for existing multi -tenant building
10. Wake County private utilities permit
❑
❑
❑
11. Copy of letter/email from Pretreatment Coordinator printed on each
set of plans, approving pretreatment system and sizing calculations
❑
❑
❑
(food service establishments and vehicle maintenance facilities only)
12. Digital copy of plans, calculations, and any support documentation
❑
❑
for each submittal
ZONING REQUIREMENTS I NEW BUILDING, ADDITION, CHANGE OF USE, ALTERATION
1. Architectural elevations providing grade points and dimension,
❑
❑
❑
showing compliance with height regulations, per UDO Sec 1.5.7.
2. Screening detail of any new mechanical equipment (ground -mounted,
❑
❑
❑
wall -mounted, roof -mounted) per UDO Sec 7.2.5.
3. Lighting plan and details for any new exterior lights, such as light
poles, wall packs, flood lights, flood lamps, vehicular canopies per LIDO
❑
❑
❑
Sec 7.4., including a photometric lighting analysis.
BUILDING REQUIREMENTS I NEW BUILDING, SHELL, ADDITION, CHANGE
OF USE, ALTERATION
1. New and existing work
❑
❑
❑
2. Building plans:
a) Foundation plan and details
b) Floor plan
❑
❑
❑
c) Roof plan
d) Structural plan
e) Life safety pages
3. Sealed truss drawings
❑
❑
❑
Page 2 of 4 REVISION 06.07.19
raleighnc.gov

To be completed by Applicant
APPLICANT
CITY
Yes
Sheet #
Yes
No
4. Wall sections
❑
❑
❑
5. Fire rated walls legend
❑
❑
❑
6. U.L. designs for penetrations
❑
❑
❑
7. Pre -cast drawings
❑
❑
❑
8. Pre -cast engineered drawings
[]
❑
❑
9. Metal building certification
❑
❑
❑
10. Energy code:
a) Building
b) Electrical
c) Mechanical
❑
❑
❑
11. Accessibility details
❑
❑
❑
ELECTRICAL REQUIREMENTS
1. Lighting plan
❑
❑
❑
2. Power plan
3. Riser diagrams
4. Fire rated walls legend
❑
❑
❑
❑
❑
❑
❑
❑
❑
5. U.L. designs for penetrations
6. Panel location and schedules
❑
❑
❑
❑
❑
7. Electrical load calculations
❑
❑
8. Fire rated penetrations
❑
❑
❑
PLUMBING REQUIREMENTS
1. Fixture and equipment plan
❑
❑
❑
2. Hot- and cold -water riser
❑
❑
❑
3. Waste and vent riser
❑
❑
❑
4. Storm riser
❑
❑
❑
5. Fire rated walls legend
❑
❑
❑
6. U.L. designs for penetrations
❑
❑
❑
7. Fire rated penetrations
❑
❑
❑
8. Minimum facility calculations
❑
❑
❑
MECHANICAL REQUIREMENTS
`1. Mechanical equipment type & schedule ❑ ❑ ❑
2. Equipment location
❑
❑
❑
3. Dampers and details
❑
❑
❑
4. Fire rated penetrations
❑
❑
❑
5. Fire rated walls legend
❑
❑
❑
6. U.L. designs for penetrations
❑
❑
❑
7. Gas riser diagram
❑
❑
❑
8. Refrigerator calculations for walk-in coolers and freezers
❑
❑
❑
9. Ventilation and outdoor air calculations
❑
❑
❑
Page 3 of 4 REVISION 06.07.19
raleighnc.gov

To be completed by Applicant
APPLICANT
CITY
Yes
I Sheet #
Yes
No
FIRE ALARM & PROTECTION REQUIREMENTS
1. CD required for sprinkler calculations, cut sheets, and fire alarm
❑
❑
❑
2. Sprinkler plans
❑
❑
❑
3. Fire alarm plans for all new sprinkler systems and all elevators, and if
required by code, for all other occupancies
❑
❑
❑
4. Hazardous Materials Permit Application (if business stores or uses
hazardous materials)
