JULY 20 2015 BUILDING APPS_2.
.-^i " ._-' i '.
,ffi,j
APPLICANT'S NAME:
DEVELOPER:
15-1455
CITY: wilmingron
APPLICATION
Number
(Office Use)
DATE: osl1sl1s
ZIP: zasoz
PHONE
f:
PROIECT ADDRESS:
3305 oleander Dri-ve
OCCUPANT/BUSINESS NAME:
Bank of America
PROPERTY
OWNER'S NAME:
The oleander Company rnc.
OWNER'S ADDRESS: p.o. Box 314s
CONTRACTOR: Potter Construction Services
ADDRESS:
1oo1 palmer
plaza Ln
PHONE
#: e1o-3e2-3300$c
-t--
\t
-a
CITY: wilminston
LICENSE #: NC6i677
ST: Nc ZIP2 2s406
ST:
Nc ZIP: zazn
#:_
CITY: Charlotte
EMAIL ADDRESS:
iosh. purser@potterconstructionservices. com
PROIECT CONTACT PERSON: ,Josh purser
(check
AIl rhat Apply)
PHONE
PHoNE
#: e8o-328-9370
Exrsr coNsTRucTroru:
I ALTERATToN
! neruovarroru
! ceruenal REPATRS
! nelocarrou
lf Relocation, is there a Natural Gas Line on the -Current Site?
f]Y"f fl No lS BLDG spntru-xlrnrD?
flves fl no
NEhl coNsrRUCTroN:
f] enecr NEt,.l
srRUcruRE
E FAsr rRAcK
I srelr-
f] uerrr
! noo ro Exrsr srRUcruRE
ACCESSORY STRUCTURE:
If UPFIT
- The
SheIIPermit #:
Is Etect Power on this Building fl Ves [ ,rO
oF occuPANCY USE?
ffives ffiNo *****
What is the New
Occupancy Type?
ls food or beverages prepared or served in this structureZ
flves
H to ls The Property Located ln The Floodplain?
[ ves
E] no
DISCLAIMER: I hereby certify that
all information in this application is
correct and all work will comply with the State Building Code and all other
applicable State
\nd local laws and ordinances and reoulations. The NHC Development Services Center will be notifi6d of any chanoes in the aooroved olans and 3becifications
ot chanoe in conlractor or conlractor information. ...NOTE: Any Work Performed W/O the Appropriate Permils will ble iq Violation of the'NC State Bldg Code
ao{
ENGR DESIGN PROFESSIONAL:
DESCRIPTION
OF WORK: Voluntary ADA remediation
to upgrade customer accessed areas.
(Qualifieo
Nole: Demolition nouficatons & asbeslos removalusing the application form (DHHS-3768) whether the facility or
contain Asbostos or not. You 8re requirsd
to call tho National Emission Standards for Hazardous Air Pollutants (NESHAP) at (919)707-5950 at least 10
days prior to tho
demoliton of any facility or building. See Asbestos Web Sito: http:/A,vww.epi.state.nc.us/epi/asbestos/ahmp.html
TOTAL PROJECT
COST: 9117, e1s BUILDING
HEIGHT: 1 srory
TOTALAREASQ FT: 5970 SQ FT PER FLR: sgzo# OF STORIES:
TOTALSQFTUNDERROOF: sgzo #OFSTRUCTURES: T#OFFLOORS: r
ACRES DISTURBED: O. 02
NEW IMPERVIOUS
AREA: +
/ -etz (38. 768 )
EXST LAND DTSTURBTNG
PERMIT?
[ VeS
[ ruO
PRoPERwusE: f]oFFtcE fIRESTAURANT
luencnrurLE f]EDUc EApr f]coruoo orHER:eranch eank
wATER: ECFPUA E]COMMUNTrySYSTEM
f]WELL EZONTNGUSECLASSTFTCATTON:
sEWER: ECFPUA ECENTRALSEPTTC
l_lenVnreSEpTtC ZCOMMUNTTYSYSTEM
*- SEPARATE PERMITS REQUIRED FOR ELECT, MECH, PLBG, GAS EQUIP. PREFABS & INSERTS *-
SQFT EXISTING IMPERVIOUSAREA: +/
-atz (38.768)SQ FT
ZONE:OFFICER:SETBACKS: F:-LH:RH: B:
Approval:_City:_DATE:_FLOOD: A v NBFE+2ft=.
Comment PERMIT FEE: $
PAYMENT METHoD:
[casn [cxecr (PAYABLE
To NHc) [nuenrcnN EXPRESS
I lacnrrse
I orscoven
(FOR OFFICE USE
ONLY)
***** IS THIS A ,
IF Yes, what was the Pnevious Occupancy
ARCH DESIGN PROFESSIOML:
Ernest Munoz
CHANGE
Type?
PHi
704-358-44ii- NC REG #:
PH: NC REG #:
11558
# OF UNITS:
REVISED OATE 4I'|1112
b/r-s /rlrl
NEW HANOVER
COUNTY BUILDING PERMIT
APPLICATION TYPE
: COI4MERCIAL
PLEASE ANSWER ALL QUESTIONS APPLICABLE TO YOUR PRO]ECT
"Project Responsibility"
Corrie Davister
\J€a-d ,Azv la Sri'rr=
SIGNATURE:
Lcls--(€/I-b
irEh*HSr* {ou*rv Burlnrrr' p'Rr,rrr 15 - i- 4 g 5
APPLTCATTUI TYtr; COII}IERCIAL
PLEASE AITISUER AtL QUE5TIOil5 AFFLICABLE TO YffJR PRO]ECT
"ProJect Responslblf tty"
APPLICAilT' S
DEVELOPERI
PEOIECT AOOftf;3S:
occupAt{TIBU$rIr5sr{srf I ytx*w 1&6Lt*
PROPERTY
O}ffER,S N/IIIE:t-.t- FaopS
O*|ER'S trXt*EtS:
6&5*l *U*ffi{ tnurr,}6 &f CITY:
ru*,
6e 6asst-,t*x:*1 o*r,Ela<#
PlOf{E *:
6. I
ST CITY: !,rl lLlvlrri&rrr,.t r* " e.
iin'@Jl
#APPLICATI€TtI
Hmber
(sffI(o uie)
3I
JJ
+
c
-_L
-St QI\)2
@
pfiSlE(T cffirAcT PrnfiCIil! f'ffirn$? ffiufqffie{'_ ,-.--_ _ P}iff*H *:
{Check AII Th6t Apply)
Exrsr cor{srRr.}crrorr
f] ALrERArroftt fi[nemvrrrgq fl eexenA. REpArRs
I nelocarror
lf
Rdocdon, is
fiere a NaturalGas Line on the Curient Site? [_lYes [_lNo lS BLDG SPRINKLERED?
LI Yes l_lNo
irErd corrrrnrr(rxon:
f] rxEcr ilru s?Ru(runr f,] FAsr
rRA(r
f] sxelr-
f] urrrr [J mo ro Exrsr srRrrcrunE
ACCESSffiY STEI}CTURE:
If UPFIT
- The
Shell Permit f:
**r** rs Tlrrs A il{r${cr oF qco";p&{cy gsg? fJvrs
frlts *****
IFYe3,dtatmsthepreflousoccupancyTyPel-t{hatlsthellaoccupancyTypel
Af,ar DEsx6{ pmFEssroHAr,
MARlt..6ffir+t$fff* W:3N'?I*J-&?{2-NC REc
;iE* DEsrcil pmFtssls{*t: ,Sffi+f+*ffirr $trLffi px: &fib- 3t*1- ll#,Jr,. xea
DESCRIPTIOII 0F lrl0RK :
ls
&od r bcvragm prtpaffi,
r mrycd h tl{s gtrrffirel Sves [ ruo b ftc Propsty Locsled ln Thc
Ftdplam?
flves E *o
DISCLAIMER: I
hsreby
cortfy th6l
sll rnfio{mation }n thrs
applrcahon rs corr€cl snd
6ll work r/ull
comily wrth
th6 Stats Burldrng
Code and sll olher appircablo S!sr6
and local laws
lnd crdinsncaa end regui6fion6. Tho NHC D6v.lopm6fit Ssrvrces Cenler will be notrfied of sny Ghangas in th6 approvod plsn8 and gooclfic&tsons
q {lar1gc I! contrccgx l,I€onUsc-tor infomatron. *NOTE. Any Work Porformad W/O lh6 Appropnate Psrmils
wfl Es rn Vrolatron o{ the NC Slat-c Bldg Code andor cftangg in contractrr g! coQ!6ctor in{om€tion. '"}'ISTE: Any \r*ork Pgrform.d wl{} IsubjadloFinrsrY*3.Y** FsbEItr K Gesspr**d
and
SIGNATURE:
{Prhl{i'Is]
€&tian A!b..&. o.
r.L Yol,
.i. r.grirud
s cdl frc f*fuld Embd{rn Srndrrrh for }l*esdosr Ah Po$nunu (NE$t{Ap} *t tg19}707.6S6O rt l!*rt 10 d.yr Fb,r b thc
dcmoSlbn af
rnylh(*igor bdldw, Saa Aibarb[W*St: hlF 1^vw\r &p.sta8.hc.r]sl*Fil*. b&r]*/ahBF"lr?:]l
Is Elect PG*er
on
this Building fl ves fl ttO
*, lTSl l
*:
Orlol?t
TOTAT AREA
$O rT : &:rq*I SO rr PER FLRI , ,,, ,Ulp # OF
STORTES: I
TorAL se FT
UND8R RooF:
L":qr #
oF
srRucruRm #
oF FLooRs:
."K
rorAL pRoJECr
cosr'tj5QrgQg- BUTLDF€ HE|GHT: I$:f," I
ACRES DISTURBED, rJlA
NEyVTMPERVTOUSAREA:
,,,*1& SQFT
pnopenryuse: fforrrce ffirsrnumrr fJmrncnmnr-e fleruc ilner fimr'roo ornEn:
WATEFI I]CFPUA ncOf,$rUN]ryS\5-rEU_ I]WELL IJZONTT.TGIJ$EG-ASSIFIC TrOr*
SEWER:
El CrpUl
tf cEhnRAL SEmc LI PRMATE
SEmc fl col*MUNtTY SYSTEM
pAylrtEf.trMETHOO: [JmSr* flCX{sCx(pAyABr.ErONHC]
fleurnlCeNExpREsS fJmOvrSe flnmcolrcn
FOn OFFTCE U8g
O{Ln REVts€OOATE rnln2
ZO}IE: OFFICER:SHIBACK$: F:-LH:* RH:- B:-
xruq
crrv:
r*ern*rAfourl sr:
lrl zwzfi?-$s
Pffx{f *: 3t? -S?$-a}st
# SF UNITS;x/n
Exsr LAND
DtsruRBtNG pERMr?nves s[No
EXISTING IMPERVIOUS AREA: Ll r^ .. SQ FT
*,\b:ffi$7&tt
5Tr*!L IIP:
Lt-c.
