BUILDING • Each section below to be filled out by Application k 1 0 5 —
L✓ ` { “-
whomever performing work. Must be owner Harnett County Central Permitting
or licensed contractor. Address, company PO Box 65 Lillington, NC 27546
name & phone must match information on Telephone Number 910- 893 -7525 www.harnett.org
license. Application for Building and Trade Permit
Owner's Name: Date:
Address: Phone:
Directions to job site from Lillington:
Subdivision: Lot:
Construction Type: (Please Check) Building Use: (Please Check)
_ New _ Moved House _ Residential _ Commercial
_ Renovation _ Addition _ Other _ Modular _ Multi - Family
Total Project Cost: Description of Proposed Work:
General Contractor Information
Heated SF Crawl Space ( ) Building Construction Cost $
Unheated SF t.r_ Slab () Acres Disturbed Stories g y
$+ ?A c o !I 9/9- Ca tFG - `c l j �`7' - ll
Budding Contractor's Company Name Telephone Ot`. C fv,
Zof Sh cniodu o/4 C,' S.. :At / /S eit r nth/ s2 -3o i ° V"`
Ad• --/ Lic nse #
- gnature of Owner /Contractor /Officer(s) of Corporation - Must sign back of form & workers comp
// Electrical Permit Information
Description of Work /N.7`lr'O.a / '77arX Electrical Cost $
TS Pole: Yes ( ) No ( ) Underground ( ) Overhead ( )
Permanent Service: Underground ( ) Overhead ( ) Service Siz Amps
?net ,ae J br-Xk4aa•Qrr rH e. _9/9- 4 ?'P6 ?'
Electrical Contractor's Company Name Telephone
Ptui,ty T.Cd -63.4 4 h// ,n a sSlG ,vv 3 - r>
Addre License #
Signature of Officer(s) of Corporation
Mechanical Permit Information
Description of Work _„__ —.. ._ ... • _ - - - --
Au of Unite Typ _ Mecha ical Goa e t -nm al Co c • r'. Coin any Nam el ph•ne �
`�'�
i L £ UL _ ( }r lad: � - . � 1
Addr -. , � � �l - 1 License#
�r
S••, 'are ofOfficer(s)ofCwporatan
Plumbing Permit Information
Description of Work PI. ;, ..
Number of Baths .2- Plumbing Cost $
JJkSnit Juj-AS v P/ Li rib L-3
Plumbing Contractor's Company Name Telephone
)q a119rk (9_ e..) L;;)i4,1 4.L. .275 5X= gl6 & 95
Address License #
ature of ffcer(s) of Corporation
Insulation Permit information Residential ( ) Other ( ) Not Required ( )
/„'�� q�" "'^ Iry -
t /g - 0 2 S - S
Insulation Con(ract s Company Name & Address Telephone
Page 1 of 3 1107
Application II
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 Contractor's 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.
Questionnaire per G.S. 87 -14 Regulations as to Issue of Building Permits (Memo available upon request)
1. Do you own the land on which this building will be constructed? _ yes _ no
2. Have you hired or intend to hire an individual to superintend and manage construction of
the project? _ yes _ no
3. Do you intend to directly control & supervise construction activities? yes _ no
4. Do you intend to schedule, contract, or directly pay for all phases of construction 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 not do so, it
creates the presumption under law that you fraudulently secured the permit?
yes _ no
Sign & date
1 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 r bility n ify the Harnett County Central Permitting Department of any and all changes.
Signature of c Owner/Contractor/Officer(s) of Corporation Date
Paoe 2 of 3 1/07
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.
Questionnaire per G.S. 87 -14 Regulations as to Issue of Building Permits (Memo available upon request)
1. Do you own the land on which this building will be constructed? _ Yes _ No
2. Have you hired or intend to hire an individual to superintend and
manage construction of the project? _ Yes No
3. Do you intend to directly control & supervise construction activities? _ Yes _ No
4. Do you intend to schedule, contract, or directly pay for all phases of
construction work to be done? Yes No
5. Do you intend to personally occupy the building for at (east 12 consecutive
months following completion of construction and do you understand that if
you do not do so, it creates the pr esumption under law that you fraudulently
secured the 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,
number of bedrooms, building and trade plans, Environmental Health permit changes or proposed use
changes, I certify it is my responsibility to notify the Harnett County Central Permitting Department of
any and all changes.
EXPIRED PERMIT FEES - 6 Months to 2 years permit re -issue fee is $150.00. After 2 years re -issue fee
is as per current fee schedule.
Signature of Owner /Contractor /Officer(s) of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87 - 14
The undersigned applicant being the:
eneral Contractor Owner Officer /Agent of the Contractor or Owner
Do ereby confirm under penalties of perjury that the person(s), firm(s) or corporation(s) performing the work
set forth in the permit:
Has three (3) or more employees and has obtained workers' compensation insurance to cover them.
Has one (1) or more subcontractors(s) and has obtained workers' compensation insurance to cover
them.
_ Has one (1) or more subcontractors(s) who has their own policy of workers' compensation insurance
covering themselves.
Has no 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.
1 C
Company or Name: Pt) (h i' � � cv L
Sign w/TitIe:_ Date: f L it o
Residential Building Application 2 of 2 03110
J
Plan Box Number 0" -3 Job Name ate"
wee.
Date: _6 -7- / l3
Required Inspections for SFAiSFD
Appl. # /0 -5 24 - s - Sc{
Valuation 1 IC 7 375r
Sq. Feet 2 ?'/
Sequence
10 ✓ R* Bldg. Footing
10 -30 R* Elec. Temp Service Pole
20 ,/ R* Building Foundation
20 Address Confirmation
30 -999 ,/ Open Floor
30 -999 R* Bldg. Slab Insp.
30 -999 R* Elec. Under Slab
30 -999 R *Plumb. Under Slab
40 t / 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
60 ,/ Pour Trade Final
60 Four Trade Final > 2500
60 Three Trade Final
60 three Trade Final > 2500
60 ['wo Trade Final
60 Two Trade Final > 2500
60 One Trade Final
60 Dne Trade Final > 2500
999 i:nvir. Operations Permit