❑
❑
❑
5. Hazardous Materials Permit Application required for fuel tanks
❑
❑
❑
6. Fire alarm drawings ❑ ❑ ❑
GENERAL REQUIREMENTS FOR MASS GRADING
1. Reference the Mass Grading Checklist as a review guide.
✓❑
❑
❑
2. Land disturbing activity plans review fee (see Development Fee
Schedule for rate)
❑
❑
3. Four sets of bound and rolled proposed plans (minimum size 18"x24"
and not to exceed 36"x42") to engineering scale (1 "= 20", 1" = 100",
etc.) including:
a) Date of preparation
b) All revision dates (resubmittals only)
c) Sealed by design professional
d) One electronic copy on a CD
❑
❑
4. Vicinity map (no smaller than 1" = 500" and no larger than 1" = 1000")
showing the site position and its relation to surrounding streets and
properties with true north arrow.
5. Existing conditions plan
6. Proposed grading
0
C0.00
❑
❑
❑
❑
✓❑
C1.00
❑✓
C6.XX
❑
❑
7. Proposed sediment and erosion control plan
❑✓
C6.XX
❑
❑
8. NPDES stabilization plan (if disturbing 1 acre or more)
❑✓
C6.XX
❑
❑
9. Proposed tree conservation plan
❑✓
❑
❑
10. Detail sheets
✓❑
C6.XX
❑
❑
11. Sediment and erosion control calculations
❑✓
❑
❑
12. Plan sheets have a legend defining all symbols and north arrow
❑✓
❑
❑
13. For secondary tree conservation area include two copies of Tree
Cover Report completed by a certified arborist, NC licensed landscape
architect, or NC registered forester
❑✓
❑
❑
14. Financial responsibility form if disturbing more than 12,000 sq. ft.
0
❑
❑
Page 4 of 4 REVISION 06.07.19
raleighnc.gov

Non -Residential Permit Application
Planning and Development Customer Service Center • One Exchange Plaza, Suite 400 1 Raleigh, NC 27601 1 919-996-2500
►; %00
s,
o
Raleigh
This form is required when seeking a non-residential building permit or zoning permit for development activity
associated with townhome, apartment, office and/or commercial uses. Development activity involving a new structure,
change of use, addition, fit up, or alteration/repair that qualifies as Tier One Site Plan as referenced in Unified
Development Ordinance (UDO) Section 10.2.8 (as amended) should use this application.
GENERAL INFORMATION r PA
OFFICE USE ONLY
2018 NC Building Code ❑
2018 Existing NC Building Code ❑
Case or Permit*
Technician
Applicant: TAYLOR MORRISON OF CAROLINAS, INC.
Date: 01/31/2022
Project Address:2701 FORESTVILLE RD, RALEIGH NC 27587
Suite #:
Subdivision/Tenant/Shopping Center: FORESTVILLE STATION (FKA PERRY FARM SUBDIVISION)
Lot #:
Property Owner: PERRY FARM LLC
Property Owner Phone:
Property Owner Email:
Project Contact: MARK ALTMAN Project Contact Phone: [phone]
Project Contact Email: [e-mail]
PROJECT INFORMATION
Review Type: Express Review ❑ Pony Express ❑ Commercial Review ❑
Choose Work Type:
There are two types of change of use: (1) Change of use according to the building code, which is also referred
to as a change in building occupancy, and (2) A zoning change of use based on LIDO Chapter 6. If a project is
either a change in building occupancy or a change zoning use, the "Change of Use" work type should be
selected.
Accessory Structure ❑ Demolition ❑ Stand Alone ❑
Addition ❑ Fit -up Interior Completion ❑ Tree Conservation ❑
Alteration/Repair ❑ Mass Grading ❑✓ Water/Sewer Service ❑
Change of Use ❑ Multi -Family ❑ Other ❑
Site Permit Review ❑ New Construction 1 ❑
Provide a detailed project description: Mass Grading Only for 27.00 acres.
Applicant signature:- — ►et
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ADDITIONAL PROJECT INFORMATION
Please fill in all blanks with the appropriate information. Missing information can result in a permit processing
delay.
