BUILDING
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910-8934759
A lication for Building and Trade Permit
Owner's Name: ( Date:
Address: _ 6,V $ D V Phone:
Directions to job site: o/ r
yv
Subdivision: Lot: 7
Construction Type: (Please Check) Buildin Use: (Please Check)
_ New _ R✓ esidential
Renovation _ Modular
_✓_Addition _ Commercial
Moved House _ Multi-Family
_ Other
Description of Proposed Work: o~. X) `JCY,-2SZ/LQ Q` L0)CL YZ
Total Project Cost:
Building Permit Information
Heated SF _Crawl Space Building Construction Cost $
UnJleated SF _Slab d Acres Disturbed Stories /1C
~/!/~M,~Inmt4F , e6x4~n.u.CZ~to~v~ am, ('9(91 - f-+-2 _38YI a f"Zr ) ~(fi r(-(o~
Building qCon`tractor's Company a Telephone
) a.t/NM AO,, R 4.4r11C a ~5a 6 '73 4 7
Addres,ss~ icen~ se #
ll/ .u cc,~ L4te v1
Signature of Officer(s) of Corporation
Electrical Permit Information
Description of Work Electrical Cost $
TS Pole: Yes() No Underground Overheard ( )
Permanent Service: Underground ( ) Overhead Service Size: Amps
Electrical Contractor's Company Name Telephone
Address License #
Signature of Officer(s) of Corporation
Mechanical Permit Information
Description of Work
Number of Units Type System Mechanical Cost $
Mechanical Contractor's Company Name Telephone
Address License #
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~ Signature of Officer(s) of Corporation
Plumbing Permit Information
Description of Work
Number of Baths Plumbing Cost $
Plumbing Contractor's Company Name Telephone
Address License #
Signature of Officer(s) of Corporation
Insulation Permit Information
Residential Other Not Required ( )
Insulation Contractor's Company Name Address Telephone
Page 1 of 3 12/04
Sprinkler System Information
Sprinkler Contractor's Company Name Telephone
Contact Person
Address License #
Signature of Officer(s) of Corporation
Fire Alarm System Information
Fire Alarm Contractor's Company Name Telephone
Contact Person
Address License #
Signature of Officer(s) of Corporation
Driveway Access
NC Department of Transportation Driveway Access/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 state the
information on the above contractors is correct as known to me and if any changes occur
including listed contractors, site plan, 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 Division of any and all changes.
-/Z/d4aa J/.&~ 40,!! Dg
Signature of Owner/Contractor/Officer(s) of Corporation Date
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Page 2 of 3 12/04
Affidavit for Worker's Compensation
N.C.G.S. 87-14
The undersigned applicant for Building Permit # NC1~ C1 being the:
r/ 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:
i
i~ Has/have three (3) or more employees and has/have obtained workers'
compensation insurance to cover them.
Has/have one (1) or more subcontractors(s) and has/have obtained workers'
compensation insurance to cover them.
Has/have one (1) or more subcontractors(s) who has/have their own policy of
workers' compensation insurance covering themselves.
Has/have not 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.
Firm Name: ~~YtG2C/Lcin+~e n;c_
By/Title: ~aeL~Q ~/~ie K o~ u t 4 ,/p-1Qni.loi
Date: lP
Page 3 of 3 12/04
12-X 1 13
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~oa~cy 1~p,D E V U~1C aN~6 ~
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Required Inspections for SFA/SFD Appl # Oes 00 1 9 °J
Valuation 1 o t#_
Sq. Ft
10 ✓✓R'Bldg Footing 60 Two Trade Final > 2500
10-30 R'Elec Temp Service Pole 60 One Trade Final
20 R*Bldg Foundation 60 One Trade Final > 2500
20 `Address Confirmation 999 / Envir. Operations Permit
30-999 R'Open Floor
30-999 R'Bldg Slab Insp
30-999 R'Elec Under Slab
30-999 R'Plumb under Slab
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30-999 R'Bldg Water/Damp Proofing
40 Four Trade Rough In
40 Four Trade Rough In > 2500
40 Three Trade Rough In
40 Three Trade Rough In > 2500
40 Two Trade Rough In
40 Two Trade Rough In > 2500
40 Q~ One Trade Rough in
40 One,Trade Rough In > 2500
50 R'Insulatlon Inspection
60 Four Trade Final
60 Four Trade Final > 2500
60 Three Trade Final
60 Three Trade Final > 2500
60 Two Trade Final
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