BUILDING
Harnett County Central Permitting
PO Box 85 Lillinglon. NC 27548
Telephaw_NUmber 910-893-4759
A lication for Bdin and Trade Permit
Owner's Name: fJll V I L 1 t~)uil Date: A
/ Address: 0 S v )[_~94 SA W Fn 12. D N_ 273Phone:
Dir ctions to job site: 1~ ~f' 3!,I L , rh
r z is 1 e 0 Iq A 0 h Q4-e0t, 94c Subdivision: lY~ , ~5 Lot: Hof 0~4
Construction Type: (Please Check) Lc Building Use: (Please Check)
New -o6Residential
_ Renovation _ Modular
_ Addition _ Commercial
_ Moved House _ Multi-Family
_ Other
Description of ProposedWQ rk: CW (I~NTjQU GTj O
Total Project Cost: lb- DO
Building peL it Information
Heated. SF% - Crawl Spece t Building Construction Cost $ CPU
Unheated SF -,Slab (r~~ Acres Disturbed
EDWRQn 5. L rwp ENT Q/4 - 7c/9Z3od~
Bwidjn Con ctor's Company N e Telephone
1 z s c. W4 rla7ss7 20 z63
Address i License #
Signature Of Officer(s) of Corporation
Electrical Permit Information
Description of Work / 1EW CONS 'I KU r TIO Electrical Cost $ /S 0 )
T Yes No O Underground Qd Overheard O
Pe anent er round Overhead ize- 'j0(7 Amps 1
M t9P6 - 21 LJ-99f7-3655
EI Iii sT 1`~~t/l EE N Telephone 3a
Addre License #
afore f Offs s of Corporation
Mechanical Permit Information
Description of Work C0,152-
Number of Units Type System a w,. -Mechanical Cost $ w
"i9. 775 //88
4ign l ntractor's Co yny Name elepfigPe
rn "M L L3JH~
License #
of Officer(s) o O rporation
Plumbing Permit Information
Description of Work Z ;W i U
Number of Baths Plumbing Cost $
P)y in Contra is C m any Name n Tele hon
N/ ~GEit9 t✓ v~13!V rp L 11
s License # 1
Addr
Vlz~e
natur of Officer(s) of Corporation
Insulation Permit Information p
Residential Other Not Jt ~o ~CwIS Hutt l~~l'77y-~/?j35
? n4u crnoci
Insulation Contractors Company Name Address Telephone
Page 1 of 3 12/04
Sprinkler System Information
Sprinkler Contractor's Cc pany Name Telephone
Contact Person
Address License #
Signature of Officer(s) of Corporation
Fire Alarm System Information
Fire Alarm Contractor's Company Name Telephone
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
Centr ermitting Division f any and all changes.
21134
Sigru'r of~ontractor/Officer(s) of Corporation Date
Page 2 of 3 12/04
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:
Has/have three (3) or more employees and has/have obtained workers'
compensation insurance to cover them.
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 the work.
Firm Name: G~(WG v~ -41 l -
Bylritle: ~J / -
Date: 34
Page 3 of 3 12/04
7
Required Inspections for SFA/SFD Appl # O 500 ISO 23
Valuation 222_,6 _
Sq. Ft
Sea Seg
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 R'Bldg Slab insp
30-999 R'Elec Under Slab
30-999 R'Plumb under Slab
30-999 R'Bldg Water/Damp Proofing
40 Foyr 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 ~sulation Inspection
60 Four Trade Final
60 Four Trade Final > 2500
60 Three Trade Final
60 Three Trade Final > 2500
60 Two Trade Final