DOCUMENTS Initial Application Date: tr)1I ` 1 '8 Application# 1 SSco4,--lam
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillington,NC 27546 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 www.hametLorg/permits
^A RECORDED SURVEY MAP,RECORDED DEED OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION'
LANDOWNER:Cummings Brothers Enterprises Mailing Address:P.O.Box 591
City: Mainers State:NC Zip:27522 Contact No: Email:
APPLICANT':Tara Rabitz Mailing Address:3300 Battle ground ave Ste. 101
City: Greensboro State:NC Zip:27410 Contact No: 919-995-5654 Email: Trabitz@wadejurneyhomes.cor
Rkase fin out applicant information if deferent than landowner
CONTACT NAME APPLYING IN OFFICE:Tara Rabitz Phone#919-995-5654
PROPERTY LOCATION:Subdivision: Summerhill Lot#:20
Lot
t� V
Size:0.5.3
State Road#165
State Road Name: Maple Leaf Ct. Map Book&Page:2051 / '((V3��'y
Parcel: 130539 0200 27 PIN: 0539-98-5468.0009-9
Zoning:RA-30 Flood zone:N Watershed:N Deed Book&Page eUtP / 0✓u(P Power Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE: 99�� Monolithic
ef SFD:(Size 28 x33 )#Bedrooms:3 #Baths:yBasement(wlwo bath)':_Garage': 1 Deck'._Crawl Space'._Slab:_Slab:
(Is the bonus room finished?(_)yes (_)no w/a closet?(_)yes (_)no(if yes add in with#bedrooms)
O Mod:(Size x )#Bedrooms_#Baths Basement(w/wa bath)_Garage. Site Built Deck:_ On Frame Off Frame_
(Is the second floor finished?( )yes (_)no Any other site built additions?(_)yes ( )no
❑ Manufactured Home: SW_DW TW(Size x )#Bedrooms:_Garage: (site built?_)Deck: (site built?_)
D Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:#Rooms: Use: Hours of Operation: #Employees:_
❑ Addition/Accessory/Other(Size x )Use: Closets in addition?( )yes ( )no
Water Supply: 1 County Existing Well New Well(#of dwellings using well )*Must have operable water before final
Sewage Supply: / New Septic Tank(Complete Checklist) _Existing Septic Tank(Complete Checklist) County Sewer
Does owner of this tract of land,own land that contains a manufactured home within five hundred feet(50O)of tract listed above?(_)yes (✓)no
Does the property contain any easements whether underground or overhead(_)yes (1)no
Structures(existing or proposed):Single family dwellings:SFD Manufactured Homes: Other(specify)'
Required Residential Properly Line Setbacks: Comments:
Front Minimum Actual 317 v
Rear ) / •O
Closest Side (-9.1
Sidestreeticomer lot
Nearest Building
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: Head west on E Front St toward S 1st St
Turn left onto Old US Hwy 421
Slight left onto McDougald Rd
Turn right onto Oak Leaf Dr
Turn right onto Maple Leaf Ct
If permits are granted I agree to conform to all ordinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing s rr,t
tants are sac/wr(3tea red to the best of my knowledge. Permit subject to revocation if false information is provided.
/
Signature of Owner Agent Date
"'ll is the ownerlapplicants responsibility to providethecounty with any applicable information about the subject property,Including but not limited
to:boundary information,house location,underground or overhead easements,etc.The county or its employees are not responsible for any
incorrect or missing information that is contained within these applications."'
"Thls application expires 6 months from the initial date if permits have not been Issued"
Residential Land Use Application Page 2 of 2 03111
IMPERVIOUS SURFACE AREA
`,iiiiiii. CAtt
` DESCRIPTION AREA
�N O4 p.. HOUSE w/ PORCH 1,093 S.F.
SI.00LFESS%�• ,. 9 DECK/PATIO/HVAC 18 S.F.
Q '+ DRIVEWAY & WALKS 640 S.F.
tSE TOTAL (PROPOSED)= 1,751 S.F.
NL-4 7 ILOT AREA = 25.725 S.F.
A SITE .•O .91.. SUPN.. O ` % IMPERVIOUS AREA 6.8%
kb •�� qN OP.��, FLATWORK WITH R/W = 240 S.F.
090
PB 2007, PG 431-436
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VICINITY MAP
Not To Scale
SETBACKS.
FRONT — 35'
SIDE — 10'
REAR — 25. 05' I• :"w
CORNER SIDE — 20'
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MAPLE LEAF COURT
50' PUBLIC R/W
NAME: OCtd i )r laLj Hof} t3 APPLICATION#:
*This application to be filled out when applying for a septic system inspection.*
County Health Department Application for Improvement Permit and/or Authorization to Construct
IF THE INFORMATION IN THIS APPLICATION IS FALSIFIED,CHANGED.OR THE SITE IS ALTERED,THEN THE IMPROVEMENT
PERMIT OR AUTHORIZATION TO CONSTRUCT SHALL BECOME INVALID. The permit is valid for either 60 months or without expiration
depending upon documentation submitted. (complete site plan=60 months;complete plat=without expiration)
910-893-7525 option 1 CONFIRMATION#
Environmental Health New Septic System Code 8 00
• All property irons must be made visible. Place"pink p roperty flags"o n each corner iron of lot. All property
lines must be clearly flagged approximately every 50 feet between corners.
• Place"orange house corner flags"at each corner of the proposed structure. Also flag driveways, garages, decks,
out buildings, swimming pools, etc. Place flags per site plan developed at/for Central Permitting.
• Place orange Environmental Health card in location that is easily viewed from road to assist in locating property.
• If property is thickly wooded, Environmental Health requires that you clean out the undergrowth to allow the soil
evaluation to be performed. Inspectors should be able to walk freely around site. Do not grade property.
• All lots to be addressed within 10 business days after confirmation. $25.00 return trip fee may be Incurred
for failure to uncover outlet lid,mark house corners and property lines,etc.once lot confirmed ready.
• After preparing proposed site call the voice permitting system at 910-893-7525 option 1 to schedule and use code
800 (after selecting notification permit if multiple permits exist)for En vironmental Health inspection. Please note
confirmation number given at end of recording for proof of request.
• Use Click2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits.
❑ Environmental Health Existinq Tank Inspections Cod e 800
• Follow above instructions for placing flags and card on property.
• Prepare for inspection by removing soil over over outlet end as diagram indicates, and lift lid straight up(if
possible) and then close back down. (Unless inspection is for a septic tank in a mobile home park)
• After uncovering outlet end call the voice permitting system at 910-893-7525 option 1 &select notification permit if
multiple permits, then use code 800 for Environmental Health ins pection. Please note confirmation number
niven at end of recording for proof of request.
• Use Click2Gov or IVR to hear results. Once approved, proceed to Central Permitting for remaining permits.
SEPTIC
If applying for authorization to construct please indicate desired system type(s): can be ranked in order of preference,must choose one.
{_} Accepted {_} Innovative OS} Conventional (_ ) Any
{_} Alternative {_} Other
The applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in
question. If the answer is"yes",applicant must attach supporting documentation.
(_}YES (XI NO Does the site contain any Jurisdictional Wetlands?
{_}YES {X}NO Do you plan to have an irr'eaCnn cvctem now or in the future?
{_}YES (x}NO Does or will the building contain any drains?Please explain.
(_(YES { }{ }NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
(_}YES (Al NO Is any wastewater going to be generated on the site other than domestic sewage?
{ }YES ', }NO Is the site subject to approval by any other Public Agency?
{ }YES {X) NO Are there any Easements or Right of Ways on this property?
{'}YES ( ) NO Does the site contain any existing water,cable,phone or underground electric lines?
If yes please call No Cuts at 800-632-4949 to locate the lines. This is a free service
I Have Read This Application And Certify That The Information Provided Herein Is True,Complete And Correct. Authorized County And
Slate Officials Are Granted Right Of Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules.
1 Understand That 1 Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
/T,hee(/SSiiittee Accessible S�o That A Complete Site Evaluation Can Be Performed.
PROPERTYOWN OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DA"IE
E-Hearth Checklist I of 3 12/10
DocuSlgn Envelope ID:5C4A7244-A8SD-4401-80CD-809C7389E449
AGREEMENT TO PURCHASE AND SELL LOT(S)OR VACANT LAND
THIS AGREEMENT TO PURCHASE AND SELL LOT(S) OR VACANT LAND (the
"Agreement") is made and entered into as of the latest date on which it is signed by either party (the
"Effective Date"), by and between WJH LLC, a Delaware limited liability company (hereinafter,
"WJH"),and Cummings Brothers Enterprises(hereinafter,the"Seller").
WITNESSETH:
WHEREAS,Seller is the owner of certain real property commonly known as SUMMERHILL,
and more particularly described on Exhibit "A", which is attached hereto and incorporated by reference
(the"Property",or each individual lot being referred to as a"Lot");
WHEREAS, WJH is engaged in the business of building and selling residential real properties in
the southeastern United States,among other places,and acquires vacant lots or land from time to time in
furtherance of that business;and
WHEREAS, WJH desires to purchase the Property from Seller, and Seller desires to sell the
Property to WJH.
NOW THEREFORE, in and for good and valuable consideration, the receipt and sufficiency of
which is hereby acknowledged,the parties hereby acknowledge,agree and covenant as follows:
I. DEFINITIONS. The following defined terms shall have the meanings set forth below:
a. "Seller": Cummings Brothers Enterprises
b. "Purchaser"or"WJH": WJH LLC,a Delaware limited liability company,
and/or any of its successors or assigns;
c. "Purchase Price":
Thirteen Thousand Dollars($13,000.00)per lot with a
Total Purchase Price of Fifty-Two Thousand Dollars
($52,000.00).
d. "Earnest Money": One Thousand Dollars ($1,000.00), to be deposited in
accordance Section 4,below.
e. "Escrow Agent": Black,Slaughter,&Black,PA
3623 N.Elm Street,Suite 200
Greensboro,NC 27455
f. "Effective Date": The date ott which this Agreement is executed by the
latter to sign of Purchaser or Seller,as indicated on the
signature page of this Agreement.
on
Seller //4/V / WJH�'kiT
DacuSIgn Envelope ID:5C4A7244-A88D-0401-8000-609C7389E449
EXHIBIT"A"
SUMMERHILL,LILLINGTON,HARNETT COUNTY,NORTH CAROLINA
(4 LOTS)
Lot# Legal Description Address City,State
19 SUMMERHILL S/D 0.73AC 137 MAPLE LEAF CT LILLINGTON,NC 27546
MAP#2007-433
20 SUMMERHILL S/D 0.59 165 MAPLE LEAF CT LILLINGTON,NC 27546
MAP#2007-433
21 SUMMERHILL S/D 0.58AC 195 MAPLE LEAF CT LILLINGTON,NC 27546
MAP#2007-435
22 SUMMERHILL S/D 0.67AC 205 MAPLE LEAF CT LILLINGTON, NC 27546
MAP#2007-435
Seller..2 W/RI kir
DowSign Envelope ID:6C1A7244.A88D-1401.00Co.600073BBE449
ADDENDUM TO PURCHASE AND SELL LOT(S)OR VACANT LAND
By this Addendum to Agreement to Purchase and Sell Lot(s) or Vacant Land (the
"Addendum"),Seller represents, in good faith, It Is the record owner of the Property described in
the Agreement to Purchase and Sell Lots) or Vacant Land. In the event it is later discovered,
whether by inadvertence orother mistake of fact,that Seller is not the record owner of the Property,
the Agreement to Purchase and Sell Lot(s)or Vacant Land is voidable at the sole and exclusive
discretion of WJH LLC, If the Agreement to Purchase and Sell Lots)or Vacant Land is voided
by WJH LLC pursuant to the provisions of this Addendum, WJH LW shall be refunded any
earnest deposit money and any extension monies,within five(5)days from such demand,even if
such demand is made alter the expiration of the Due Diligence Period. WJH shall also be entitled
to recover the actual,out-of-pocket fees,costs and expenses Incurred by WJH as a result of Sellers
failure to be able to convey good and marketable title to the Property.Upon being refunded, WJH
LLC and Seller shall have no further obligations or liability to one another.Any capitalized terms
used In this Addendum shall have the same meaning as used in the Agreement.Unless otherwise
modified by this Addendum,all other terms,conditions and covenants contained in the Purchase
Agreement shall remain unchanged.
WJH LLC
.—D.,umw.uby:
(SEAL)
'Bytatiahaed.D.Taylor
Director of Lot Acquisition
Date:2/26/2018
^-� ✓ '---'J�� (SEAL)
Sy II er: guntub gs Dratbeua Eute•pulses
y: Ja<js'y Q.a mmNc\q5
Title: P&Mtc2=_ J
Date: 3- 14-t 1
(SEAL)
Seller:
Title:
Date:
Sellert.6i WJH[ 1
Application it
'Each section below to be filled cut Harnett County Central Permitting
by whomever performing work. PC Box 65 Lillington,NC 27546
Must be owner or licensed
contractor. Address,company 910.893-7525 Fax 910-693-2793 www.harnen.org/permits
name&phone must match
Application for Residential Building and Trades Permit
Owner's Name: Cummings Brothers Enterprises Date:_
Site Address:165 Maple Leaf Ct. Phone: 919-995-5654
Directions to job site from Lillington: Head west on E Front St toward S 1st St Turn left onto Old US Hwy 421
Slight left onto Mcoougald Rd Turn right onto Oak Leaf Dr Turn right onto Maple Leaf Ct
Subdivision: Summerhill Lot: 20
Description of Proposed Work: SFR It of Bedrooms: 3
Heated SF:1606 Unheated SF:401 Finished Bonus Room? No Crawl Space: Slab:
General Contractor Information
Wade Jurney Homes 336-282-3606
Building Contractor's Company Name Telephone
3300 Battleground Ave Ste. 101 Trabitz@wadejumeyhomes.com
Address Email Address
49262
License#
Electrical Contractor Information
Description of Work Electrical Install Service Size: 200 Amps T-Pole: ✓ Yes_No
W-3 919-550-7341
Electrical Contractor's Company Name Telephone
308 W.Main St.Clayton,NC,27520 Ewigly@w3electnc.com
Address Email Address
11452U
License#
Mechanical/HVAC Contractor Information
Description of Work Heating&Air
Comfort Air 336-794-9730
Mechanical Contractor's Company Name Telephone
PO Box 527 Clemmons,NC,27012 Kayaustin@outlook.com
Address Email Address
4218
License#
Plumbing Contractor Information
Description of Work Plumbing Install #Baths 2.5
Thornton Plumbing 919-550-4833
Plumbing Contractor's Company Name Telephone
3160 A Vinson Rd.Clayton,NC,27520 Thorntonsplumbing@embargmail.cx
Address Email Address
22152
License#
Insulation Contractor Information
Builders Insulation 919-788-9806
Insulation Contractor's Company Name&Address Telephone
`NOTE:General Contractor must fill out and sign the second page of this application.
Homeowners Applying to Build Their Own Home
Please answer the following questions then see a Permit Technician to determine it you qualify for permit under Owners Exemption.
Questionnaire per G.S. 87-14 Regulations as to Issue of Building Permits(Memo available upon request)
1. Do you own the land on which this building will be constructed? _Yes be No
2. Have you hired or intend to hire an individual to superintend and
manage construction of the project? ✓ Yes No
3. Do you intend to directly control &supervise construction activities? d Yes No
4. Do you intend to schedule, contract, or directly pay for all phases of
construction work to be done? / Yes No
5. Do you intend to personally occupy the building for at least 12 consecutive
months following completion of construction and do you understand that if
you do not do so, it creates the presumption under law that you fraudulently
secured the permit? Yes d No
I hereby certify that I have the authority to make necessary application, that the application is correct
and that the construction will conform to the regulations in the Building, Electrical, Plumbing and
Mechanical codes, and the Harnett County Zoning Ordinance. I state the information on the above
contractors is correct as known to me and that I affirm that I have obtained all listed contractors
permission to obtain these permits and if my changes occur including listed contractors, site plan,
number of bedrooms, building and trade plans, Environmental Health permit changes or proposed use
changes, I certify it is my responsibility to notify the Harnett County Central Permitting Department of
any and all changes.
EXPIRED PERMIT FEES-6 Months to 2 years permit re-issue fee is$150.00. Alter 2 years re-issue fee
is as pe current tee schedule.
Signature of owner/Contr Officer(s)of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87-14
The undersigned applicant being the:
General Contractor Owner / Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of perjury that the person(s), firm(s)or corporation(s)performing the work
set forth in the permit:
✓ Has three (3) or more employees and has obtained workers'compensation insurance to cover them.
Has one (1)or more subcontractors(s) and has obtained workers'compensation insurance to cover
them.
Has one(1) or more subcontractors(s)who has their own policy of workers'compensation insurance
covering themselves.
Has no more than two(2)employees and no subcontractors.
While working on the project for which this permit is sought it is understood that the Central Permitting
Department issuing the permit may require certificates of coverage of worker's compensation insurance prior
to issuance of the permit and at any time during the permitted work from any person,firm or corporation
carrying out the work.
Wade Jurney Homes,LLC
Company or Name:
ApSign w/Title- /at / Date: up 11l>
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed on: 05/31/2018
Entry #: 861031 Initially filed by: wjh2013
Designated Lien Agent Project Property Print & Post
Investors Title Insurance Company SUM 20 El. -El
165 Maple Leaf CI 0. 4
OnRae:www.lirnmccorn �- -. -: Lillingtoo,NC 27521
Addrnn 19 W Hargett St..Suite 507 I Raleigh,NC Harnett County 13. 7t4+
27601 Contractors:
none:8884967384 Please post this notice on the Job Site.
9l3-48-sol Property Type
Suppliers and Subcontractors:
Scan this image with your smart phone to
view this filing.You can then file a Notice
1-2 Family Dwelling to Lien Agent for this project.
Owner Information
WJH,LLC
3300 Battleground Ave Ste.101
Greensboro, NC 27410
United States
Email:lrabim@wadejumeyhomes.com
Phone:336-282-3606
View Comments(0)
Technical Support Hotline:(888)690-7384
HARNETT ':OUNTY CASH RECEISTS
xem CUSTOMER RECEIPT 'sae
Date: JFROc 52
ece: CP 385: 1
Receipt no: 385630
Year Number
2018 50044226 Amount
91749 TECH 2
LILLINGTDH, NC 27546
84 6F - ENV HEALTH FEES
NEW TANK $750.20
WIN
render detail
CK CHECK PAYNEN 17168 $756.66
Total tendered
Total payeent 6756,06
6750.06
Trans date: 6111/116 Time: 11:36:35
** THANK YOU FOR YOUR JAYNENT wr