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Home My WebLink AboutNCC230179_FRO Submitted_20230123%'' < Financial Responsibility Ownership �" ENGINEERING Sedi ( mentation Pollution Control Act) SERVICES F e ExchangePaa, Suite 304 leigh, NC 27601 This section to be completed by City of Ralei h staff Submittal Date Effective Date Transaction Number Permit Number LD- The remaining sections to be completed by the Applicant 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 Hunter's Pointe PERMITTED PHASE(S) 3 PROJECT ADDRESS 4020, 4100, 4112 Holden Road �MB NUMBER(S) COUNTY PARCEL ID 1747223177, 1747211664, 1747214445 ANTICIPATED DATE OF PROJECT INITIATION 02/2022 EXPECTED DURATION OF PROJECT 2 years ACREAGE OF LAND TO BE DISTURBED 9 29 51 PROPERTY OWNER'S INITIALS: J Stormivater Inspections Form 112 08.01.16 Page I of 5 SECTION 3: PROPERTY OWNER INFORMATION Lennar Carolinas, LLC PROPERTY OWNER OF RECORD 1100 Perimeter Park Dr. Suite 112 919-465-5900 MAILING ADDRESS (NO P.O. BOX) TELEPHONE NUMBER FAX NUMBER Morrisville, NC 27560 robert.smart@lennar.com CITY, STATE, ZIP E-MAIL ADDRESS 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 da of !/ 20y� Q i ✓1 S l � r1�✓pS14��r^'1 PROPERTY OWNER SIGNATURE TITLE IN WITINESS WHERE the undersigned Notary Public has hereunto set his hand and seal, this day of 6e , 20 ZZ_ A6 Ko �q aze Notary Public (print name) (�/ My Commission Expires: / 7Z5- G�� Notary Public Si nature Notary Public Title / Position .RT°° NOTARY 3�'i (SEAL) l's'" ®'l-rrc o u PROPERTY OWNER'S INITIALS: Store inater Inspections Form 112 08.23.16 Page 2 of5 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 , 20 APPOINTED AGENT SIGNATURE 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) Stonnivater Inspections Form 112 08.23.16 Page 3 of 5 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. Robert Smart Division President FINANCIALLY RESPONSIBLE PARTY TITLE Lennar Carolinas, LLC 919-465-5900 COMPANY, IF APPLICABLE TELEPHONE NUMBER 1100 Perimeter Park Dr. Suite 112 STREET ADDRESS (NO P.O. BOX) FAX NUMBER Morrisville, NC 27560 robert.smart@lennar.com CITY, STATE, 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 'j 4av-o 20 2-�! t S 1 an 6' yy5ldo FINANCIALLY RESPONSIBLE PARTY SIGNATURE TITLE IN WITNESS WHEREOF, the undersigned Notary Public has hereunto set his hand and seal, this _iday of , 2071=::�.. a Wvi, fff5zk C/ Notary Public (print name) My Commission Expires: 4 , —27aZ-!(— aitt�d Notary Public Signature n 4rfi Naxayv Notary Public Title / Position NO'iA i � (SEAL) PUBLIC Sl PROPERTY OWNER'S INITIALS: V"illi lLwiv;10 /`7isnecf s Form 112 08.23.16 Page 4 of S 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. Robert Smart Division President APPLICANT/PERMITTEE TITLE Lennar Carolinas, LLC 919-465-5900 COMPANY, IF APPLICABLE TELEPHONE NUMBER 1100 Perimeter Park Dr. Suite 112 STREET ADDRESS (NO P.O. BOX) FAX NUMBER Morrisville, NC 27560 robert.smart@lennar.com 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 Applilcaant/Permittee, if not an individual. This, the y L 20-2d/ APPLICANT/PEFIMITTEff SIGNATURE TITLE IN WITNESS WHEREOF, the undersigned Notary Public has hereunto set his hand and seal, this _ day of ZPM , 20 -a? V44W �I/ ky9-g0 Notary Public (print name) "( � Notary Public Signature My Commission Expires: I � �%Z � V 4�(/ ,aIt ayi— Notary Public Title / Position Ro (SEAL) f NOTARY I. PUBLIC v PROPERTY OWNER'S INITIALS: ��` _ �Pa <C` •'1j•w..... • C%i nnt,ritet• Iraspectiats Fornt 112 �,0 1�19�9 �,`s`•4�' Page J 6