NEt^l HANOVER COUNTY BUILDING PERMIT
APPLICATION
TYPE; FACILITY LICENSING
PTEASE PRIIIT CLEARLY
& ANSWER ALT QUESTIONS
Aol5-tae
31
APPLICATION
Number
ti++r." tl*l
ssls; L-l2-/3APPLICANT,S t,lA"IE:
DEVELOPER:
"Project Responsibility"
PRO]ECT ADDRESS:
SUBDIVISION:
zIP | 7r', n,
BLOCK#:LOT T:
PROPERTY Oh[{ER,5 ttA E:
Ott {ER'S ADDRESS:
v,ll;e,- -l ou).,PHONE
*:
CITY: t.:, J.a STt /v- ZIP 2
7&1q
ACCOUNT
*:
ST: ZIP:
ToTAL # 0F PERSoNS UNDER CARE:
rur? AGE MNGE 0F PERSONS UNDER CARE:
/w /1
rs caRE ro BE pRovrDED oH a z+ xi-aasrs l
I ves
fuioIF NO, WHAT ARE THE HOURS PER DAY?-
ZZ-
WHAT IS THE TYPE/CLASSIFICATION SPECIFIED BY THE STATE LICENSING AGENCY WHICH YOU ARE APPLYING?
rs rHE PRoPERTY LocArED rN a FLooDPLATN?
ff v"s
[l Ho
Is ELECTRICAL PowER oN THE BUILDING?
fi ves
I Ho
IS A I{ATUP,AL GAS LINE ON THE PROPERTYI
I Ves ,P Uo
rorAL sQ Fr: -!l!?-
OFFICE R:
(FOR OFfTCE tsE q{tY)
SETBACKS: F:-
F
LOOD :
LH: RH: B:
REVTSED 4/12/72
BFE+2ft=
N
PER14IT
lllXlllll'-'%ili:Y
El,lAIL ADDRESS:
d,-rer',- <- b-J l< .^v*!.,. n-f PHONE *: 9rt -U.,ro
PROIECT CONTACT PERsoN: 5 6 ^r,u:j, pHoNE
#r 3E}-ttt"a
(CHECX
ALL THAT APPLY)
! mur-r cARE
E ADULr cARE-DFs
f) cnrr-o cARE-Home
! cxrr-o crRe cerlrrn
[l aLr
DEscRrPrroN oF r,JoRK: E r,'.B 'f -.r,,l, "--
and ordinances and r6gulalions. The NHC Oevelopmonl S€rvices C€nterwjllbe notifod of6ny changos in lh€ approved plans and specilications orchang€ in
cont.actor or
WATER:
! CreUA
! COMMUNIW SvSreU
! PRTVATE WELL
sE!'rER:
I cFpuA
f] CENTRAL sEprrc ! enrvnrr sEprrc
fl coMr4uNrrY sysrEM
**X SEPARATE PERI'IITS REQUIRED FOR €LECT, MECH, PLBG, GAS EQUIP, PREFABS
& I'IISERTS *X'I
ravnerr mernoo ' I cmx ftlorecx (PAYABLE
To r{{c) [ erll rccourr
f] nclvrsn I orscoven
ZoNE : _
Approval:
Comment:
conlractor informalion. '"NOTE: Any Work Psrformed w/Olhe Appropriale Permib willbe in Violation of the NC State Bldg Cod6 and Subjectto Fin6s Ljp To
,*,t
'* '*,*,* )t*,i+*+:t +* +,1.,ti.+ +:t:lrt+*** )t* *)t,t ++*ir* !*+ i. **,* )t
t,t *,1 ,*,1*,* * * '8,* '*
,t
*,t ** )t*)t ++:* + +rN*,t
i* PLEASE ATTACH A COPY OF THE APPLICATION
& F LOOR PLAN YOU A8E SUE"IITTING TO THE STATE **
City:DATE:
PHoNE
*: >E
^-
tL@
Ot.lNER/CONTRACTOR:SIGNATURE :
NEhI }UTM)VER COUNTY
BUILDING PERilTT
ApplrcarrcJ
rr"E: C(I IERCIAL
PLEASE
AEt*t aLL quc:sttoE arpLtcaslc m rltl ptoJEcT
-Prorect Responsibuitld
4ttsFZ'r ?,/V/c//EL /
hotY -
(t''(1
ADPLTCATIO{
,tlrbcr
(Offlcc t
r.)
olrrc 7/t6/ rl'APPLTCATT'S MI!E:
D8YEI.oPER:
PRO'ECT ADONESS:
oCCUPAfI/UISI ESS ilAllE3
PROPERW (I{ ER'S UUiE
!
