SEPT 1 2016 BUILDING APPLICATION9,,..,-,.
d;
hf4Vr^1, &e/na- . \v t, (^ -1---, .
'/ffEe N+IC^.^L-% -L v' Y "r.--..
'NEW HANovER couNry BUTLDTNG eww-fuffu>J4(g
APPLICATION IYPE; COI4iIERCIAL
PLEASE AI,JSWER ALL QUESTIONS APPLICAETE TO YOUR PRO]ECT
'Project Responsibility"
APPLICANT, S NA'4E
DEVELOPER:
PRO]ECT ADDRESS:
OCCUPANT/BUSINESS
APPLICATION
Number
(Office ute)
, /u\-tK /vl c
NAitE:
MIi'IE:/1o/A----
_zlP | _PROPERTY OWNER'5
OUNER, S ADDRESS:
CONTRACTOR:
ADDRESS:
EtitAIL ADDRESS:
PRO]ECT CONTACT PE
If UPFIT - The SheU Permit f:
****i Is THIS A CHAI'IGE
IF Yes, what was the Previous Occupancy Type?
oF occuPANcY usrr flves $rc *,***
What is the N€l, Occupancy TYPe?
oarcr 8')o /6
PHONE #:
CITY: r,; \m,"gic.r . 11, c ZIP:rLg:llt
LICENSE *:ACCOUNT *:
PIloNE $: (((C -^rt a,(. in
nrparns l--l REtocATroN
rs arDG spffixleneoz I v"s flt'to
NEr,t coNsrRucrroN: fl EREcr NEtl sTRUCTURE I rasr rmcx f] sxrr-r- ! urrrr fl aoo ro Exrsr srRUcruRE
ACCESSORY STRUCTURE:
Is Elect Power on this Building E Yes E rO
ARCH DESIGN PROFESSIOML:
ENGR DESIGN PROFESSIOML:
NC REG *:
NC REG #:
DESCRIPTION OF WORK:c{q 6/t-A.tor
ls food or beverages prepared or served ln this srnraure? [ ves No ls The Propedy Located ln The Floodplain? [ ves f] no
(Ou€lllld) (Pnrl1Nsfl6)
Not.: Domollion notncdbns ., asD$tos r€.novet pqmt apptL[oos alr io be submltbd uslno b€ 6pplicatlon lorm (DHHS-3768] whetheltE lsdllty or bulldln! was buid lo
; ah Asbosos or mt yoo ar6 Equlrsd to cel th€ N6tionst Embslon Sbndads br tlszardoG Air Polluiant3 (NESHAP) 6t (919)7075950 at lcssl 10 days p.ior b the
domolltlonofsnyhdlltyorbullding.so6A3besro6w€bsit€:hts,/Nrrw,.opl.'6t.'nc.us/epuasbesiovahmp.htnl
TOTAL PROJECT COST: i( i.' BUILDING HEIGHT:
TOTAL AREA SQ FT :
TOTAL SQ FT UNDER ROOF:
ACRES DISTURBED:
NEW IMPERVIOUS AREA:
(check alr That aPPIY)
EXrST CONSTRUCTTON: M ALTEMTTOT ! nercvlrroN E GENERAL
n'n roca,lon. n*"rea NatGt Gas Line on the d-urrent sitez fives ftr'ro
CUCc.. llri"'n,,,aA ( r 3,c,-l.,\ ,Vi rri.z,i t PHO E *:
CITY: ST:
CITY: Lc.\,',.,,rr(,r ST:4ZIP: jlli!t
-
PIloNE *: (lrc 2>e 'ltr t 7
# OF UNITS:
SQ FT PER FLR:
# OF STRUCTURES:
# OF STORIES:
# OF FLOORS:
SQ FT
WATER:
SEWER:
BFE+tr
J=*u'r**E(E-
Exsr LAND DrsruRatNo peRiilrr l:'lves fl to
SO FT EXISTING IMPERVIOUS AREA:
pRopERryUSE: floFFtcE f]nesreunmrr flurncemtu [eouc EAPrr EcoHoo orHER-j12|--
CFPUA T-'ICOMMUNIry SYSTEM T-I WELL EIZONING USE CLASSIFICATION:
crpua EceHrRALsEPrtc E iFivare seprrc fl coMMUNlrY sYsrEM
,saPA;lArltititlll:ili:cUl!11:L,r(-)iiLlt(:r.M:(lrrtr:i1(la,r'!Eo!ri'r.:i!:r:qtsi\li'lsLlis"
pAyNtENr METHSD: ficesx ficxecx leevaslE To NHc) flatu accourr fluovrsa flotscovrn
(FOR OFFICE USE ONLY) RElrlsED D rE/utl,l2
SETBACKS: F:-LH:- RH:- B:ZONE:-OFFICER:
Approval:- CitY:- DATE:- FLOOD:
Comment
OISCLAIMER: I hereby cenrly lhal allinformalion in lhis
"no Gcai taws ana orajnancea and regulations. The-N!tahd local laws and
or chanoe in contrE6i Etiinoe in iontractor or contractor
Subjectlo Fines Up To $500.00"'
reoulations. TThe
is corred and all wort $lllcomplv wlh lhe Stale Building Code and all other applicable Slale
,i$"*#H:: 9,'3:Iyl$1i3]i'i"'""J,""it'*iitiilillBfr3f '3i3l tl"i33l"' 6ffif 333:%'"i
OWNER/CONTMCTOR:SIGNATURE: CC: i-AoRa{
X Ne P;AHrS t-2ctu-g?7o
t
'ffi,
NEt,{ HANOVE* COUNTY BUTLDING PERMIT
APPLICATfitt rYPEr RESIDEI{TIAL
PTEASE AIISI.IfN AtL QqE'TIGIIS APPIIO{ELE TO YOUE Pf,O]ECI
"Project Responsibility"
APPLICAffT'5
DEVEN-OPER:
PRO]ECT AD3RE55:
SUBDMSION: nrnt^ o.t|r+", *.* -
BLOCK r:
PBOPTRTY OWfiER'5 }'IAI'IE :
UdNER,S ADDRfSS:ITY: (- t L,^-,
CO$TRACTSR:
ADORESS:
LICEN5E
CITY:
E|'IAIL ADoRESS:c.o
PRO]ECT CONTACT PERsON:
PHONE r:
<Y._zlr-)pq / e
s'r:!!!*rP: ePVlg-
ExrsrrHG copsrftu{rro}r, fJ alrrx*tror f nrmovarroH ffi,eeruraar, REeATRS f} nerocarroru
NEi., coN5TRUcrroN: I EREcr NrH RESTDENCE or I aoorTloN To ExrslrNc REsrDEtlct
'TPLEASE CHECI( AND A'{SEIIR BTLOH ALL TTIAT APPLY TO YOUR PRO]ECT:
I nrr 6ARAGE
-
st f, oer cABAGE *- sF I roncx
-sF
I sronae: sHED- stfl roor-
-
sFl] surunoor'r
-*
sF
I-l cnrrr*nousE sr SF OTil€R r SF
rcz tu.Lbb+
APpucar:oil
Humber
(c}ffi(e ure)
ti -?r*#f,r
pl,NE *i 1to-alS:?A3L
[*] oecx
rorAL HEATTD sQ Fr ,l /O O*-. rorAl sQ FT uNDER *oor: I /O A- . rorAL AREA 5Q Fr: J-|""e'-?
