BUILDING
&Mott county Caatml Pemiltting
PO'Box 65 UJUngton, NC 27546
TelepboaaNumbor 910.893-4759
Il at f n an Trade Pe
Owner's Name: ate: S-/pi p
Address: ~r~ yx-so g• Phone;
Directions to)ob site
Lvti
Type Construction: (Please Check) ByYildmg Use: lease check)
Now ;-Ranovation Q Addition 0 Residential Modular
Moved House 0 Other 0 Cgmmercial 0 Multi-Pama!
p
Specii'* Type of Work; Y
Buildlhe Permft Information
Heated ::22 Crawl Space, Building•Constractiozl Cost $ qi
Unheated lab Q Acres Ditturbod
Building Contractor's mpanyName Addr
ature of Officer(s) of Corporation Lrcause # . Telephone
1e a I n atl
Description of Work ~ Electrical cost S
TS Pole: Yes, No() Undergrouh • Overheard 4
pannanentServiae: Undarground; Overhead 0 Service Size Amps
Blectdcal Contractor's Company Name 4 Address zl lah~ s 95~ 7 7 - . 2
Signature oP ffictr(s).bfcorporetion•. License# T.elep one.
Insuloon Perm!$ Informatl'on
Resident#el QtGer p ~.NotReguired Q
roulation.Contractor''s Company Name Address
Talephona
~,YlechanlcalFermltlnfotmattoir ~y,,,o~ '
Description of Work ~fl r~aa,PK Numb0rofUnits_-2Typ0Systcr4W-& eehaniealcost $ELX0~
Number of Tons ZYI<
Mechanical. Contractor's Comp y Nama Address U -Ld3 s6~
y~/zrt3 //6/5~ 9///-i z5•--~I'Jo7~
i t`ure of Officer( of Corporation License # Telephone
~Q PlunbingPermltLnftirmatfon
Daeription of Work 1g,JEE NumberofBaths Plumbing Qost
v 7s~vt~60" t«lc~ y/~~ ~if~
PI b' ontractor's m anyN e Address b
Sig o of OlI er(s o orporation License # elephone
ouol
Affidavit of Worker's Compensation Coverage
N.C.G.S. 87-14
The undersigned applicant for Building Permit # being the
Contractor
i Owner
Officer/Agent of the Contractor or Owner
do hereby con5rm uemderpenaltles ofperjury that the person(s), firm(s) or corporatioi
pmfonning the work set forth in the permit:
_ has&ave three (3) or more employees and &s&ave obtained workers.'
compensation insurance to cover then.
has/have one or more subcontractor(s) and has/have, obtained workers'
compensation insurance covering these-
has/have one or more subcontractor(s) who has/have their own policy of
woi meen'a Compensation covering themselves:
_ has/have notmore than two (2) employees and no subcontractors.
White working on theproject.for which thispermit is sought it is understood that the
Centraj permitting Department issuing the permit may require certificates. of coverage of
workers' compensation insurance priorto issuance of the permft and at any time during
the permitted work from any person, firm or corporation carrying out the work.
Finn name:
By:
Title:
Date:
i
02/01
Sprinkler System Information
Sprinkler Con c or's Company Name Address
Contact Person Telephone
License Number
r
Fire Alarm Svstem.Information
Alarm Contractor's Company Name Address
Contact Person Telephone
License Number
DrivewayAcaess /
NC Department of Transportation Dtiveway 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 theregWations in the Suildfil& 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 in the above contractors I certify it is my-responsibility to
notify the Hernett County Inspections Division of any changes. '
-
Si a re o Owner/ ontractor/Officer(s) of Corporation -Dater,
I? G E
Required Inspections for SFA/SFD Appl # bG 560
I f
Valuation *I Yj i o
Sq. Ft ZEQD
'e Seq
10 R•Bldg Footing 60 Two Trade Final > 2500
10-30 ~ Iec 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
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'Insulation Inspection
60 Four Trade Final
60 Four Trade Final > 2500
60 Three Trade Final
60 Three Trade Final > 2500
60 Two Trade Final