BUILDING
i' Each section below to be filled out by 1 1 /
ZOZ
~whomejr performing work. Must be owner 1 l ✓ C--
of liven d contractor. Address, company Application # Lr
name & phone must match information on Harnett County Central Permitting
license. PO Box 65 Lillington, NC 27546
910-893-7525 Fax 910-893-2793www.hameft.org/permits
Application for Residential Building and Trades Permit
Owner's Name: V! w u Date: ti C~ U
Site Address: 0 Auqr VC Phone: 1l1 ~9~ rJ%roL
.
Directions to job site fromlLillington: i . CI io r ;"l (4(
Il; n✓1 .ln ~P5 r7 ~!1r7~v,tr F-0 Subdivision: F~^ Lot:
Description of Proposed Work: 7Ui^ f ^1 i- JG P r' n O j o-, #Bedrooms:
Heated SF Unheated SF Finished Rec Room? Crawl Space Slab ( )
General Contractor Information q
~ 0 4.1
Building Contractor's Company/(N'~ a Telephone
S~?6 Q! A a In t 0 V
Addres License #
i
S[.J~-t'-~,~ Must sign & fill out second page
SignatuC wre of ner/Contractor/Officer(s) of Corporation
Electrical Permit Information
Description of Work !t A2'v 10 Service Size: :J4o Amps TPole: yes/no
.cr,/9 iG -X77- on
Electrical Contractor's Company Name Telephone
Addres4s License #
Sig ature of Officer(s) of Corporation
Mechanical/HVAC Permit Information
i
escription of Work
Mach ical Contractor's Company Name Telephone
Address License #
Signature of Office of Corporation
Plumbin Per Information
Description of Work # Baths
Plumbing Contractor's Company Na Telephone
Address License #
Signature of Officer of Corporation
Insulation Permit rmation
Insulatio ontractor's Company Name & Address Telephone
8/21/08
iT
Homeowners Applying to Build Their Own Home
Please answer the following questions then see a Permit Technician to determine if you quality for permit under Owners Exemption.
Questionnaire per G.S. 87-14 Regulations as to Issue of Building Permits (Memo available upon request)
1. Do you own the land on which this building will be constructed? - yes X no
2. Have you hired or intend to hire an individual to superintend and manage construction of the
project? - yes _ no
3. Do you intend to directly control & supervise construction activities? _ yes -no
4. Do you intend to schedule, contract, or directly pay for all phases of construction work to be
done? - yes -no
5. Do you intend to personally occupy the building for at least 12 consecutive months following
completion of construction and do you understand that if you do not do so, it creates the
presumption under law that you fraudulently secured the 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,
number of bedrooms, 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 Department of
any and all changes.
EXPIRED PERMIT FEES - 6 Months to 2 years permit re-issue fee is $150.00. After 2 years re-issue fee
is as per current fee s hedule.
Signature of O ner/Contractor/Officer(s) of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87-14
The undersigned applicant being the:
X General 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:
Has three (3) or more employees and has obtained workers' compensation insurance to cover them.
Has one (1) or more subcontractors(s) and has obtained workers' compensation insurance to cover
them.
X Has one (1) or more subcontractors(s) who has their own policy of workers' compensation insurance
covering themselves.
Has no 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. /
Company or Name: .5 a 1/? ISL'E' /1 1 o~/dl ~J
Sign w/Title: I~ (17 L s Date: J q
- ° /
8/21/08
0 22 o23
t ~w
l J 1f7.~ 4
PRIVILEGE LICENSE
1
r r rt One year privilege license for projects under $30,000. License must be renewed
Harnett each year. This is not a business license. Does not cover work in Angier, Dunn or
Ervin zoning. Only for Building Permits, not trade work.
COUNTY
strong roots • new growth
Date: S' y' 0
Name: ) i ~v( V"' PO e r-
Company Name: n 2)'52 (fie m e i' n
Address: 5V 3 O Gr ry\es K&
Mailing Address: 34-----
City, State, Zip: n c . ay' o to
Phone Number. 1 0 1 q 1~ t7 Fax: 5W `lag 99 rS
Type of Business/Work Performed: ~ern oAe-) P
Signature of Applicant: z
COMM PFRIOr7LYU DePAR71120?
108 Ea11 Fn 50111, PO gar 65 UkOpn, NC 77516
Ph r (610) 807.7625 - Fu (810) 083-7780
w .hwd"
1/07
J S u RaoM
PLAN BOX NUMBER F:~L ig-r JOB NAME fi3 L Pd R T~ R
DATE C-- 4 -65
REQUIRED INSPECTIONS FOR SFA/SFD
APPL. # O 9 <560 22 0 z3
VALUATION L)18-3o
SQ. FEET 33 ~
SEQUENCE
10 / R* BLDG. FOOTING
10-30 R* ELEC. TEMP SERVICE POLE
20 / R*BUILDING FOUNDATION
20 ✓ ADDRESS CONFIRMATION
30-999 OPEN FLOOR
30-999 R* BLDG. SLAB INSP.
30-999 R* ELEC. UNDER SLAB
30-999 R*PLUMB. UNDER SLAB
40 FOUR TRADE ROUGH IN
40 FOUR TRADE ROUGH IN > 2500
40 THREE TRADE ROUGH IN
40 THREE TRADE ROUGH IN >2500
40 v~ TWO TRADE ROUGH IN
40 TWO TRADE ROUGH IN > 2500
40 ONE TRADE ROUGH
40 ONE TRADE ROUGH IN > 2500
50 ✓ R* INSULATION
60 FOUR TRADE FINAL
60 FOUR TRADE FINAL > 2500
60 THREE TRADE FINAL
60 THREE TRADE TINAL > 2500
60 TWO TRADE FINAL
60 TWO TRADE FINAL > 2500
60 ONE TRADE FINAL
60 ONE TRADE FINAL > 2500
999 ENVIRO. OPERATIONS PERMIT