TRADE TSP
Application # 09-50022786
Temporary Service Pole
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910-802-8525 Fax 910-803-2793
www.harnett.org
Certification of Work Performed By Owner/Contractor
Owner (s) of Structure: Campbell University Phone: 910-893-1610
Owner (s) Mailing Address: PO Box 97
Buies Creek. INC 27506
Land Owner Name (s): Campbell University
Construction or Site Address: 141 T.T. Lanier Street Extension. Buses Creek. NC 27506
PIN orParcel
Job Cost: ~ - Description of Work to be done Temporary Service Pole for
New Science Building
Mechanical: New Unit with Ductwork New Unit without Ductwork Gas Piping
Electrical: 200 Amp <200 Amp _ Service Change Service Reconnect Other X
Temporary Pole
Plumbing: Water/Sewer Tap _ Number of Baths Water Heater
Specific Directions to Job from Lillington:
From 421 East to Leslie Campbell. Turn left on Judge Taylor Road. Turn left at stop
sign. Follow road around curve, building is on left
Subdivision: Lot
I, Triple-R Electric. Inc. have provided or will provide the Electrical labor
(Contractors Name) (Trade)
on this structure. I am the building owner or hold a NC state Electrical license
(Trade)
number 13241-U which entitles me to perform such work on the above structure legally.
All work shall comply with the State Building Code and all other applicable State and local laws,
Ordinances and regulations.
Structure owner(s) signature: Date:
Company Name: Triple-R Electric. Inc. Phone: 252-523-3558
Address: PO Box 6116. Kinston, INC 28501
County: Lenoir Contractor's License 13241-U
Contractor's Signature: Date: 10-06-09
*Company name, address and phone must r nformation on license
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