BCZ139- Certificate of Zoning Compliance Application

63 River Road
Belville, NC 28451

TOWN OF BELVILLE
CERTIFICATE OF ZONING COMPLIANCE APPLICATION
finance@townofbelville.com

Phone: 910.371.2456
Fax: 910.371.2474

Date

***PLEASE NOTE: ALL FEES MUST BE SUBMITTED WITH APPLICATION TO BE PROCESSED.ALL FEES ARE NONREFUNDABLE AND SUBJECT TO CHANGE. ***

Select Type:
New ResidentialNew CommercialAddition/RemodelSign (see BCZ 168)Mobile HomeFenceElectricalSwimming PoolMechanicalPlumbingAccessory StructureOther

Subdivision Name:

Lot#:

Property Owner’s Name:

Tax Parcel #:

Street Address:

City: BELVILLE

State: NORTH CAROLINA

Zip Code: 28451

Phone#:

Mobile#:

Email:

Is Property in a Flood Zone?
YesNoDo not Know

Flood:

If so, Height of lowest finished floor above mean sea elevation:

Zone:

Zoning District:

Height of Building (ft.):

Contractor’s Business Name:

Business Owner’s Name:

Contractor’s Address:

Cell Phone/Home#:

Office/Work Phone#:

City

State

Zip

N.C. State License#:

Fax #:

Email:

***List all Subcontractors on the additional pages. Please Enter A Complete Project Description:

AFFIDAVIT OF WORKER’S COMPENSATION COVERAGENCGS §87-14

The undersigned applicant for this certificate of zoning compliance being the
ContractorOwner

Do hereby state under the penalties of perjury that the person(s), firm(s) or corporation(s) performing the work set forth in the certificate of zoning compliance:

has/have three (3) or more employees and have obtained worker’s compensation insurance to cover them,has/have one (1) or more subcontractors and have obtained worker’s compensation insurance to cover them,has/have one (1) or more subcontractors who has/have their own policy of worker’s compensation insurance to covering themselves,has/have not more than two (2) employees and no subcontractors,

while working on the project for which this certificate of zoning compliance is sought. It is understood that the Town or County Inspections Department may require certificates of coverage of worker’s compensation insurance prior to issuance of a certificate of zoning compliance or permit and at any time during the permitted work from any person, firm or corporation conducting the work.

Printed Name:

Title:

Signature:

Date:

SETBACKS: Please call to schedule Setback Inspections.

Front:

Side:

Rear:

PARKING:

Parking Space Required:

Parking Spaces Proposed:

Paving Required:

Parking Layout Approved:
YesNo

NOTICE: I hereby certify that I have read and examined this application and know the same to be true and correct. I also am aware that all work done under this certificate of zoning compliance shall comply with the latest edition of the North Carolina State Building Codes and all Town Codes. I agree that I am the responsible person for contacting the Town for setback inspections. (Property must be staked.) Failure to do so could result in fines and/or revocation of this certificate of zoning compliance. “Additionally, applicants are responsible for complying with any Subdivision and/or community Deed Restrictions for said property, i.e., (setbacks, etc.)”

NOTE: CERTIFICATE OF ZONING COMPLIANCE SHALL BE VOID AFTER ONE YEAR FROM THE DATE OF ISSUANCE UNLESS SUBSTANTIAL PROGRESS ON THE PROJECT HAS BEEN MADE BY THAT TIME.

***THIS APPLICATION IS NOT A PERMIT! ***REQUIRED PERMITS MUST BE OBTAINED FROM THE BRUNSWICK COUNTY OFFICE,FOLLOWING APPROVAL OF THE CERTIFICATE OF ZONING COMPLIANCE.

LIST ALL OF SUBCONTRACTORS FOR CONSTRUCTION PROJECT(S)
(Attach additional sheets if necessary)

Business Name:

Owner:

Address:

City:

State:

Zip:

Mobile Phone:

Office phone:

Email:

Fax:

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Owner:

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63 River Road
Belville, NC 28451

Hours
Monday–Friday: 8:00AM–4:30PM
Saturday & Sunday: Closed

BCZ139- Certificate of Zoning Compliance Application

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