ToTAL PR0IECT COST(Lss'Lc,) , * 1%*O s oF sToRreS, . f"
PROPERTY USE / OCCUPA}.ICY:
DESCR!$ffoli OF WORK:L,
DISCLA1MER Ifler€by,t;ll,i/ lri 3'r lit)r.r'6 ,t &tt. applkilir^ ts cqrert and all
"rnrk
wil complt wal+] !}e Srale SurH*r$ CoOe and a[ o&e, apFkable Staq] and bcal lrdr
ild ordsa.ros Md tefulaims f he tll-lq
coouscbr inbmaion. "'No]c. Any
Ol,lNER/COI'ITRACTOR :'tlt
-ffi-
f-{Prlnt tnrt}+tt*+*ir.rr***t+*+*t***14*t*****.**tai*lt***t*tr+r1*alrt*ltt**lrrtri.ttrrt*+arttalal*rrtl
rs rHE pnoprnry Locarro nir A FloonFlarxr fi yrs F *o BC$(1
-SQ
TT
r.rArER: F.creun f] communrry sysr[fi f] nnrvr* uer-l f crurnal t"tell
L
sEwERr Scrpua f]] cruranl sEprrc f] nn:vlre sEpri. f] conmururry sysr6l,r7--'1' SIPAHAIT PERI{]TS JTEQUIRED FOR ELEC'[,
'4ECH,
P186, 645 €QUIP, pREFABS & I|.ISEBT5 ."
PAYI,IE,$T r.lErltoo: f, casrr ffinta* (aAvABLE To NHc) fla*r*rcm ExpREss I ncrurso fiors.ovent*ai+atttrf,*-1a**1.+***/***r*rt*+t*t+*****.*+**rr*+r*+trt*+*?*+a?+ati**+++ir*fr+**lt+41**
(foR ofrtar ute oi[Y)
Is Any ETECTRICAL, pLUliSING or
''iECHAIIICAI
Ho.k Being oon€
If the project is a Refoc*tion, is there a llatunal
Is there Electr:cal Por.,er on this BuildinglfJves
srr.rGLE rAilrLy I uueurx f] rounxousr
sETBAcKs: r : r{fg. r-H: N./& an, t-r./4 e,N /4
to the Accessory Structurel f] ves E ruo
Gas Line on the current Site? fi ves fJ ,o
fl no
EXXSTIN I,I1PEEVIOUS AREA:
NEIJ I}IPEXVICI,JS AREA:SQ FT
TOTAL ACRES DISTURBTO:
EXIST LATJD BTSTURBINC PERr4rr: l-j vrs i-'i ruo
tfvltED rrlIt 6{/t:.,tt
J'r**r, ,ru, t*3$rP
,'tu lnsnqefiffi kftr*{, f'l{}f5{-*t
SIGMTURE:
PilOilE X:
zoNr: P-5 orrrce",
7ev.oY. BFE+2ft=npproval:0K
RECEIVEDAUG2szoffi
NEI^J HANOVER COUNTY BUILDING PERMIT
APPLICATION TYPE; RESIDENTIAL
PLEASE ANSWER ALL qJESTIoNS APPLICAELE TO YOUR PROIECT
"Project Responsibility,,
6104 WilIow QIen Drive CITY: witminston
BLOCK #:
PROPERTY 0WNER'S },IAME: eobbv lu1il]er
OWNER'5 ADDRESS: G104 wilIow Glen Drive CfTY: 9lilminston
CONTRACTOR: NC solar Now, rnc.LICENSE #: 69583
ADDRESS: 3401-101 Arlanric Ave CITY: aaleiqh
Et'lAIL ADDRESS! permirrinq@ncsolarnow. com
l{ArtlE : Chris, Baker (NC Solar Now, Inc . ) DAIE I / 2a {t5
PHoNE #: 919-833-eo9G
PRO]ECT ADDRESS:
SUBDIVISION:
PROIECT CONTACT PERSON: chris Baker
ExrsrrNc coNsrRucrroru, E ALTERATToN I nrruovarroru [ crruennr- REnATRS f nrrocarroru
NEW coNsrRUCTr0N: f] rnrcr NEt,t REsrDENcr or I ADDrrroN To ExrsrrNG REsTDEN6E
**PLEASE CHECK AND ANSWER BELOW ALL THAT APPLY TO YOUR PRO]ECT:
flarr GAMGE sF I orr GARAGE sF trPoRCH
-sF
fl surunoom _ sF
fl cnre ruHousE _ sF
TOTAL HEATED SQ FT:
f eoor _ sF
I oecx
TOTAL
f sronacr sneo
OTHER: sofar Pv
_sF
SF Array SF
TOTAL AREA 5Q FT: 180
T0TAL PROIECT COST1r-essr-oq : $ rr, roo # OF STORIES: z
Is Any ELECTRIGAL, PLUITIBING on I{ECHANICAL hlork Being Done to the Accessory Structure? [l Ves D No
If the project is a Relocation, is ther e a Natural Gas Line on the Curnent Site? [ves E ruo
Is thene Electrical Power on this Buildingl [l ves E no
pRopERTy usE / occupANcy: I STNGLE FAMTLY ! OUer_eX ! rOwruxousr
DESCRIPTION OF WORK: rnqt.allation of a reside!tia1 roof-mounted solar pv array
and ordinances and regulations. The NH C Development S€rvices Center will be notified of any changes in 01e approved plans and specifications or change in contractor or
conltactor inbrmation. "'NoTE: Any Work Performed wo the Appropriate Permits will be in violation of the Nc staE Btdg code gDd subject to Fines up To $500.00.,.
