BUILDING
Hametl County Central Permitting
PO'Box 65 Ullington, NC 27546
Telepbonb Number 910.693-4759
AtivIlcatton for t din and.TY depezm
Owner's !`lame: L C /a(A,,., o r ate:
Address: .f o< ~x f r z =.a o 9 Phone; ' _
Drectionstojobsite: ii,
Tom'-----
Subdivision; Let;
c Construction: lease Check ?lam------
nF ) Butildwg Use: (Please Check).
Now 0. Renovation 0 Addition 0 Rosidendal ie Modular
Moved House Q Other 0 Commeraial 0 Mulp_Par nl
Specq Type of Work: e / c,, y
Buildln~PermftFnFormaHpr~
Heated2,2k_4,Crawi Space 0 Bnilding•Construction Cost $ P.z~~oa
Unheated r~C Slab _ Acres Disturbedf? / e Stosaea
/tI e
Building Contriictor),e
z92?3i~ - ~z5 otC
Signature of Offloer(s) of Corporation License # . Telephone
le I ation
Description of Work -tz;z~ form Bleettical Cost S ?
TS Pole: Yeses No 0 Undergroundo- Overheard Q
Permanent Servico: Undergroundt Overhead Q IS "O Sim: =Z, . Amps
. E/Ga<-~.rr . 27 r7 L.u/o C~G .1u<r/5
Electrical Contraacttoor's Company Name Address
~_P _ (n7 • I tc6iwev-~ ~ 9'r3 z.-C- 9//l - ~ s~ -C7 ~-k~_..
Signature of0 chs (s)bf Corporation License: # Telep- o ne.
ul 1 InaftTlatton
Real dentta! Oilier Not Recjuiied
_ i._`~LtT-ta/,o ice. '3S3G, ~wr Z
En ation.Contraotor"s Company Name Address
Telephono
tint NechanicaiPermit Infotmatton f/s o
lhs,ripdonofWork _ e rf~~ Number of Unite 2 Typo System~MechanicalCost$ /s,A
Number of Tons ~ ' /
•~T L T,w. rS~a„e~ ,d - rL/7 s",oi.,.e~ /St</Jtr %G/vt,
Meobanical, Contractor's Comp Name Address 7 y3 y P,
i turo of Officer( of corporation License # Telephone
^,o, Plu binePermltla ro maUon
I)esoripttoa of Work l Number ofHsthe Z v Plumbing Coot S .Y 7 % S~ Lr
b
PI b' 0ontractor's m anyl' ama Ad=
2s- 2-,2 4-,~
Aaw
Si a of Of er(s o orporation License # Telephone
02)01
Sorinkler System Information
Sprinkler Con ctor's Company Name Address
Contact Person Telephone
License Number
r
Fire Alarm System.Information
Alum Contractor' Company Name Address
Contact Person Telephone
License Number
Driveway Acoe'ss
NC Department of Transportation Driveway Access 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 theregulations in the Building, Electrical, Plumbing and MachawcW
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 is the above contractors I certify it is my.responsfbility, to
notify the Harnett County Inspections Division of any changes.
4,47
j ~
S! aa re of Owner/Contractor Officer(s) of Corporation -Date
Affidavit of Worker's Compensation Coverage
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 underpenalties ofperjury that. the person(s); firm(s) or corpora-do:
pertbnning the work set forth in the permit:
_ has/have three (3) or more employees and lias/have obtained workers.'
compensation insurance to cover them.
has/have one or more subcontractor(s) and hawhave. obtained workers'
compensation insurance covering them.
haslhave• one or more subcontractor(s) .who has/have their own policy of
wosd=en'a compensation covering themselves:
_ has/have notmore than two (2) employees and no subcontractors.
While rlnng on theproject.for which this permit is sought it is understood that the
central Permitting Department issuing the permit may require certificates of coverage of
workers' compensation insurance prior,to issuance of the permit and at any time during
the permitted work from any person, Sam or corporation carrying out the work.
Fires name:
By:
Title:
Date: S .
02/01
Required Inspections for SFAISFD Appl a cc Soa 1 Sb 1
Valuation
1-71 0q?-
Sq. Ft I L-6
SOCI Sea
10 *Bldg Footing 60 Two Trade Final > 2500
10-30 /R`Elec Temp Service Pole 60 One Trade Final
20 R'Bidg Foundation 60 One Trade Final > 2500
20 Address Confirmation 999 Envir. Operations Permit
30-999 R'Open Floor
30-999 Bldg Slab Insp
30-999 R`Elec Under Slab
30-999 R'Plumb under Slab
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 One Trade Rough In
40 / One,Trade Rough in > 2500
50 r Winsulation Inspection
60 Four Trade Final
60 Four Trade Final > 2500
60 Three Trade Final
60 Three Trade Final > 2500
60 Two Trade Final