OIiIIER'S ADORESS:
CO IRACTIoR t
AI'ORESS:
EI'iAIL AIX'RESS:
PNOJECT CO TACT PERSO
:
CITY 3
If UPFIT
- The
Shell pernit *:
.r... Is r I5 t
IF Yc',
rirt hs tha Prcvlfls Occuprncy
crurcE
G occtpscy usrr
flws
ffn .rr..
T,!.? _ tllat ls tl|e d Occup.ncy T)rpe?
PHO
E *:
PIOIE
':;a2i
Utt'
Is Elect pouer on
this Buitdlng [t{es I rrc
C RE6 f:
c 8E6
*:
b bodorbrrrle,*Fpl,"da..n.r husanarcrflvesfBtG r rrre pmgary Lo*d rn Tho
Fooobm[]ve fiffi
DlSCLAlliGR: I lE rOy cdry lhat afl lnbrmston tn thts
sDdlcafon ts
co.rE t dd dt wt x
arxr loc8l
brrs 8d odlnstri End r€ouhlldre
s1ff rEHgUfr
rs,o"g*"","*r,silH#ffi ffi^ffi#ffi HffiHff
ffi ffi .*.fl[ffiffi
34-srcrerune,Oq!, C,fri{.'tr)ift o.fto al iodtcdEL &
Elatlo. Eiorrd D..n apdt ib.!.n b !a
ctr{o.i, llrie 0l.ppHon
kfi (D[r6-Jrcs, iha$r, r|. b.ry d bJE!
E hrd
bc(rr.[r Aa.&. G' ool Yqr
r.r rqii td 5 d t r iso.ll E !*dar
sffi k
lbrd; * a"ru.rr.
OrsiGrlii6i#&'Jff o oB
st ,"
o"d€Oroldoo of rV tcey q ltAft. S.r Aqbldor
Vlt!
stli t E i^rywrdrlb.rErJ./bd/fhdcrur.rD.tt||i
AcREsDlsruRBEv. lLattl
r{ElYrMPEmnousAR*. -Ln
S( gn D(sr rANo DtsruRene pERurr? Eves
I xo
OOSNNG MPERVIOT.,S AREA
-pnopEnwrrsE W*FW Enesrurmrr fluencrrnre leouc ftanr floonoo orrcn
IH^H
E8ffi Effiffi't Fffi.="," trtrBffililffiJffirHcar'o*
ZONE:_OFFICER:_ SETBACKS:
F: LH: RHa_B:
Appoval Clt]r-DATE: .-_--FLOOD:___BFE+2ft=
- SEPARAIE FERMITS REOUIRED FOR E.ECT, T{EO{, Pl'rG. GAS EOL'IP, PREFABS
! INSERTS -pAyilernilEnoe EcAsH fA(fiEo((pAyABlEromrc, flaxrnclt.looness firtlcrrmr floscoveR
(FOR OFFTCE
lrSE O]{LY)
AAO{ OESIH PIOFESSI(IIAL:
E,.q EsIEI PETFESST AL:
DEscRrPrror{ oF loRK: EC,fznc.<
TOTAL PROIECT@ST:
TOTAL AREA SO FT : E" P 3A FT.
TOTAL SA FT UNDER ROOF:
_
BUII.DIIIGI HEIGHT:
SO FT PER
TLR*orsrnucruResT--
* OF UNITS:
#OFSIORIES:
I*orn-oons:7--
SQ FT
FSVEED
UIE
',lfi2
PloLE *3 €to Ztz-
/a17ctw:ztPt
!g?o I
*t,ub,auub 0Qo nflE
r: ?o-zYl-f to6
3lz
-ztPz
29/f,'€
LTCE SE T:
*rtucrer/F/t/
;trffi
ffi lH,srtr'"'fr
ffi*'fl ,ffili*,sr.m,F^,t.,*ffg"*6^."
irEr ooEr rcrrcr:
ft rnecr Ex
srR crnE
f] msr
rucr
I sxrr.l
I urrn
ffi D Errlrr srmrnnE
ACGE55oiY SInUCnnE
!
ea t[
-
PERMITFEEI-
PRO]ECT ADDRESS:
SUBDIVISION:
zrD:Z(')t?-
BLOC(t.
PROPERTY OWNER's
OWNER,S ADDRESS:
MI'IE:5
Llol
PERSON:
:t )i
* *,| * )t,*
* + rt
't * *,1 *,*,t 't:* *,* ,*
* )t )*,*,i )r,* )**
*:t )i
+,i )i
*,t
*,t,t ,*,*:l )i)r)t*** * )* )t )i*ri*:r*)r )i )*** * * )*
*:t + )t,t,t * )i )*:r ,*
* + +**+,**
ZONE :
Approval:
OFFICER:
(FOR OFFICE USE ONLY)
SETBACKS: F:
_ LH:
_ RH:_ B:
F LOOD :BF E +2ft =
TJ
PERiIIT FEE: $
-b0 g<,
,rr '7gxlt L
PHoNE
*:9lo-9ot'lq\-j
DEScRrPrroN oF !,roRK:
aemal ti-iot)
(hi'at Type
of Buj.ldtng Do You 9lant To Denolish?)
and ordinances and regulations. The NHC Developmeni Services Cefllerwillbe nolified ofany changes in the approved ptans and specificaiions or change in
contractoror
otrNER/coNr*cro ,
fr,//, k* sr.NAruR
r:r,*r* rt + + r**r* )t,*,t )k*
*,** )t,t,t !** )*,1:* rr,i+:** r*,*
*:l )r,t )r:i )*
* ,*,* *,N +:* rt+:**,r,**:t *,t,1 ,t
* :r
* r**:r +
I5 THE PRol EcT XREsIDENTTAL / E cotryrncrar T9TAL AcREs DTSTURBED:
_
ToTAL PRo]EcT cosT{LessLoo:
I85OO.OO EXI5TING LAND DI5TURBING PERMIT?
tr vrs F{o
DOES THrS STRUCTURE OR BUTLDTNG CONTATN
ASBESTOST
I VrS 7RO
rs rHERE A T,TATURAL GAs LrNE coNNEcrED To rHrs BUrLDrNcl
fi "rr (ro
I5 THERE ELECTRICAL POI.IER
ON THI5 BUILDING? IWS I TTO
WATER:
! creua
! coMMUNrry svsrrm fi.enrvATE r"tELL
sE!,rER:
! creua
f| CENTRAL sEprrc ffenrvnre seerrc
! corlMuNrry sysrEM
Nob: The National Emission Standards for Hazardous Air Pollulants (NESHAP) Regulations Require that you contact them at (919)707-5950 at teast 1O
days prior to the demolition ot any facility or building, whether lhe facility or building was found to conlain Asbestos or not. Demoljtion notificarions &
asbestos removal permit applicrtions are to be submitted using the application form (DHHS-3768). This form can be found on the web site shown below.
Note: Obtaining a demolition permil from ihe NHC lnspeciions Dept. does NOT satisfy or meet the notilication requirements of the HHCU (Heafth
Hazards Control Unil). 'Keep in mind that an asbestos survey is required by a NC accrediled asbeslos inspeclor prior to any renovation or demolition of
a tacility. Please see the Asbestos Web Site htto:/
^/ww.eoi.state.nc.us/eoyasbeslos/ahmo.html
pAYnE[T
irET]OO: ICISX I CxrCx (PAYABLE TO r*tc) flaru accourr
I nnsrrncrno ,(rr*
Comment:
City:DATE:
NBz P€+ ts- (tbs
r A NE,, HAN,,ER
couNry BUTLDTNG pERn,,rr ?ol5 -
LzlV
flA\) appLrcatro, rypE: DEioLrrroN I appLtcatror{
\f,pfl "'*"':xil'j::?-i:':rlL'Jii'fi#*'* tE+r*ua
orrlr**,s n-r, [1
ickr/ ]1,1",* oryr.r_,
b'21- za tr
CONTRACTOR:
ADDRESS:
El'lAIL ADDRESS:
, LICENSE *: _ accoti{T $:
crrv: [v, /rrrin$o* st,
i[-:.re.)4aL
PHONE
#:
DEVELOPER:
NEW HANOVER COUNTY BUILDING
APPLICAfiO TYPE; DEI{OLITION
PLEASE PRINT CTEARI-Y & AIISWER ATL QUESTIONS
"Project Responsibility"
TeE-rTzz
PHONE #:
Slt./-?44tW@
PRO]ECT ADDRESS:
SUBDIVISION:
PROPERW
OhNER'S
CONTRACTOR:
AIDRESS:
OWNER,S TIAiIE:
ADDRESS:CITY:
pRoJEcr coNTAcr ,r*ton, dVF /n * PH0NE $: 4 -6(1?- z
DESCRIPTIoN oF hroRK: ? ,,, L/ ' ,rt'. '
(that Type of 8u1ldln8 Do You uant To oenollsh?)
snd ordinancos and r€gulations. Ths NHC Developm6nl Seruices Csnl€rwill b6 nolilied ofEny changes in lhe approved plans 8nd specilicalioos or chang€ in
contraclor or
contrscror infomation. -'NOTET Any Wort Psrforn€d WO the Appropdare Pemib will b€ in Molalion ol tho NC Siate Bldg Code and Sub,ecl lo Fines Up To
$500.00"'
owNER/coNrRAcroa,
V*/*t/ srGNAruRE:
(Print t{ane)
ACCOUNT
#:
CITY:
ElllAIL ADDRESS:
**,* 't *:t ir * )t,t* + + + :i
*:t:i ,t i( ,1,*
* *t+ *+ *,f ,l )i ,* ,*,*,t
*,t * l.
'*
r*
* *,4,t,* 't
,*
*,t )t* * * ,* )*,* ,*,t
rs rHE PROIECT:
fi nrsrOerurral
/
[ cottmrncral TOTAL ACRES DISTURBED:
TOTAL PROIECT CoST lress r-oe:
$,7f.ExrsrrNc LAND DrsruRBrNG pERMrr?
ff VrS
fi rc
DoEs rHrs srRUcruRE oR BUTLDTNG coNTArN AsBEsrosl
I ves
fi Ho
rs rHERE a NATUML GAs LrNE coNNEcrED To rt-trs BUrLDrNcl
I ves
fi to
rs rHERE ELEcTRTcAL powER oN THrs BUTLDTNG?
[ vrs ffiuo
mrER:
il creun
! coMMUNrry svsrem
! PRrvArE htELL
sE!,rER:
I creua
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Noio: The National Emission Standards for Hazardous Air Pollutants (NESHAP) Regulaiions Require that you conlact them at (9'19)707-5950 al least 10
days prior to the demolition of any facility or buiHing, whether lhe facility or building was found to contain Asbestos or not. Demolilion nolifications &
asbestos removal permit applications are to be submitted using the application form (DHHS-3768). This form can be found on the web sile shown below.
Note: Obtaining a d€molition permit from the NHC lnspections Dept. do€s NOT satisry or meei lho notificalion requirements of the HHCU (Health
Hazards Control unit). 'Keep in mind that an asbestos survey is roquired by a NC accredited asbestos inspector prior to any renovalion or demolition oI
a facility. Please see the Asbestos Web Site htto:/i,vww.eoi.stale.nc.us/eoi/asbestos/ahmo hlml
pAyr,rEr,rT ilEnoD ! flclsn I cxrcx (PAYABLE TO N{C) flerll lCCOUrr I r'rC/VrSl
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