OWNER/CONTRACTOR: Chri.s Baker SIGNATURE:
* * * d( +* * * * *,k * * * * *+ * * * + * * * * * *(Ii'Il Jil? * * * * * * ** * * * )* * * + *,* ** * * * ** * * * * * * * * * +* * * * * * * * * * * * * ** * * * *
rs THE pROpERTy LOCATED rN A FLOODPLATN? n yES E HO
EXISTING IMPERVIOUS AREA: _ SQ FT
NEhJ ImPERVIOUS AREA: _ SQ FT
TJATER: ! creua f coruururw sysrEM f] enrvarr wrll I cerurnnl wrll
sEWER: f] creua ! crrurnal sEprrc I nnrvare sEprrc f] commururw sysrEm
*** SEPARATE PERMITS REQUIRED FOR ELECT, IIECH, PLBG, GAS EQUIPJ PREFABS & INSERTS **+
'^yi[.H'-1':;--.H-'l'l..8.1'.T-l:11'.'f.]:-ii'.,..tr-..:l::1.f3]1.--tr--.1:1yr.1.--F--r.1'-.-.ff1-
sQ FT UNDER ROOF:
TOTAL ACRES DISTURBED:
EXIST LAND DISTURBING PERMTT: l-l ves [-l r'ro
ZONE:OF FICE R:
Approval:_ City:_
Coment:
(FOR OFFICE USE ONLY)
SETBACKS: F:LH: RH: B:
REVISED DATE 04/77/72
BF E+2ft=
2otL-g-731
l(aqn
AP-Fi:cnm'N
Number
(office Use)
ZIP 284L2
LOT #:
PIJONE #: (e10) 3s0-269s
ST: wc ZIPI 28412
ACCOUNT #:
ST: NC zIPi 27q03
PHONE #: e1e-833-e096
PHONE #: 919-833-9095
DATE:_ FLOoD:
J.*r, ree, s -16r&
RECETytD AU6 1" lltj ?T * rb -ffiT{
APPLICAIJT'5 I,lAJtlE:
OEVELOPtk : ii I ,.r. " *. _*_*
PRO]ECT ADORESS:
SUBOIVi 5 lON:
'i;:*ir,i ';)vi{iJ: -
APPLICATION
Number
(0tfica Use.)
DATr: ;'. i'V: rr.,
Fla^(E Ar,lSi/,'tp AtL qJE5tiONS APPLICABTT TC yOt,F. pR.:1!"r
"Frajert Fesponsibilitv,,
P}IONE f,:
PR0PERTY 0l"Jliilt,s t$,r'1! :
Otlf'{t: Xi' S ADD.E E5S :
FI4AIL ADDRESS:
PRO]TTT TONTACT T{ilsON:
-r'r"r )n l*.:
Nrw HAr{Hn,:3'xI- *Y*'-#: PERI1: r ? o$ :fr t\3
\t"t
.-,}K- l]. r'' u, \iuar,l r-1[--** rr, !!- r,,, ) Tt 0h"'V- LATHY s Sl\fuelan0ei;t{, -, --. -.
-..-..-; .I"-l..:...-l - -- prKlNE ,: , . ," ;1, 1-'"-..-:jto-,''{
ExrsrItiG cotrsrnucrroH: fJ atrrnerton i*J nrnovarrou []lcrr,unau R[pArRS [,] Re lxr,"::ioru
NEI^I cONsrEi"JCrI0N: 1-J s*rcr HEhl Rts:DENCE c:^ f, ADBr r ron T0 Exrsyjr,tc REsIDEiia[
i*PL'AI[ CHECK AND ANSUIE BILOH ATL :},iAT APPTY }II YOUR PR*]!IT:
f] arr cARAGE sF f] crl GARAcE sr I eoncH
f] surunoor sF l] poor.
--
sF ,iJ sunaer sHro *- .lgr sr
I cnrrr'rxousE _.-_ sF T orcx _ 5F r::'r;iEn: .._ sF
T0TAL HEATED 5Q FT:TOTAL SQ rT UNDER BOOF:TOTAL AREA 5Q FT:
TOTAL PROIEfT COST,L...,,g:: i $S OF STORIES:
Is Atry €LECTRI(AL, ptl.lrsiNG or FIECHA!,aICAL Nork Being Done to the A.itriso..y Structurel ffi VeS ffi tfo
If the pno)e.: ls a Relocation, is there a ll3tur;] 6as Line on the Curre:lt Site? f, ves fIs there Electricai Power on thi.s Burldingi llf ves [] Ho
PR0PTftTY uSE / OCCUpANcv: 'fi STNGLE FAMrry ] Ountrx i_l roxNilCuSr
DEscRIprIoN sF hoii(' S]"tu.:{.cil,jj,,:-.1::: ,*.U)__}-kjU"_.: "{*!-_ .r:i::*
ot,JNER/C8ilTRAc.|.C}R.-(-MsIGNATtJR6,{-.*-|,4,!..:..].:'..:,*,)-,,,',--,
*ri'1rr*,*,rrr.:i'l*"..,,,.'Il';;ilr;-. rr:.r,.r,...\rj.r.-. -j,-".,,.rii+;***
!*;, \, I :I5 THE PROPEPTY LOCATFI] IN A FLOODPLAIN? I-."...I VES i IN} NO \I i
Exrsrrrr6 lrlpERvtous ARE&:
-
sQ FT ,K[o.*r, ]rrrr*uur: -*..*,
NEl., :llPtRvlous AREA: .--,*-.--sQ Fr txisT LAND DisTuRBING oiiili-IJ ,r, il rc
htArf;*: ffi creua I c0r'ru,urir;y syl.r:lt f] Rnlvnrr lrll f] ccru;a,ri u,irlr
-+.sE!,[R: ffi crnua ] crt;rit,u Sr:t>Tl(: f enrvarr sEprIC J conmuru:n' sy5-EM
i&T <TPAAi)Ti PERI{ITS P.?I]:!iT] FOR ELI.: IIECH, PLBG, 6A5 EqJIP, PRfFABS 8 IHST'T;,..
pAyr{ENT s.llioc: il cot, !lcxrcr (pAyaBLE To NHf) fiarenrca* EXPRESS fi rclrrsa fiorscovrn
r . ;.,r r ! ;.-.r i, ) /.,-. _ CITYI f' -_\1.:_itiL.;*I_ ZIp:.,r
.o*r, R-15 pFrriii:
I
/rpprovai : .,1 { ity r
i rt 1* l:,:g,
Cr,'r,nrnt ' lr1L1'' i''1( v
_ -"1 arr* zrt"
I
fiI rI5r:' t,',r r.if ,, *u,
coNrR,{cToR: i, j'i":**,X_u$ t Lfi.ttt 1 blKkt'\ rrcrrsi *,
++l+r r,*+ti,a ' i 'tti !t 'r rr*+4 aa3rl1 ,r r r-,'r::.:+a1*ij i *
nft w:a*q*
?nu g+5Lt
APPLTCATIOT{
Number
(Office Use)
APPLTCAI{T' s l{AllE: Eqan Realrv services Aqent For verizon wireress DATET B/a5/2016
DEVEIOPER:PHO{E *:
PROIECT ADDRESS: 4428 sourh collese Rd CITY3 wilminqton NC ZIP i 28412
OCCUPAI{T/BUSINESS ilA E: N/A
ttsi
tAktc txl -
RECE1yED Ar[ 19 tOf
NEhI HANOVER COUNTY BUILDING PERII,IIT
APPLIcATION rype: C0ltltttE RC IAL
PLEASE ANSbIER ALL QUESTIOiIS APPLICABLE TO YOUR PRO]ECT
"Project Responsibility"
MltlE: Duke tnerqw
P. O. Box 1090 CITY: charlotte Sf: Nc ZlPi 2a272
C0 TRACTOR: Infinitv Communicarions NC LLC LICENSE #: 14679
PROPERTY ()}INER'5
OI,NER'S ADDRESS:
PHONE #:
ADDRESS: 110 Lirbo ,ray CITY: Durham
EMAIL ADDRESS: susans@eganrs. con
PROIECT COI{TACT PERSON: Susan sul-liwan Eqan Realry services
PHOI{E
PHOi{E
ST: Nc ZIP: 27?03*.wzL
$: s7o-266-5993
Occupancy Type?
