HomeMy WebLinkAboutRBPR-07-2014-19549.TIFIgA �o
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THIS IS NOT A PERMIT Case # RBPR-07-2014-19549
CATAWBA COUNTY HEALTH DEPARTMENT
PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
Residential Building Plan Review - Building Addition
IMPROVEMENT
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Owner ARQUIMIDES CRUZ, 5471 BROOKWOOD LN, HICKORY NC 28602
C:8289620663
NAME TO APPEAR ON PERMIT
Arquimides Cruz
SITE ADDRESS: 5471 BROOKWOOD LN, HICKORY NC 28602 PIN # 279115525583
NAME of SUBDIVISION: WOODRIDGE 4
Lot # Section/Block
PROPERTY SIZE: Square Feet Acres 0.38
DIRECTIONS: Hwy 127 S/ left on Woodridge Dr/house on right
PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank
GALLONS PER DAY: 360 WATER SUP Public Water
DESCRIBE WORK: 24 x 14 deck with partial roof on rear of home
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: Existing Structure
STRUCTURE TYPE: PRIMARY RESIDENCE
FACILITY TYPE: Single Family Residence OTHER DESCRIPTION:
DESCRIPTION OF single family dwelling
EXISTING STRUCTURES
ON SITE (IF ANY)
DIM EXISTING STRUCTURE: 55 x 31
NUMBER OF EXISTING BEDROOMS: 3 # OF OCCUPANTS: 2
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: 24 x 14
BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED?
Desired system types (Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY:
Other described:
Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions. An
Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well
Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility.
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 site accessible so that a complete site evaluation can be performed.
Date: Signature of Applicant or Agent
An Environmental Health Specialist will contact you within 2 working days of application date.
If you need further information or assistance please call 828-466-7291
AREA2
MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 MAX HEIGHT:
k9 - ehappl cation 07/21/2014 09:08 Page 1 of4
THIS IS NOT A PERMIT Case # RBPR-07-2014-19549
CATAWBA COUNTY HEALTH DEPARTMENT
PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
Residential Building Plan Review - Building Addition
IMPROVEMENT
a
F13
102q
Owner ARQUIMIDES CRUZ, 5471 BROOKWOOD LN, HICKORY NC 28602
C:8289620663
NAME TO APPEAR ON PERMIT
Arquimides Cruz
SITE ADDRESS: 5471 BROOKWOOD LN, HICKORY NC 28602 PIN # 279115525583
NAME of SUBDIVISION: WOODRIDGE Lot # 4 Section/Block
PROPERTY SIZE: Square Feet Acres 0.38
DIRECTIONS: Hwy 127 S/ left on Woodridge Dr/house on right
PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank
GALLONS PER DAY: 360 WATER SUPPLY: N/A
DESCRIBE WORK: 24 x 14 deck with partial roof on rear of home
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:
STRUCTURE TYPE:
Existing Structure
PRIMARY RESIDENCE
FACILITY TYPE: Single Family Residence OTHER DESCRIPTION:
DESCRIPTION OF single family dwelling
EXISTING STRUCTURES
ON SITE (IF ANY)
DIM EXISTING STRUCTURE: 55 x 31
NUMBER OF EXISTING BEDROOMS: 3
NEW STRUCTURE DIM:: 24 x 14
# OF OCCUPANTS: 2
PROPOSED CONSTRUCTION
BASEMENT? Yes BASEMENT FIXTURES? Yes
Desired system types (Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE:
OTHER: INNOVATIVE:
Other described:
PLUMBING REQUIRED?
CONVENTIONAL:
ANY:
Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions. An
Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well
Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility.
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 site accessible so that a complete site evaluation can be performed.
Date: 7 — /� -) �/ Signature of Applicant or Agent �Avi r1, deS Z -
An Environmental Health Specialist will contact you within 2 working days of application date.
