BUILDING
Harnett County Central Permitting
PO Box 65 Llllington, NC 27546
Telephone Number 910-693.4759
SwIldina and de Permit
Owner's Name: cK~'ber( A Ioor Date: 6'1'0(0
Address: t 0'7 i,h NL 3 Phone: 9
Dir tions to'ob site: L o- %u.o '.oti L
ow 0 (,a++ W JTTiO oi-
Subdivision: (arOUla. Lu,4R-S Lot 51 H
Construction Type: (Please Check) Building Use: (Please Che )
✓New Residential
_ Renovation _ Modular
-Addition -Commercial
_ Moved House _ Multi-Family
_ Other
Description of Proposed Work:
Total Project Cost:
Bulldln i Pno Heated SF Crawl Space (-r Buildst $ ?0'5' i 7"
Unheated CSF5'7b Slab ( AcreStories a
.j wIr 9s
Bulldlng Contractor's Company Name t5ox ?A"? OJ4• n) C x373!` Address Signature of Qfficer(s) of Corporation
Electrical PermDescription of Work New Electrical Cost $
TS Pole: Yes (X) No Underground (X) Over rd ( )
Permanent Service: Underground (X) Overhead .Service Size: 200 Amps
Wester & Pace
Electrical Contractor's Company Name Telephone
546 Leslie Dr. Sanford NC 919 99-5389
William Wester
Address License $1 l2oc 7(0
Slgna ure of Officer(s) of Corporation
Mechanical eernmit Information
Description of Work New
Number of Units Type System at Pum Mechanical Cost $
Jackson's Heating & Air
Mechanical Contractor's Company Name Telephone
Jackson eatin & Air /910-89J-6410
PO Box 82. Benson. NC
David Jackson
Address/J,~ ` 1 /1~0, License #23670
Sign ture of Officerr((s)` Corporation
Plumbina Permit Information
Description of Work New
Number of Baths Plumbing Cost $
Pb%mhin nntra~yrr' r:o~~}}o~anvName Telephone' q•tty
~u~I S rc j Qo%c.~w.q
ialA3 o(~psb_ Wddtx ►xd~34s"
Address aW License # 7p~ ip
Sig ature of Officer(s) of Corporation
Insulation Permit Information
Rwq=R al (X) they NQt Required Pp ~aS ~yY NC cl tc% 4$6 - Q859
Insulation Contractor's Company Name Address Telephone
Sprinkler System Information
Sprinkler Contractor's Company Name Telephone
Contact Person
Address License #
Signature of Officer(s) of Corporation
Fire At rn System Information
Fire Alarm Contractor's Company Name Telephone
i
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 Dlvisil of any and all changes.
to
Signature of Ow /Contractor/Officer(s) of Corporation Date
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Affidavit for Worker's Compensation
N.C.G.S.87-14
The undersigned applicant for Building Permit # being the:
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:
l/ Has/have three (3) or more employees and has/have obtained workers'
compensation insurance to cover them.
j 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 thee wor'kk.'
Firm Name:_` r 1AC1
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BylTitle:
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Date: 6 ' -96
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Page 3 of 3 12/04
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b~~aY (J6.99 is
Required Inspections for SFA/SFD Appl # ° C 50 0 15oa
Valuation aDO
Sq. Ft b
seq Seg
10 R*BIdg Footing 60 Two Trade Final > 2500
-177~'
10-30 ,R*F:lec Temp Service Pale 60 One Trade Final
20 R*BIdg Foundation 60 One Trade Final > 2500
20 dress Confirmation 999 ~Envir. Operations Permit
30-999 R Open Floor
30-999 R*BIdg Slab Insp
30-999 R'Elec Under Slab
30-999 R'Plumb under Slab
30-999 R*BIdg 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 One Trade Rough In
40 One,Trade Rough In > 2500
50 _,,,,R'Insulation Inspection
60 Four Trade Final
60 Four Trade Final > 2500
60 Three Trade Final
60 Three Trade Final > 2500
60 Two Trade Final