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BUILDING HamottCounty Central Permitting PO Box 65 Lillington, NC 27546 TelephoaaNumber 910-893-4759 d arrd.Trade Pe m III H4 Owner's Name: . L, ate: Address: s /LI& Z- S-,? e Directions to job site Z' Subdivision: 17z,,L~.C(//r LOt Zd' Type Construction: (Please Check) B 1 New 0 Renovation Addition Os ~8 Use: (Please Check Moved House 0 Other 0 0 - Commercial 0 m iii-Pawl!, Specq Type of Work: /I~BLv /m/FTi1, e Bulldln e• Permft Informatio Hoatod •2.4T a Crawl Space 0 Building Construction Cost $ q/ yam/ / rj Unheated s?[ Slabs _ Acres Disturbed z Storn Z Building Contractor's p=y Name zg 737 9%O-SZS/J ocC i aturo of Officer(s) of Corporation Lfcense # . Telephone ectric a I o at1 Description of Work Electrical cost $ 3s-- sue= ) TS Pole: Yeso No() Undergroi n' Qverheard 0 PermanentS'erviee: Underground Overhead Q Service Size; 0 . Amps Electrical Contractor's Company Name Address 21x3 O Z, 4- Si-gnaturoof fficbr(s)•bfCorporhtiori•, License# Telep one. Insulation Pew Information Residential Other 0 NotRe4uirod Q T.r~/ la 3s3d .verr/© la F .a.(~ ~~30/ 1asulatlon.Contractor's Company Name ~i,I Address Telephone /yow MechanicalParmitlnfiirmatfoa DescripdoaofWork rfca,~t' NamborofUnlta Z_TypeSystem•~ MechaaicalCost~s3soe Number of Tons . Mechanical Contractor'& Company Name Address a z € 3 y8 turo of Of&cer( of Corporation License # Telephone igna Ober i In6rM!IffQR Deaoriptloa of Work Number of Bathe z-AL Plumbing Cogt S 1222S. Gen /7 PI b' g ntractor's m any Na a Address c» S~ 9 5 a of Off er(s o orporation License # elephone Sig ruf 07/01 Affidavit of Worker's Compensation Coverage N.C.G.S. 87-14 The undersigned applicant for Building Permit # being the Contractor a/ Owner Officer/Agent of the Contractor or Owner do hereby confirm underpenalties of perjury that the person(s); 5rm(s) or corporatio; performing the work setforth in the permit: _ has/have three (3) or more employees and liss/have obtained workers' compensation insurance to cover thbin. has/have one or more subcontractor(s) and has/have. obtained workers' compensation insurance covering them- has/have: : One or more subcontractor(s) who has/have their own policy of worJonen's compensation covering themselves: has/have notmore than two (2) employees and no subcontractors. Whilo worldng on theprojcct.for which this permit is sought it is undcrst4od that the Central permitting Department issuing the permit may require certificates of coverage of workers' compensation insurance priorto issuance of the permit and at any time during the permitted work from any person, firm or corporation carrying out the work. Firm name: By: Title: Dete: 4 r 02/01 Sprinkler System Information Sprinkler Contrctor's Company Name Address Contact Person Telephone License Number r Fire Alarm System-Information Alum Contraoto s Company Name Address Contact Person Telephone License Number Driveway Access NC Department of T ransportatlou Driveway Access Yes- No I hereby certify that I have the authority to make necessary applfcat(on, that the, application is correct and that the construction will conform to theregulations in the $uilding, 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.respomibility to aotify the Harnett County Inspections Division of any changes. Sign a of Owner/ ontractor/Officer(s) of Corporation Date ~i✓ h/T ~j E/i'CE r ' Required Inspections for SFA/SFD Appl # b6 2;76jj $ fj (3 Valuation 77 54 Sq. Ft seq Seq 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 RBldg Slab Insp 30-999 R'Elec Under Slab 30-999 /'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