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HomeMy WebLinkAboutRBPR-06-2023-44798.TIF lilt THIS IS NOTA PERMIT Case# RBPR-06-2023-44798 a CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 18 sM Residential Building Plan Review- Manufactured Home NEW WELL ENGINEERED OPTION I3o j)3 lCv1 Stc4 IMizt ein i Contractor *CLAYTON HOMES OF CONOVER#8I (UNLICENSED GC-BILLING ACCT), 1230 CONOVER BI,VI)W, CONOVER NC 28613 B:8284653450 C:8282057855 IIC081(rCLAYTONHOMES.COM Owner DENNIS HARDIN,PO BOX 395,VALDESE NC 28690 H:828-368-3028 I IOME:828-368-3028 CORDERS 1980@GMAIL.COM NAME TO APPEAR ON PERMIT *Clayton Homes of Conover#81 (unlicensed GC- billing Acct) SITE ADDRESS: 3735 SI IANK TIPPS RD,LAWNDALE NC 28090 PIN# 265701068119 NAME of SUBDIVISION: Lot tE Section/Block PROPERTY SIZE: Square Feet Acres 1.02 DIRECTIONS: Hwy 18 N Left Roger Hill,Left Pea Ridge Rd,Right Shank Tipps Rd on Left PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well SCRIBE OR : " EOP submittal, county issued well"; New 4 bedroom Double Wide Manufacture home w/6x6 deck/8x8 deck with ramp SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES',then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 8 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 32x76 Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO �•I r.:�•pli:::na, 07/17/2023 16:35 Page 1 of ( C E as o 0,Q cA 0 O i.► ap C j(*. W U_ j Q.N o M b rea c.� W H Z U N �• Gp al �� G o LL MS L f0 a o m co 3 co ~ co c� m o -i 6 U N co ti .0 H 1 / _ / / I / / /// , ,/ / m / ,.,-, / N / O ti S O ry ------ -- / 1 S 1 i . / / // / j. r L d ./ _ 11 �1°2 VI UJ p N N :0_ W N Q O 0 VI Ty 12�n W O T U 6 U rn ' a V p` d Z [o . „Zr.''''''''''.---. 3f. • L �......1 LAGOVIS-01 JROBBINS ACORro' CERTIFICATE OF LIABILITY INSURANCE DATE DIYYYY) `„�� 7114/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: _..--- __ Robbins&Associates Insurance Agency,Inc. PHONE No,Ext:(704)226-1300 FAX PO Box 1458 ) (A/C Na):(704)226-1320 E-MAIL obbi d t m certs rnsanassociaes.co Monroe,NC 28111 E-MAIL ADDRESS: @ _._ _ INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Erie Insurance Exchange 26271 INSURED INSURER B:_ Lago Vista Landscaping INSURER C: __.___ Manuel Rocha 2517 Pageland Highway INSURER o_._. Monroe,NC 28112 INSURERS:___—_ INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADDL SUBR I POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY1 (MMIDD/YYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE l'$ 1,000,000 CLAIMS-MADE X OCCUR Q26-0521176 2/5/2023 2/5/2024 DAMAGE TO RENTED 1,000,000 PREMISES(Ea occurrence) $ _ __ MED EXP(Anyone person) S 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- LOC PRODUCTS-COMP/OP AGG $ _ 2,000,000 JECT OTHER: $ NED AUTOMOBILE LIABILITY (Ea accCOcdentSINGLE LIMIT _ $ ANY AUTO BODILY INJURY(Per person) $- - OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIREDONLY _ AUTOS ONLY PROPERTY DAMAGE _ --^- (Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ I DED I RETENTIONS $ A WORKERS COMPENSATION j I X STATUTE I ERH AND EMPLOYERS'LIABILITY Q89-3000667 5/30/2023 5/30/2024 100,000 ANYICE RIETOREMBER EXCLUDED?ECUTIVE Y f N NIA E.L.EACH ACCIDENT $F (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS(VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Carolina Septic Systems,PC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p y ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 26072 Charlotte,NC 28269 AUTHORIZED REPRESENTATIVE I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD