BUILDING
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910-893-4759
Application for Building and Trade Permit
Owner's Name: Sena a a,aD f p, Date:
Address: S'a9,\ pr.A~a0.~op Cx0.~a¢- Dtl. ,.1.C,2.r1613Phone:<glS90-j04~V
Directions to job site: Sr 4 0? ` a\o w ,a ea t„~ kS~ S; M1~ L w- a Sr \5 z
na J ,i Ilk i.ecT oa-o S~ IS4"S tiPD N a rte.. - . a 15410
lAS to Dv the f~~5 rt- P3, W- Yv"~e c-~~r+. 1.>+t •,.S¢crwu
Subdivision: ~~Ca rcL, a C rln?9nftFA Q3,~, ncK i SU{L S~AO,4 S,=J Lot: (1P
Construction Type: (Please Check) Buildin Use: (Please Check)
✓New _ Residential
_ Renovation _ Modular
_ Addition _ Commercial
_ Moved House _ Multi-Family
_ Other
Description of Proposed Work: 3 STOao 6eo oov~ 4 e s :acme.
Total Project Cost: v J
Building Permit Information
Heated SF 4&A..a_Crawl Space (v)/ Building Construction Cost $
Unheated SF Slab Acres Disturbed Stories
SP.C~p ,x 5AU(S (91G)) SDo SOLP, .
Building Contractor's Company Name , Telephone
5' a ;h ar¢ Da,o~ le~at A.(,A)6(3 rl-r.ry_X4-
A dr s License #
ign re o 1 Officer(s) of Corporation
Electrical Permit Information
Description of Work r-N e u N Electrical Cost $
TS Pole: Yes No ( ) Underground Overheard ( )
Permanent Service: Underground W Overhead Service Size: Amps
`'oweaso~,e_ce. E..eczsttc (0, 1 5SD - $33S
Electrical C ntractor s Com me Telephone
0C)5 taoLhv, t;. G F \,C. "'15~~( N, C. 1 ~,Li t S U
License #
5 ture of Officer(s) of Corporation
Mechanical Permit Information
Description of Work Nev'
Number of Units a Type System 50 L,~ Mechanical Cost $
Mechanical Contractor's ompany Name Telephone
413c,5Ma7nSt r+~em;IlsNC )433w8 N,C. 10 5a.3
_44 License #
AddWss
Signature of Officer(s) of Corporation
Plumbing Permit Information
Description of Work t.) e w
Number of Baths 3 f ui~, 3a,7as / o, qn~c 6a7 Ns Plumbing Cost $
ir~P. l,.) PL~nY~341o C. o.. lac. (4o,l U.,n-w( s
Plumbing Contractors Company Name t'o 03oxi 1119 Telephone
F1P~ eaze 5/~0//,,a c,ev. h1,c~. t~. C., 1'Vol;`1 C~.~s=., i
Addres /l.Y., ~Z~- License #
Signature of Officer(s) of Corporation
Insulation Permit Information
Residential (Other O Not Required O S I q Oro Oren, 5-ro Aa
Ta cv m IL r~'>u vaT i0~J Aa a,)S;kq 6 Q1 ) D1o 1- Jq'%c~
Insulation Contractor's Company Name Address Telephone
Page 1 of 3 12/04
Application #
Commercial Jobs must fill out this portion
Sprinkler System Information
Sprinkler Contractor's Company Name Contact & Telephone
Address License #
Signature of Officer(s) of Corporation
Fire Alarm System Information
Fire Alarm Contractors Company Name Contact & Telephone
Address License #
Signature of Officer(s) of Corporation
Driveway Access - NC Department of Transportation Driveway Access/Permit? Yes No
Homeowners Applying to Build Their Own Home
Please answer the following questions then see a Permit Technician to determine if you qualify for permit under owners Exemption.
ble upon request)
Questionnaire per G.S. 87-14 Regulations as to Issue of Building Permits (Mem7ves
1. Do you own the land on which this building will be constructed? _ no
. Have you hired or intend to hire an individual to superintend and manage construct' n of
2
the project? -yes no
3. Do you intend to directly control & supervise construction activities? !dyes _ no
4. Do you intend to schedule, contract, or directly pay for all phases of cot}s~truction 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 no do so, it
crea s the presumption under law that you fraudulently secured the perm' .
yes _ no
_ I 6.
Sig & date
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,
tdaian d trdl Environmental Health permit changes or proposed use changes, I certify it is
sibility to not' the H ett County Central Permitting Department of any and all changes.
/a-, -a~
Signat re of a ontractor/officer(s) of Corporation Date
Page 2 of 3 10/06
I
Affidavit for Worker's Compensation
N.C.G.S.87-14
The undersigned applicant for Building Permit # being the:
Contractor
--7-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.
IVas/have one (1) or more subcontractors(s) and has/have obtained workers'
compensation insurance to cover them.
V/ 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: S2.0,0,,A- Ar~0 ~AP,~~uaa JAiS S
Byrritle: 2P.
Date:
Page 3 of 3 12/04
J S~ Ls
a-1_ aL
Required Inspections for SFA/SFD Appl # 6 K ,5~6Q ) Jam" 6 Z Lr
Valuation x;* %59
Sq. Ft lyt9 g `/L~ `jd'Dl
Seq Secl
10 'Bldg Footing 60 Two Trade Final > 2500
10-30 l-&'Elec Temp Service Pole 60 One Trade Final
20 R'Bldg Foundation 60 One Trade Final > 2500
20 JAddress 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