Site Information
Zoning district: R-10-CU
Overlay district: NONE
Existing use (LIDO Ch. 6): VACANT
Required parking (LIDO Sec. 7.1): N/A
spaces
Proposed use (LIDO Ch. 6): N/A
Required parking (LIDO Sec. 7.1): N/A
spaces
Will impervious surface change?
Yes ❑ No
Existing impervious surface: 0
sq. feet
Proposed change in impervious: 0
sq. feet
Proposed total imperious: 0
sq. feet
Building Information
Existing building: N/A
sq. feet
Is the existing building: Heated ❑
Unheated ❑
Proposed new building: N/A
sq. feet
Is the proposed new building: Heated ❑
Unheated ❑
Total building size: N/A
sq. feet
Is the total building: Heated ❑
Unheated ❑
Existing height: N/A feet
Proposed height: N/A feet
Number of stories: N/A
Total construction cost: N/A
MECHANICAL EQUIPMENT QUESTIONS
If the scope of the proposed work consists of replacement of existing mechanical equipment only, and the answer to
ANY of the below questions is "No" then a tier one site plan is required. See the Non -Residential Permit Checklist
for submission requirements. If the answer to ALL the below questions is "Yes" a permit could be obtained using the
E-Permit process.
1. Is (are) the A/C unit(s) for which the permit is being applied for at the same location YES LiNO
❑
of the old/existing unit?
2. Is (are) the A/C unit(s) for which the permit is being applied for the same size or YES
NO
smaller (BTU or Tonnage) than the old/existing unit(s)?
3. Is (are) the A/C unit(s) for which the permit is being applied for the same type (split YES ❑ NO ❑
or package) unit?
LIEN AGENT INFORMATION I www.liensnc.com
NC law requires appointment of a lien agent. Contractors/subcontractors can give notice when they are working
on the project. Lien Agent appointments are not required for improvements under $30,000, or to the owner's
existing residence, or for public building projects.
PLANS HOLDING POLICY
It is the responsibility of the Applicant to pick up plans after each review cycle. If plans are not picked up 180
days from the last review cycle, they will be considered abandoned and will be destroyed.
RESIDENTIAL INFILL COMPATIBILITY (UDO 2.2.7) 1
If this project is subject to residential infill compatibility (LIDO Section 2.2.7) a foundation survey may be
required. The foundation survey must be available at the time of zoning site inspection. For more information
about residential infill, visit the Residential Infill web page.
Please select the response that applies to your application:
❑ Yes, this property does qualify as residential infill development
❑✓ No, this property does not qualify as residential infill development
NOTE: If you are not sure if your property meets the infill standards, please complete an Infill Verification
Request in the Permit and Development Portal. There is a $45 fee for this request.
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Signatures are required for all license holders performing work. Permits will not be issued until all signatures are
received. A Permit Application Signature Addendum is available for signatures not on this application.
BUILDING
License Holder Signature:
Contractor N/A
NC License #/Class
Address
City/State/Zip
Phone
Email
Total Project Sq. Ft
Total Building Cost
Land Disturbing Permit #
Wake Co. Well/Septic Permit #
Utilities
Water: Public ❑ Private ❑
Sewer: Public❑ Private ❑
ELECTRICAL
License Holder Signature:
Contractor N/A
NC License #/Class
Address
City/State/Zip
Phone
Email
Voltage
1 50 or less❑ 600 or less❑ over 600❑
Total Electrical Cost
PLUMBING
License Holder Signature:
Contractor N/A
NC License #/Class
Address
City/State/Zip
Phone
Email
MECHANICAL
Contractor (HVAC) N/A
License Holder Signature:
NC License #/Class
Address
City/State/Zip
Phone
Email
Type of
Heating
Electrical ❑ Gas ❑ Hot Water ❑ Oil ❑ Air Condition Size in Tons:
Appliances ❑ Appliance/Duct ❑ Ventilation ❑ Refrigeration ❑ Fuel Piping ❑
Work
Includes
REFRIGERATION
NC License #/Class:
Address N/A
City/State/Zip
Phone
Email
HOOD CONTRACTOR
NC License #/Class:
Address N/A
City/State/Zip
Phone Email
ZONING
Contractor N/A
Phone
Email
Address City/State/Zip
Type of Accessory Structure ❑ FenceNVall/Retaining Wall ❑ Site Plan ❑ Swimming Pool ❑
Work Landscaping ❑ Parking Lot ❑ Solid Waste/Recycling ❑ Other ❑
URBAN FORESTRY
Contractor Phone
Email
Address
City/State/Zip
Type of
Work
Tree Conservation Area Tree Pruning (TCA) ❑ Tree Impact (Right -of -Way) ❑
Tree Buffer Protection ❑ Tree Removal (TCA) ❑ Prop. Street Trees (Right-of-way) ❑
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FIRE
COMMERICAL SPRINKLER CONTRACTOR
NC License #/Class:
Address
City/State/Zip
Phone
Email
FIRE ALARM CONTRACTOR
NC License #/Class:
Address
City/State/Zip
Phone
Email
FIRE SUPPRESSION CONTRACTOR
NC License #/Class:
Address
City/State/Zip
Phone
Email
If hazardous materials are involved please submit a Hazardous Materials Permit Application.
Type of
System
Compressed Gas ❑ Hazardous Materials ❑ Standpipe ❑
Fire Pump ❑ Hood ❑ Storage Battery ❑
Flammable/Combustible Liquids ❑ Industrial Ovens ❑ Suppression ❑
Flammable Spray/Dip ❑ Private Fire Hydrant ❑ Other ❑
Fuel Tank ❑ Sprinkler ❑
SIGNS
Sign Company Phone Email
Address City/State/Zip
Type of Awning* ❑ Construction[:] Off Premise❑ I Special Events❑ Tract Identification❑ Wall ❑
Sign Canopy ❑ Ground ❑ Projecting ❑ ITemporary ❑ Under Canopy❑ I Other ❑
*Awnings do not require a sign permit under the UDO; however, if the awning encroaches over the public
right-of-way, a Minor Encroachment Application is required.
NOTE FOR ALL SIGNS: If your sign projects over/is placed on the public right-of-way, please submit a
Minor Encroachment Application.
LAND DISTURBING/FLOOD
Contractor
Phone
Email
Address
City/State/Zip
Total Disturbed Area (sq. ft.)27.00 ACRES OR 1,176,120 SF
Construction Cost
Flood Contractor
Phone
Email
City/State/Zip
Address
RIGHT-OF-WAY
Contractor Phone Email
Address I City/State/Zip
Performance Bond and General Liability on file with City? Yes❑ No ❑
NOTE: Permits for work within the right-of-way cannot be issued without bond.
Type of Work
Number of Driveways
Driveway new/mod ❑
Sidewalk/Curb and ❑
Gutter new
Linear feet
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UTILITY CONNECTION (Plumbing Utility, Stub, and Right -of -Way Permit may be required)
Contact Person
Phone
Email
Address
City/State/Zip
Tap will be installed by: City[] Property: Residential ❑ Commercial ❑
Contractor ❑
Water ❑ Type of Meter New Meter ❑
Type of Service Sewer ❑ Individual 13 Split Meter ❑
Irrigation ❑ Master Meter p Size of Meter
UTILITY SERVICE (Water and Sewer service in Right -of -Way or Easement for Single Parcel)
Contractor
Phone
Email
Address
City/State/Zip
Performance Bond and General Liability on file with City?
Yes ❑ No ❑
NC License #/Class
Water Size
Type
Sewer Size
Proposed Stub Location
Easement ❑ or Right -of -Way (req. Right -of -Way Permits) ❑
Easement ❑ or Right -of -Way (req. Right -of -Way Permits) ❑
Easement ❑ or Right -of -Way (req. Right -of -Way Permits) ❑
Easement ❑ or Right -of -Way (req. Right -of -Way Permits) ❑
If utility services for multiple parcels are needed please use the Water & Sewer Service Addendum
PLUMBING UTILITY(Water and Sewer line from Right -of -Way to Foundation
Contractor
Phone Email
Address City/State/Zip
Water Service (From Meter to five feet of
foundation)
Sewer Service (From property line to ten feet of
foundation)
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