DOCUMENTS Initial Application Date: W 'ILA 1 Q Application# Igc 4L-1 xi l
CU#
COUNTY OFT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillington,NCC 2754627546 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 www.hamett.orglpennits
"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 Slate:NC Zip:27410 Contact No: 919-995-5654 Email. Trabitz@wadejurneyhomes.cor
*Please fill out applicant nformaton it different than landowner
CONTACT NAME APPLYING IN OFFICE:Tara Rabitz Phone#919-995-5654
PROPERTY LOCATION:Subdivision: Summerhill Lot#:21 Lot Size:0.47
State Road it 195 State Road Name: Maple Leaf Cl. Map Book 8 Page:S /0(453
Parcel 130539 0200 28 PIN: 0539-98-5387.000
Zoning'.RA-30 Flood Zone'.N Watershed:N Deed Book 8 Page':. J 0i✓ Power Company:
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
s Monolithic
SFD:(Size 28 x 33 )#Bedrooms:3 #Baths:ABasement(w/wo bath)._Garage: ✓ Deck:_Crawl Space:_Slab:_Slab:_
(Is the bonus room finished?(_)yes (_)no w/a closet?(_)yes ( )no(if yes add in with if bedrooms)
❑ Mod.(Size x )#Bedrooms #Baths Basement(w/wo 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 T W(Sizex )#Bedrooms:_Garage: (site built?_)Deck: (site built?_)
❑ Duplex:(Size )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:#Rooms: Use: Hours of Operation: #Employees:_
❑ AdditionlAccessory/Other(Size x )Use: Closets in addition?( )yes ( )no
Water Supply: ✓ 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(500')of tract listed above?( )yes (✓)no
Does the property contain any easements whether underground or overhead( )yes (I)no
SVudures(existing or proposed):Single family dwellings:SFD Manufactured Homes: Other(spedty):
Required Residential Property Line Setbacks: -'T Comments:
Front Minimum Actual 131 ' D.
Rear ‘A' q
Closest Side 03
Sidestree#corner lot
Nearest Building
on same lot
Residential I and Use Application Page I of 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: Head west on E Front St toward S'Ist 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 conformopto all ordinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing stateme((`/ is are accurate and correct to the best of my knmNedge. Permit subject to revocation if false information is provided.
Signature of Owner s Agent Date
"It Is the ownerlapplicants responsibility to provide the county 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."'
"This application expires 6 months from the initial date H permits have not been issued.'
Residential Land Use Application Page 2 of 2 03/11
IMPERVIOUS SURFACE AREA
:%% mu, lDESCRIPTION \ AREA
.` ............RO.... HOUSE w/ PORCH 1,093 S.F.
1.9.eSS%p• .,• T DECK/PAT10/HVAC 15 S.F.
Q @ DRIVEWAY & WALKS 641 S.F.
SE TOTAL (PROPOSED)= 1,752 S.F.
in
aL-4 7 LOT AREA = 25.194 S.F.
SITE .
9 0 •• 4 {O`• .` % IMPERVIOUS AREA 7.0%
_ FLATWORK WITH VW = 243 S.F.
°40
il PB 2007, PG 431-436
Z—
VICINITY MAP
Not To Scale
SETBACKS:
FRONT - 35'
SIDE - 10'
REAR - 25'
CORNER SIDE - 20' N/F
EARL B. CHAMPION
D.B. 2042, PG. 970
To
•'3
- 1o. arc, 30"W
•BASEMENT 173.
m
20' SL�pE DRgINA E k U11LIfl EAS�MENi
N I _ _ _ _
N —
rn 114.4 / O
/ CI
\ 25,194 S.F.
rr
\ 0.5B AC a co / OI
[ •
' a S
\ ig
terifit
co k/ B
20 . v, 32.77 / 5
1- 30.3. m
2 V / <<
y� oto
Lu Lu
O -C2 \
-
Opf." Ep
x /
SEM `
76 °"�
MAPLE LEAF COURT
50' PI IRI I(' R/W
NAME: UJOa 'J. s)fVlr U F40,111.th 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 I CONFIRMATION I/
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.
D Environmental Health Existing 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 u se code 800 for Environmental Health ins pection. Please note confirmation number
given 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 {X‘} 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 (X)NO Does the site contain any Jurisdictional Wetlands?
{ }YES {X} NO Do you plan to have an 'rr'eafnn system now or in the future?
{ }YES {X}NO Does or will the building contain any drains?Please explain.
{ }YES {j( I NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
{_}YES Q8,}NO Is any wastewater going to be generated on the site other than domestic sewage?
(_)YES (E,X,}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?
{I 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
State Officials Are Granted Right Of Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules.
I Understand That I Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The
(/SSiite�Ascce�ssss� So
Accessible So That A Complete Site Evaluation Can Be Performed.
PROPERTY OWN OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
E-Health Onecklist 1 of 3 12/10
DocuSlgn Envelope ID:6C4A7244-A88D-4401-8000.609C7389E449
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, WIN desires to purchase the Property from Seller, and Seller desires to sell the
Property to WWH.
NOW THEREFORE, in and for good and valuable consideration, the receipt and sufficiency of
which is hereby acknowledged,the parties hereby aclmowledge,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": WW1 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 on which this Agreement is executed by the
latter to sign of Purchaser or Seller,as indicated on the
signature page of this Agreement.
us
Seller /pH1/ MI-1[r
DocuSign Envelope ID:5C4A7244-A88D4401-8000-609C7389E449
EXHIBIT"A"
SUMMERHILL,LILLINGTON,HARNETT COUNTY,NORTH CAROLINA
(4 LOTS)
Lot it Legal Description Address City,State
19 SUMMERHILL S/D 0.73AC 137 MAPLE LEAF CT LILLINGTON, NC 27546
MAP12007-433
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
rw
Seller JzY� wlH 147.
•
mocuSt n Envelope le:6C4A7144-A880-4401.8000.00007360E440
ADDENDUM TO PURCHASE AND SELL LOT(S)OR VACANT LAND
By this Addendum to Agreement to Purchase and Sell Lot(s) or Veennt Laud (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 or other 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 Lot(s)or Vacant Land is voided
by WJH LLC pursuant to the provisions of this Addendum, WJH LLC 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 ofSellers
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
cOacunened by:
loch T yke (SEAL)
'By6FJ6ichaadD.Taylor
Director of Lot Acquisition
Date:2/28/2018
(SEAL)
S. len tumult gs Brodie! Enterprises
y: osctr. P.0 :,tqq5
Title: Parfhcr_'_ m.,. J
Date: 3- lit
(SEAL)
Seller:
Title:
Date:
selleryQst WJ {
H
•Each section below to be filled out Application#
by whomeverpertorming work. Harnett County Central Permitting
Must be owner or licensed PC Box 65 Lillington,NC 27546
contractor. Address,company 910-893-7525 Fax 910-893-2793 www.harnett.org/permits
name Si phone must match
Application for Residential Buildina and Trades Permit
Owner's Name: Cummings Brothers Enterprises Date:_
Site Address:195 Maple Leaf Ct. Phone: 919995-5654
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 McDougald Rd Turn right onto Oak Leaf Dr Turn right onto Maple Leaf Ct
Subdivision: Summerhill Lot: 21
Description of Proposed Work: SFR #of Bedrooms: 3
Heated SF:1606 Unheated SF:401 Finished Bonus Room?No Crawl Space: Slab: 1
General Contractor Information
Wade Jurney Homes 336-282-3606
Building Contractor's Company Name Telephone
3300 Battleground Ave Ste.101 Trabitz@wadejurneyhomes.com
Address Email Address
49262
License#
Electrical Contractor Information
Description of Work Electrical Install Service Size: 200 Amps T-Pole: 1 Yes_No
W-3 919-550-7341
Electrical Contractor's Company Name Telephone
308 W.Main St.Clayton,NC,27520 Ewigly@w3electric.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#
Plumbina 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.
2 a ,
Homeowners Applying to Build Their Own Home
Please answer the following questions then see a Permit Technician to determine if you quality 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 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? / 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 / 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 stale 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 a y 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. After 2 years re-issue tee
/is as p current fee schedule.
r,«Pith CAL I
Signature of Owner/Con c r/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.
Company or Name'Wade Jumey Homes,LLC
Sign w/Titl=• _ Date:L. 1lig'
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed on: 05/31/2018
Entry #: 861034 Initially filed by: wjh2013
Designated Lien Agent Project Property Print & Post
Investors Title Insurance Company SUM 21 Er !!ii
195 Maple Leaf Ct
Onnee:www.lkmneaom._,. Lillingan,NC 27521 Tib
Address:l9W Harden Si..Suitt 507 Raleigh,NC Haman County O
27601
Contractors:
mom:888-690-7384 Please post this notice on the lob Site.
Fax:913-48Q-523I Property Type Suppliers and Subcontractors:
email aupPs¢anemncmm-._.,_ 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
WIH,LLC
3300 Battleground Ave Ste.101
Greensboro, NC 27410
United States
Email:trabitzl@wadejumeyhomes.com
Phone:336-282-3606
View Comments(0)
Technical Support Hotline:(888)690-7384
HARNETT COUNTY CAE^.. RECEIPTS
*** CUSTOMER RECEIPT ***
Aper: JEROCK Type: CP Drawer: 1
Date: 6/11/18 52 Receipt no: 385632
Year Number Amount
2018 50044227
91749 TECH 2
LILLIHOTON, NC 27546
64 8w - ENV HEAiTH FEES
$756.00
MEW TANK
WIN
fender detail
CK CHECK PAYHE$ 17168 $750.06
Total tendered 4756.00
Total payment $750.00
Trans date: 6/ii/18 Time: 1::36:58
** THANK YOU FAR YOUR PAYMENT **