ARCH DESIGN PROFESSIOTIAL:
EN6R DESIGI{ PROFESSIOML:
PH:NC REG #:
Tower Enqineerinq Professj.onals PH: _9fl_j!l:j3!l_ I'lC REG #: C-L794
DESCRIPTION OF I{ORK: Removinq and/or addinq antennas, RRUS, Raycaps and Fiber Lines to exist. tower
ls food or beveragee propar€d q s€rv6d ln ths *nrauo? [ ves fl llo ls Tho Propo.ty Locatod ln Tho Ftooddalnr I ves [l r.ro
DISCIAIMER: I hereby certily lhal all information in lhis application is correct and all work will comply with the State Building Code and all orher applicable Srate
and locallaws and ordinances and requlalrcns. The NHC Develooment Services Center will be notifed o{anv cianoes in tha aooroved olans and sdecifications
or chanqe in contractor or @ntractor information. "'NOTE: Any Work Perlormed WO the Appropriate Permib will Eb in Violatidn ol lhe NC State Eldg Code and
Subiecrlo F'nes Up To S500.00"'
OWNERyCONTFIACTORI susan sullivan-eqan neatty serv STGNATURE: Susan Sullivanffi**-
(Ofl.r, lPr a|Jr.)
cootein A5b.6b6 or not Yoo ars rEqulr.d b c.ll lh. Nadon l Emhsbn str.d..ds tu Hrz.rdoos Ar tuluiantB (NESHAD st (919)707-5950 ar to6c 10 &:E trk, b rh.
dqrcllton of 8rly f..rit or bullding. Soo Arb.3bs lrr€b SIE htD:#.,w. efi.state. nc.us/opi/asbosto6/atxnp.htnl
TOTAL PROJECT COST: 25ooo BUILDING HEIGHT:
SQ FT PER FLR:
# OF UNITS:
TOTAL AREA SQ FT :
# OF STRUCTURES:
Exsr LAND DrsruRBrNG pERMrr? E ves I Ho
SQ FT EXISTING IMPERVIOUS AREA:
PRopERTy usE: [orrrce lnesreumrr [uencarvnr-e leouc lner [conoo oTHER.lq]e!p!_
WATER: E CFPUA fl COMMUNITY SYSTEM E WELL fIZON|NG USE cLASstFtCATtoN:
sEwER: T-'ICFPUA f_ICENTRAL SEpTtC E PRMATE SEpTtC ICOMMUNITY SYSTEM
". SEPAMTE PERMITS REOUIRED FOR ELECT, MECH, PLBG, GAS EOUIP, PREFABS E INSERTS "'
PAYMENT METHoD: EcAsH flcnecx leeveaLE ro NHc) flnuenrcen a<eREss EMc /lsA I olscorcn
TOTAL SO FT UNDER ROOF:
ACRES DISTURBED:
# OF STORIES:
# OF FLOORS:
NEW IMPERVIOUS AREA:SQ FT
(FOR OFFTCE USE Oi{LY}
SETBACKS: F:_LH:RH:_ B:
BFE+2ft
REVISED DATE ar'l 1/12
N
(Check At1 That Apply)
Exrsr cor{srRucTroil: f] ALrERArror{ f] nemvarror I eeteul REparRs l-l nelocarrot
lf Rolocatlon, is there a NaturalGas Line on the -Current sirez Ive;[r.ro ts aloc spfitr.ixleReor ftves flruo
NEt,l coNsrRucrrav: ! enecr NE!'r srRUcruRE ! rasr rnacr ! sxer-r- ! unrrr fl ADD To Exrsr srRUcruRE
ACCESSORY STRUCTURE:
If UPFIT - The Shell Permit #:rs Elect Poler on this Building E Yes E] ruo
r**.r I5 THIS A
IF Yes, rihat uas the Prevlous Occupancy
CHII'{GE
TYPe ?