If you need further information or assistance please call 828-466-7291
AREA2
MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 MAX HEIGHT:
F9 - rhapplicauon 07/18/2014 17:28 Page 1 of
IgA CATAWBA COUNTY Case # RBPR-07-2014-19549
Public Health Department Subdivision WOODRIDGE
d �= Environmental Health Division PIN# 279115525583
PO Box 389, 100-A Southwest Blvd, NeNvton, NC 28658
1842
NAME ON PERMIT: (ARQUIMIDES CRUZ), 5471 BROOKWOOD LN, HICKORY NC 28602
( Arquimides Cruz)
Site Address: 5471 BROOKWOOD LN, HICKORY NC 28602
Property Size: Square Feet Acres 0.38
Directions: Hwy 127 S/ left on Woodridge Dr/house on right
FEENAM-9 „ DATE FEE AMOUNT
Improvement Permit Fee 07/18/2014 $150.00
TOTAL FEES $150.00
FEES ARE NON-REFUNDABLE
ONCE A SITE VISIT IS MADE OR
WORK ON A PLAN REVIEW HAS COMMENCED
SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
1-9 - chappliration 07/18/2014 1728 Page 2 of 4
CA THIS IS NOT A PERMIT
CL ' CATAWBA COUNTY HEALTH DEPARTMENT
�`�" � �o�,„o.{ Application for Environmental Services Page 1
Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑
Septic Expansion ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑
Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑
``ii Application is for New Construction El Existing Facility F1Property Address5V \ �A covo,)Cu\ Subdivision
,In. Lot # Acres
Section/Block/Phase
Driving Directions to Property CO\ �O�O�YC�� m. 5
1�1.
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NAME TO APPEAR ON PERMIT? EdOwner ❑ Applicant ❑ Contractor 'Wnnooaw _
Applicant Contact Information
i Name
Address
Phone Cell Phone
Owner Contact Information
Name q � \�(`(1 \6n ;
I Address
Phone j�37 p, I q (0 7 -Q(h r- j I Cell Phone
Contra&or Contact Information
Name
Address
Phone Cell Phone
WHO WILL BE THE PRIMARY CONTACT? �wner ❑ Applicant ❑ Contractor
Description of Existing Structures on Site 5\i ve . ruvni I J
# of Bedrooms *f Structurehimensions, of X ; # of Occupants
Basement E Yes ❑ No Basement Fixtures WYes Q No
The Applicant shall notify the local health department upon submittal of this application if any of the following apply to
the property 19.question. If the answer to any question is "yes", applicant must attach supporting documentation.
13 Yes ONO Does the site contain any jurisdictional wetlands?
:Yes MhOk Does the site contain any existing wastewater systems?
9 Yes i Is any wastewater going to be generated on the site other than domestic sewage?
'mss d Is the site subject to approval by any other public agency?
0 Yes @'�To Are there any easements or right of ways on this property? Describe
Existing water supply in use ❑ Individual Well ❑ Community Well ❑ Semi -Public Well
❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes [:lo
If applying for an Improvement Permit or Authorization to Construct, Please Indicate Desired System Type(s):
(systems can be ranked in order of your preference)
0 Accepted 0 Alternative ❑ Conventional 0 Innovative ❑ Other ❑ Any
QAJA
ATHIS IS NOT A PERMIT
J
CATAWBA COUNTY HEALTH DEPARTMENT
Application for Environmental Services Page 2
Proposed Facility Type
❑ Primary Residence M New Residenc ❑R Addition to Residence # of New Bedrooms
Project Description 9q X14 &VIA re'a'(' ex) -Vne-_ "O .
Structure Dimensions ff of Occupants
Basement M Yes R No Basement Fixtures a Yes [2 No
Accessory Structure(s) Describe
# of New Bedrooms *t if applicable Structure Dimensions
# of Occupants Accessory Dwelling R Yes R No
Plumbing R Yes R No Describe Plumbing Needed
EJ -Multi-Family Residence# Units #Bedrooms per Unit*t
Total # Bedrooms *t Structure Dimensions
El Food Service Specify Type
# Seats Floor Space -Entire Food Service Facility (Sq Ft)
# Employees per Shift # of Shifts Dining Area (Sq. Ft,)
❑Business Specific Type of Business Retail Floor Space
# of Employees per Shift # of Shifts
0 Other Facility Type Specify
If Church # of Seats Kitchen 0 Yes El No If Daycare Specify Occupancy
Application for Well Construction/Abandonment/Repair
Proposed Well Type ❑ Individual Well n Semi -Public Well F] Community Well
Abandonment Type n Drilled n Bored 71 Dug 17 Unknown
Well Repair Requested n Yes F] No Describe
Calculated Design Flow, Commercial t Additional information may be required to determine
design flow from certain facilities. This value will be determined during consultation with on-site staff.
*Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroom and
counted on all applications. The number of bedrooms will be confirmed by rooms identified on house plans as a bedroom at the time
of building permit issuance. This may prevent the need for septic system size increase in the future.
t If structure is plumbed but no bedrooms, calculated design flow is required.
** If No, a well permit must be issued with the Authorization to Construct
SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE)
Improvement Permits issued as a result of this information are valid for 5 years or maybe non -expiring under certain specified
conditions. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not
transferable; Improvement Permits and Well Permits are transferrable. Permits maybe revoked if the information on this application,
site plans or intended use changes for the proposed facility.
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 comers and making the site
accessible so that a complete site evaluation can be performed.
Signature of Owner or Agent C__6- Z_
Printed Name of Owner or Agent
Date
N'
1 inch = 60 feet
Catawba County, North Carolina
This map product was prepared from the Catawba County, NC, Geospatial Information System.
Catawba County has made substantial efforts to ensure the accuracy of location and labeling information
contained on this map. Catawba County promotes and recommends the independent verification of any
data contained on this map product by the user. The County of Catawba, its employees, agents and
personnel disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect
or consequential which arises or may arise from this map product or the use thereof by any person or entity.
Selected Parcel Number: 2791-15-52-5583
Prepared for:
CATAWBA COUNTY NC - Parcel Report
Information Regarding Selected Parcel(s)
Parcel ID:
2791-15-52-5583
Name!
CRUZ ARQUIMIDES S
' Name2: '
Address:
5471 BROOKWOOD LN
Address2:
City:
HICKORY
State:
NC
Zip:
28602-5506
Account:
Calc Acreage:
0.38
Tax Map:
219H 01004
LRK:
64341
Deed Book:
3095
Deed Page:
1177
Subdivision Name:
WOODRIDGE
Subdivision Block:
Lots:
4
Plat Book:
15
Plat Page:
4
Building Number:
5471
Street Name:
BROOKWOOD LN
Site Zip:
28602
Township:
HICKORY
Fire Dist:
MOUNTAIN VIEW
City/Tax:
State Road:
2511
Total Bldgs Value:
$135,500
Land Value:
$16,800
Total Value:
$152,300
Year Built:
1986
Year Remodeled:
Last Sale Date:
Last Sale Amount:
Neighborhood:
76
Watershed:
WS -III Protected Area
Watershed Split:
NO
Voter Precinct:
P23
E911 District:
COUNTY
Zoning:
R-20
Zoning2:
Zoning3:
Zoning Split:
N
Zoning Overlay: MUC-O,WP-0
Zoning District:
COUNTY
Split Zoning Dist:
N
Split Zoning Dist(1):
0
Split Zoning Dist(2): 0
School District:
COUNTY
Elementary School: MOUNTAIN VIEW
Middle School:
JACOBS FORK
High School:
FRED T FOARD
School Split:
NO
P&Z Case Number:
RZ2012-05
Census Tract 2010: 011102
Census Block 2010:
2044
Small Area Plan:
MOUNTAIN VIEW
Agricultural District:
Printed: Friday, July
18, 2014 05:00 PM