oF occuPAr{cY usel flvrs I r,n
lfiat is the t{ff
fivg7ry-OFFICER:
Approval:_ City:_ DATE:_ FLOOD:
Comment PERMIT FEE: $
v lotta-stb I
APPLICATION
Number
(offi(e use)
oNEtT l/1 llborStu@PTIONE
P}lo E
NEW HANOVER COUNTY BUILDING PERMIT
APPLIcArIott TYPE: RESIDENTIAL
PLEASE ANS}IER ALL QIJESTIONS APPTICABLE TO YOUR PRO]ECT
"Project Responsibility"
a/'c(4APPLICAIT'S MITE :
DEVELOPER:
zre StPRO]ECT ADDRESS:
SUBDIVISION:LOT $:
PROPERTY OhINER,S M'4E :
OTJNER'S ADDRESS:
CONTRACTOR:45
ADDRESS:
ET1AIL ADDRESS:
PRO]ECT CONTACT PERSON:Au / (-o.-,o-PHONE
I rnecr NEhl REsTDENcE o" ! moruot ro ExrsrrNc REsrDEl{cE
Al'lSl.lER 8EL0w ALL THAT APPLY To YoUR PRoIECT:
,r.ic zprLt'fol
*,QT *1--7rG{
o, qru36t '7/A9
! arr ornace sF I orr clnacr
(surnoor.r 22k--sr ! eoor
f] onreNxouse SF fl orcx
sr f] poncx
-sF
SF ! srome e sHro
SF OTHER:
SF
SF
€;,,n^t
TOTAL.HEATED S q fi, /724 rorAL sQ Fr uNDER RooF:TOTAL AREA SQ FT:
ToTAL PRolEcT CosTrressrorr : $ 25, cuL # oF sToRIEs:
rs Any ELEcrRrcAL, pLu6BlrG or irEcH4t{rcAl work Being Done to the accessory structure? (v"t I m
If the pnoject is a Rel.ocation, is there a Natural Gas Line on the Current Site? EYes E No
rs there Electrical Power on this Building?[lves !ruo
BLOC(
t1- t22\
ExISTr,tG C9NSTRUCTION: I llrenarrOl I nrmvarrOru [ Ctlrnal neerrns ! REL9CATIoN
NEVJ CONSTRUCTION I
*'PLEASE CHECK ANO
pRopERw usE / occuPAilcY, [t srrclr raurrv p ounrrx ! rohlNHousE
^E ,^,^or.. /,,a,:arha., /,iJered nr,,acL 1-, <.l arcQf4d Dzt C fcn*tt ilo s*^.ft..< | a I'e"o,e*.DESCRIPTION Ot *On*' a.-r',.1,t -------:_i?;i;, /"A h lrcr^l\ <4+*+1
cerrt that a[ hbrma$on in hrs apprrcadon ls conecr and a[ work willcompry wft tle Slal€ Euilding 6ds and all oher appllcable Stab and local urs {+C41€d
;;;;;;";."r"-d "'d;i"'"i. it'" p,c o","roge+nr ;rvices cenb' witrbe norifed ot any chanses h be apploved plans and specircatrons orchanse in co rEcbr,or
"""n*rir;-"u".11orc:ry worrr pelt# wro qrqeoo,optiae e"rnits willbe hiElaii;no,lrte Nc sl,aE Btdg{-ode and $bjecr rc Fher up Io i500 tlo"p,opriat Perqlitswillbe ir VElaton otlne NC Sl]aE Bkig+ode and SubFcl b Fnet Up Io 5500 tlL
..-4.-- 5TGiMTURE: /o-^ | hor-,n
*,i** * *)i,* )*,t * * *,i,i * ,*,t * **,f rt l(*
I5 THE PROPERTY LOCATED IN A
,t,t*** ** !t,l *,* * ,l,l i(,i,i *,t )t *** *,t* *,*r*,t*,f*ri(*,*** ****'** ** 'i* 'l )t * '*
t l--'l vrs I rrc
MTER: I creur fl comt"luNrrY svsrrr.r I PRrvArE wELL I celrnal wrll
sEwER: ! crnul ft CENTRAL sEPTrc f] enrvare srprrc n coMMUNrrY SYSTEM
*** SGPAIATE PERI'iITs REQUIRED FoR ELECT, li'tEcH, PLBG, GAs EQurP, PREFABS & It'lSERTs ***
oo"rr* "rrroo, Ecrss Ecxec( (PAYABLE to "rc1 [ *r*rcAil ExPREss E nclv,to I orscovrn
* *,**,| *,|,|rt**,**** *,t,! *,r,*,i )r*,1*:t*** ***)t*,t)t,I*** *****,!,* * 't,i,l ,| * !t * ,I *,* ,t * * * *,1,i !* *,l,l,t 'l 'f i ******** * *** **
EXISTIT,IG IT.IPERVIOUS AREA:
-SQ
FT
NEW IMPERVIOUS AREA:
-SQ
FT
ZONE:OFTICER:
Approvat:- CitY:
PERMTT: E YEs nNo
REVr5E0 DArE 04l11/12
RH: 8:
BF E+ 2ft=
N
PERMIT FEE:
TOTAL
EXIST
(fOR OFFICE UsE ONLY)
SETBACKS: F:
ACRES OISTURBED:
LAND DISTURBING
LH :_
comment:
DATE :FLOOD:
CITY:
LICENSE S:
clTY | /,a)t /-
sT: ZIP i
OUINER/CONTRACTOR:
?otrotlal
pERmrr @
APPLICATIOiI
Number
(Office Usc)
,orr, I7k/,-b
PHONE fI
zrP; Jryol
PlrslrE *: 1go-46,3183
PtroNE *: .!kt16-85:l
[} aoo:rror ro Exrstrllc eEsrDEHcE
YOTJR PRO]ECT:
I
t--
J&.
Et$-4->'
APPLICANT, S
DEVELOPE[:
PRO]ECT AONRESS:
9UEDIVISION:
PROPERTY
ohlNtR's
PRO]ECT COI|IIACT
',ln ,k;
Exrsrrp6 corisr1urrrgn, I alrrr,r.rroH f RENovATIoN I srtrnal RrP,ur,s [*] ntlocailorl
NEId HANOVER COUNTY BUILDING
APPLICATrmI rYPf: RESIDENTIAL
PltASf ar.|Sr{ER Att grEsTICtlS APPTICAS!€ T0 YOUi
"Project Responsibility"
Mr{E: f.rorr} J ?a+ h"
PRO]E.I
' o^ililsR' s
ADDRESS:
XcorfiRncton:
f AD*&Ess: -.f
F ErlAlL
'ODRESS:
r-+/\A
NEhr CohrsrRutrrou: fl €ft[rr NfN RESTDENGG or
..PLEASE CHECX ANO ANSWER EELOU' ALL IHAT APPLY TO
flrrr 6AM6E *--..-.- sF f] oet GARAGE
I-l surunoom sF
[--] cnpttlrousE si
[-'] poor- sF
I orcr
ExISTItlG IPIPERVICIUS AREA:
--
5Q Fr
NEti I}IFERVIOUS frREA; _ SQ fT
sr f] roncn
-
sr
fl sronact sHEo -- sr
OTHt R:
TOTAL AREA
SF
sQ fr:rorAL r{EATEo sQ Fr,WE!l- rorAl sQ Fr uNDER RooF:
.**.'....*.....-......
OISC|AIMER. I rer€by cen,ff ri:r sI nb@ars. n &is &tlaa&n b cqiec! atd a! mrl ni[ cohpt, r.i tle State Eerldiog Cods tid ti 6Aer !o?'babb SAS &ii bcal ttdl
f] srneue FAMTLY l?{oupt-sx I i rq,ruHouse
:"(1?'44-. - r\ i .r.^. ,,
)+/tl ,
LL lrad e s
rs rHE pRopERTy LocArrD rN A FLo*tpurur IJ vrs d *,
sd c,!,iance3 9.!d .e{l!:8,tri5- .ihe NHC Oe*'aire.r Sar(es C€nbr wis be no!6ec of ay cheges n *a app{oEd pbns aod 5qfti6cab4s or chrqt , congrlot or
conlaclorFtlqrlon...ilo"IE;Afrrt4rortPerhtra€tlvrot?iAppEtlrialaP6rmi6wrlosnyobt'mottheNCStabatlqcoorrrlsubisclrot4rslrpIa3$000r"
or.r,{EB/coNrRACroR: c-.." F--.-kJ'-:n sr@'lAruRE , -wlL-
+rrr r r * *r* i r r!+.. r r r+* r r. * *(I?31,!t:lti.. ** rr +*r? r *?*r *, t t i * ' tr r * r. t/.1tt r r 4 r r t r r t *+**.**+:) I
n
Is Any ELECTiICAL, Plull*:tie or HE(HANTtAL l''ork Eeing oone to the Ac(essory
If the project is a Relocation, is there a Natural Gas Line on the
1s thene E}€(tri(af Porlot" on this Euildlng? f! ,", ff*o
TOTAL PROIECT COST(LesiLor): $- # 0F STORIES:
PROPERTY USE /
DESCRIPTIOI{ OF
TOYAL ACRES DISTURBED:
EXIST LAND DISTUREING
*.tu"", ffi", fr
current site? f, ves
PE*i4rr: fl vrs fll ilo
NO
d*o
rllrER: fl3rruo f] cowurrw sysr[t'l f]eR:vare wrll I crNrnal ue ll
sEhlER: dcrruo f] cen"rRal sEprrc f] na:varr stPrrc fl coruur,rrrY sYsrFf'l
PERHIT5 REQilTRID rop tttcl, HECH, PLB6, 6A5 EQUIP, PRETASS & It{fre?S "'
'^'::'ll"::"1':..-"8"'f:-,F3'.':"1:::1'.::,]:.:T-',,.F.r:l',.':.::"-i"'.'..,H.lY,Y::..-H:::::'-
LICENSE *: _:rrv, Cc+{e-lffi,If . .- . sr:$f*z:.s ')-&q?'l
PHONT T:
,o*,, p - s f#S)--:r^-'T,.j;:;] ", jje- .n,*ifi. *n,siL u,Nb.""" 'a' si,: ii
cityu.lltjflfl- oarr &12l4\1l FLooD: f11UX* $rr+2rt=
Jt*r* ret, tj*ffi-
:::EIVED AUC 24 2016
ApPLICAft'S llAllE: stevens Buildins Conpany
Aptc, . v1:Ll
'-liio-+f#
APPLICATIO{
ilurber
(office U5e)
oa.,,* tlzrlft|
ZIP: 2a4ll
NEtl HANoVER COUNTY BUILDING PERI|IT
APPLICATIfiI TYPE: RESIDENTIAL
PLEASE AT{$TER ALT QUESTIq{S APPLICABLE TO YOT'R PRO]ECT
"ProJect Responsiblutlf
DEYEL(PER: Torchivood
PRO]ECT ADDRESS:
PHO E #:
v'li.Iminqton
SUBDMSIO{: Maple Ridge at liest Bay Estates BLOC( #:LOT *: 22
PROPERW OrItlER's tU$tE: stevens Buildinq companv Pl(IlE
ft[tlER' 5 ATDRESS: 5710 oleander Drive suite 200 CITY: wiloington
COrrRACToR: Stevens Buifdj-ng conpany LrcEt{sE #: w,s_
AITITRESS: 5710 oleander Drive suite 200 CITY: wilninqton
E arttlL AODRESS: s n ichol sonG s tevens finehone s . com
PROIECT COI{TACT PERSO : staci Nicho.lson
PI{OT{E
PT(XE
*:910-794-8699
ST: Nc ZIP:28403
ST: Nc ZIP: 28403
#:910-794-8699
#:910-332-8515
Exrsrrl{G cd{srRucTloil: I rlremrror I nerwarioN ! cer,rrml neearns ! RELocArroN
NEr{ CO STRIJCTTOT{ r @ rneCr IEU RESIDET{CE o" ! OOrrrOt TO EIISTIiIG RESTDEI{CE
**PLEASE CHECK Ai[' AI{SIJER BEL(,$I ALL IIIAT APPLY TO YOUR PRO]ECT:
[|arr ennree l1J sr ! orr eanace
E sulnoor _sF ! eoor
I eaeeuorsr
-
sr ! orcr
TOTAL HEATED SQ FTl ,CqA TOTAL SQ
TOTAL PROIECT COST Gess r-a) : $ lzo,ooo
fs Any ELEGTRIGAL, PL$iarI{G or IBCHAICAL Work Being Done to the Accessory structure? p Ves l] lo
If the project is a Relocation, is there a Natural
Is there Electrical Power on this Building? EYes
pRopERTy lrSE / occlparcy t @ sruclr rar,Er-v I u.rer-ex I Toh,NrousE
DESCRIPTI(X OF t{RK: New residential construction.
DElq-AllER I her€by certry $atal hbmalion in tli6 appLalon i6 corect and d woft wil comply wit| he Star6 Bulldlng Code sE €[ ofier €ppllcsbb Sbts.nd bc€l l&vs
and odlnanc6.nd legulatons. The NHC Developm€nt Servi:es centr vvii be nolified of gly d|arges h tre approved p&hs and
cont-acb. lnrrmalbn. ''NOTE: Any Work Fbrb'm€d W/o hs AppopriaE P€lmlts rrll b€ h Voblion of tl€ NC SEE &dg Up To $500.0(r"
Oil{ER/COiITRACTOR ! craiq Stevens SIG TITURE:
*,*x *)*,t,* **** *:i*.t + *
I5 THE PROPERTY LOGATED I A FLOOOPI.AI ? E YES
Exrsrrrc mpERvrous * , Zbz( qrr
I{E{ IfiPERVIq,S *,
..l
,q,,
El no
TOTAJ- ACRES DTSIURBED: ll3_
Exlsr LArf,, DrsruRBr G ,r*r-, 5 YEs [I ix,
neren, p crrua I cofflrrNrw svsrem I pRrvATE wELL fl crrrml ueu
serrn: @ creua ! cENTRAL sEprrc I enrvare sEprrc E cofi]'nlNrry sysrElt
*+* SEPAIATE PERiITS REq{JIRED FoR ELECT, l,lECH, PLBG, 6As EqJIP, PREFABS & IT{SERTS
ql ,,8<***-t 'I "
payHE[r iETHoo: E cAsr E c}ro< (payaBLE To ]lf,) E ariERrca[ ExpREss E mmsl E orscoren
SF
sF E PoRcH 3-t,. ! sroneer SHED
-
sF
OTHER: SF
FT U$,ER
*
amrzfu
OF STORIES3 L
TOTAL AREA sQ Fr, 1b51
Gas Llne on the current site? ! ves fiil uo
lilno
zo E :OFFICER:
(FOR OFFICE UsE q{TY)
SETBACKS: F:
REVIsED DATE O4/L7/12 '\
RH:- *J +(t0 fn o.\
v.
BFE+2ft=Approval:_ City:_ DATE:_ FLoOD:
comEnt:
LH:
Jrorrr r.r, $lfuL'j-
#fL, RECETtlED AUq 2 e zolo
S g-- NEw HAN',ER cou'Ty BU*DrNG pERMrr liFntrl I
? /" AppttcAT,ovrypE: RESIDENTT,ALt* rfr plEAsEANswER1;fflff#*,rc;:#royouRpRorEcr
2Dv8T(
I Piint I
Appllatim
Numb€r
(offirc us€)
AppL;CANT,S rvAME: F.S., L.L.C. dba RamJack 931s. 8/26/2016
pROJECT ADDRsgy 222 Pilgrim Circle _ crw: \y'Vilmington 71p,28401
SUBDlVlstoN: Heritage Park Cape Fear LOT #: 44
pRopERTy owNER,S NAME: Mary Bumgardner pHoNE #: 717-7924633
owNER,S ADDRESS: 2?2 Pilgrim Clrde qpy. \Mlmington
C6NTMCTOR: F.S., L.L.C. dba RamJack
ADDRESS: 4122 Bennett Memorial Road suite 304 gryy, Durham
EMAtt ADDRES5T chadie@ramjackusa.com
pRoJEcT cogTAcT pERSoN: Chadie Lewis
EXISTING coNsTRUcTlON: D Alteration D Renovation [? General Repairs
NfWCONSTRUCTION: [] ErectNewResidence E AddftiontoExistingResidence D Relocation
aa* tta
E Det Garage (sF)
-_
E Porch (5F)
tr Pool {SF)
D Deck (sF)
! Storage Shed (SF)
Tota! Acres Dlsturbed:
a1p1284Q1
BLDG UCEN5E g' 53778
Sr: NC Ztp: 27705
pHONE: 919-309-9727
pHoNE: 919-3099727
D Att Garage tsF) _
D Sunroom {5F}'--
D Greenhouse (SF)-D other(SF)
ls the proposed work changing the existing footprint? D Yes EI No
TOTAT Sq rT UNOER ROOF lfor proposed work) Heated;Unheated:
TOTAL PROJECT COST (Less Lot): $4600'00
ls the proposed work changing the number of bedrooms? D Yes I ruo
ts any Electrical, Plumbing or Mechanlcal work being done to the Accessory Structure fl Yes E No
lfthe project is a Relocation, is there a Natural Gas Line on the current site? D Yes D No
lsthereElectrical PoweronthisBuilding? E Yes E No
Prop€rty Use/ occupancy: El Single Family D Dupler E Townhouse
Description of Worlc lnstal helical piers to stabilize foundation
laws and ordinafices and regulations. The NHC Derelopment Services Center wll bc notified of eny changes ln the apprwed plans and specilrcatk]rE or ch.nge in contractor
lnformation. '"'NOTE: Any work performed withmt the appropriate p€mits will be in violrtlon of the NC to fines up to S50O.00'*'
Owner/Contra.1ot, Chades Lewis Signature:
'Licensed Qualifier' Print Name
ls the property located in a floodplain? E Yes E t,to
Existing lmpervious Area: _ Sq Ft
New lmpervious Area: _ Sq Ft Exlstlng tand Dasturbint Permlt: D Yes fl No
WATIR: n CFPUA E Community System E Private Well 0 Central Well D nqua
SEWER; 0 CrpUn 0 Community System E Private Septic E central Septic [1 Aqua
zone:-_ officer: Setback{F}_(tH)_(RH} (B}_
Approval: City:_ Date:_ Flood:(A)_(V)_(Nl_BFE+2ft
Comment:Permit Fee: $
w.qflr
1 6-2388NE}'I HANOVER COUNTY BUILDING PERMIT
MPLIaTIOtt ryPE: RESIDENTIAL
PTEASE AT,ISHER ALL QUESTIOilS APPLICABLE TO youR pRolECT
oProJect Responsibilltt',
PORCI{ CONVERSION
PROIECT ADDRESS: 233 RACTNE DRrvE uNrr e CITY: rtILMINGToN
SUBDIVISIOil: ASHT0N sEC 2 PH 1
APPLICAIiIT'S IIA}IE:
DEVELOPER: N/e
APPLICATIOIII
Itrnber
(Office Use)
DATE: s/11/r.G
PROPERTY Olf{ER'S l,lAltlE: RocER & TRrNA RYAN
ZIPi 2s4o3
BL0CK *: _ LOT #: e
PlloNE *: -gpjry_
CITY: WILMINGToN ST: Nc Z\P:284a3
LICENSE #:
-
sT:gg_zIPi 2840s
PHOi{E f;
PIO{tlE *: gto-"ttt -ztaz
P}IOHE *i gi.o-777 -3363
I nelocarroru
OdttER'S ADDRESS: 233 RACrr{E DRrvE uNrr e
COT.ITRACTOR: PORCH CONVERSION
ADORESS: d821 MARKET srREEr
EIIIAIL AIDRESS: porchconversi-on@crmail . com
CITY: WILMINGTON
PRO]ECT COIiITACT PERSON: SHERRT BRII,T
EXrSTil,rG COI{STRUCTTON: I ALTERATTON f] nrrcvarrOr flCeNenal REPATRS D
NEl{ CONSTRUCTIOITI: f] TneCT ilEH RESIDENCE or EIruOTTTOil TO EXISTIIiG RESIDEITCE
**PLEASE CHECX AI{D AT{SI{ER BELOT{ ALL THAT APPTY TO YOI.IR PROJECT:
f]nrr GARAGE _ sF
fl survnoor'r
-
sF
fl cnrrruxousE
--
sF
f] oe r cARAGE sF f] PoRCH
-
sF
E pooL _ sF ! sronacr sHED
-
sF
fl orcx SF OTHER: SCREENROOM 96 SF
TOTAL HEATED SQ FT: O TOTAL SQ FT UNDER ROOF: go TOTAT AREA SQ FT: ge
TOTAL PROIECT CoST(t-es'r-ot) : $ ttgz * OF STORIES: 1
Is Any ELECTRICAL, PLUI{BIIIG or liEcHAilIcAL hlonk Being Done to the Accessory Structure} fifr Ves E f{o
If the project is a Relocation, is there a Natunal 6as Line on the Current Site? fiV"t E *o
Is there Electrical Power on this Building? [lves EI tlo
pRopERw usE / occupAlty: I srr,rcr-e FAI'1rLy f] ruer-ex [lrowNrrcusr
DESCRIPTIOTiI OF tiORK: CoNSTRUCT A 96 SF PP.E.ENGINEERED SCREENP.oOM ON 4, CONCRETE SLAB
DISCLAIMER lhereby c€rllfy hat all Inbrmation in this applicaton is correct and all work willcomply wilh Ure State Bui6ing Code and all oth6r applbabb Strb and local 16ff$
ard ordinances and regulations. The NHC Developrnent Services CenEr will be notifie{, of any changes in he @proved platQ and
conlraclcr inbrmaton. '-NOTE: Any Work Ftrbnned w/O he AppropriaE Permits wll be in Violation orlhe NC StaE
ffi AGEN? .}EREMY MARTIN SIGNATURE:
(prlnt Name):t,t)*'t*,t{.*)t)t***:i*{r:}**,t*:l*:t*,X,t,},ll(**,t**,i***t,l,i,l*rt:t,**)3*****,r***:t*)t*)t,t** {.,f * **,1.* *,C * * ** ** * {.
rs THE pROpERTy LOCATED rir A FLOODPLATN? Fl VeS EI nO
EXISTIITG ITTPERVIOT's AREA: 1420 SQ FT TOTAL ACRES DISTURBED: A.OA2 F
NEr,r il,tpERvro.ts AREA: sQ Fr Exrsr LAND DrsruRBrNG ,.*iIr-EJ rrt til] *€
MTER: fl creua ft ccx"naur.rrry sysrEu fJ enrvnrr wrll fl ceNrnal urlu S
sEr.rER, 7 .rrro fr.r*r*l sEprrc ffi^rroru sEprrc E aor*nrry sysrEm tq
?
*** SEPAIIATE PER'.IITS REqJIRED FOR ELECT, I,IECH, PLBG} GAS EQUIP, PREFABS & INSERTS IT'' S
pAynEirr r,tErHoD: EJcosx Elcnecx (IAvABLE ro nrc) ff nllenrclr ,ir*rs El ,czrrro florscoven E**,1.d.,1.1.{.{.*,i*'t:f,t**t *:!,r***,1*,t****)trr:t!t,t*,t!t'i****+,t*****t*,t**:t***********,t*****,t**,t*,i,t{r,4.{.'t't*{.* j,j
/->\ (FoR oFFrcE usE oiry) REVTsED oArE ult/tLli'
zorr: rIlFL oFFrcER: KtP sErBAcKs: F'lqp r-H: NIA nn' rJfl ,,,7.5'
Approval:_ City: Onre :8- ll-lda FLOOD: { BFE+2ft= _
comnnt: &dd,rro n rwo+ be umm.ted screens* -jb e"",*fflf rll?*Jmk*r"
fffi.H,lXT;:;XHj€
Pt0ItE *:fufft;1@(.>
t1,./ Z--.t+.,1) A y'da-/zrP. ZQ?t /
BLOCK *: _ LOT *:
PROPERTY qflER'S t{A E: { ^,8 fr,€/-rr. Pl{IlE #: @.ql{ER'S ADDRESS: J/n //F1€ttF- ( t-n.. Ctry z t*..,.c , '--c u Sf z rfcztp:Zequ
LICENSE f:
crrYz ts..tc-t*r .;/...t.-. st.*C@3
PHO{E *:
PHO'{E #:
.TPLEASE CHEC(
narr eanace
ADDRESS:
E!4AIL AIDRESS:
mOIECT CCIIIIACT PERSOI'I:
AID ATISI{ER EELO{
5F
POOL
DECK
l--l srome e suro
OTHE R:
R taStt/qn AUo 1 I ?010
NEhI HANOVER COUNTY BUILDING PERII,IIT
APPLIcarIut rypE: RESf DEilTIAL
PLEASE AIIS}'ER ALL QUESTIOI{S APPLICABI,E TO YOUR PROJECT
'project Responsibilit}f
-en62olb1@6
APPLICATIOI{
l{t.rber
(Offtce Use)
tue: fF-Fp ilimtz-zarw oor*glg/b -
ACCflNT #:
,o- ?./Z-/620
SF
5FSF
_5F
SF
ToTAL SQ FT rrM)ER R@F: 2o.( TOTAL AREA SQ n: ZO7
TOTAL PROIECT COST lress r oe z t /j ISD s OF STORIES: /---_-
Is Any ELECTRICAL, PLlllEI G or IGC}iAI{ICAI- Work Being Done to the Accessory Structure? Q V"r fffi
If the pnoject is a Relocation, is there a l.laturaL Gas Line on the Current Site? f,t Ves Q to
Is there Electricat Powen on this Building? En{"r 0 Ho
PRoPERTY usE / occrrPAflc v, ff*nett rarr r-v ! ruplrx J-l rOtrrcuSr
DESCRIPTId{ OF HORK: .Q71 2 , ,V C;.A- .c/2a4..-/ A2c4 77) E .tt/< =, atK OEZ<
SQ FT:
EXrSTrr{G Co{STRUCTTO : @-llrrnnrron ! nerwarrori ! e eHrnar nrnrrns ! RELocATroit
r{Ex cor{sTRrcTrcn: fl rnrcr NEx RESIDEiTE o" ! aOOrrror To EXISTII{G RESIDET{CE
! orr eaneer
_-.-
sr ft -[-eoncu _fi_sF
Isunnoor.r SF
flcnrrHxousr
TOTAL HEATED
ALL THAT APPLY TO YOUR PROJECT:
nn
57 I?J'YJ E.E-
and ordinanc€s aod regulations The NHC Oevelopmenl Servi:es CenEr will be notfed ofany chaooes in he approved plans and specifica0ons or chage in contacbr or
Ot{t{ E R/ CO{T&ICTOR :-1 6
(Prlnt taar€),t,t:|,t:i t:t,a * 4,| ,l * * !a rht )ht )t,t,t ,i,* )t,t ,t,* :i )i *:*:t :t:!:t * * * * +,* * * 'l !t:l * * )t,t )t +,t,t**
S IGI,IA
****,i*** *,t,* **** )t +,t,i
IS THE PROPERTY LoGATED I A FLqDPLAIil? O YEs
EXISTIiT U4PERW(US AREA: _ SQ FT
t{ET IiTPERVIOUS AREA:
TOTAL ACRES DISTURBED:
SQ FT EXIST UIND DISTUREII{G PERflIT: ICI VCS Ir Trc
(FOR OFFICE USE OXTY) REVISED DATE OiY11l12
SETBACKS: F: LH: RH: B:
IAIER: EleFpuA f] coraurrw svsrem I-l pRrvArE T,JELL l-l cerrnnr wrrr
sEHER: ! cFpua f] cEirrML sEprrc fJfnrvare sEprrc E cor,u{JNrry sysrEr.r
**' SEPAITATE PERNITS REQUIRED FOR ELECT, NECH, PLBG, GAS EQUIP, PREFABS & IiISERTS I*'
payxErr rrErrrD: Oasr O crro( (payABLE ro rrc) OBrLL rcorr Q r,rcmsa Q orscoven
a*,tt,t:t:tt+tt+'t+:l:tt:taia+,it+a,it'.at}tt t**tttattt+tIt*It*t,tt+t,l*ata:trrtlt'l:l,ttltrt++*ttItt:t:ta,t,x*
ZONE :OF FICE R:
DEVELOPER :
PRO]ECT ADORESS:
SUBDIVISIOI'I:
CO TRACTOR: