BUILDING • Each section below to be filled out Application # /O- StO -.&y / 3 S
by whomever performing work. Harnett County Central Permitting
Must be owner or licensed PO Box 85 LIIIIngton, NC 27548
contractor. Address, company 910 -893 -7525 Fax 910-893-2793 www. harnes.orglpemdts
name 8 phone must match
//,,/I Application for Residential Building and Trades Permit
Owner's Name: Synorin 1 sl` ...c,4'a.� Date: 6/
Site Address: //Z n. 'a lid /2.Q • /I �
.�i`nw it . Phone:
Directions to job site from Lillington: %QI-P fe n; g. -2 014 /7 boa
.
Subdivision: T;iiet n Pr Lot: -/
Description of PropBsed Work: /tea✓ .44'1r # of Bedrooms: 3
Heated SF: Unheated SF: Finished Bonus Room? Crawl Space: Slab:
'�/ /� General Contractor Information
fvynn /.1w.a..t- 4• 9i9 5:2K ;97
Building Contractor's Company Name Telephone
7 Add s , / Email Address
Signature of Owner /Contractor /Officer(s) of Corporation Li dense #
Electrical Contractor Informatioq _ _ /
Description of Work NMI) �thP/ K� Service Size: _ Amps T -Pole: !/Yes No
RA ,/ .S�. a / � r• 9 / 73a cats
Electrical Contracto s Companx Name Telephone
9 A % 0 -,t �.sa-1 m,,c. 82509 Add 1,g t! Email NclAress dtinit
Si na re • er /Contractor /Officer(s) of Corporation License #
Mechanical/HVAC Contractor Information
Description of Work freer) /4"e,
5/eAe.<.r. ,4'44:14, 9,4 - VS- o6FL
Mech nical Contractogi Com ny Name Telephone
g93 5A4.a li gg GWYtkr 4/l_ 1
Address Email Address
' � /e #
Slgna of Own /Contractor /Officer(s) of Corporation License #
Plumbing Contractor Information
Desc ' d of Work */ /44 # Baths
o'+.• s #t 'era/ 9/9- C-5 - d en,3
Plumbing Contractor's Compardame Telephone
3/6o V , - t c. a 7s1
Addre� Z....-/::-
Email Address
2 Z152�
i naturjOwner /Contractor /Offtcer(s) of Corporation License #
71 ;4 0 "/ sr
Insulation Contractor IInfformation p
/a nel ,S79 O //f // /G ivl4A' 4nJer gig -/vli f/f
Insulation Contractor's Company Name & Ac ,pc el 2s�f Telephone
*NOTE: General Contractor must fill out and sign the second page of this application.
1 a 2
Homeowners Applying to Build Their Own Home
Please answer the following questions then see a Permit Technidan to determine if you qualify for permit under Owners Exemption.
Questionnaire per G.S. 87 -14 Regulationsas 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? .-• , _ No
3. Do you intend to directly control & supervise cons •. ion activities? _ Yes _ No
4. Do you intend to schedule, contract, or •' - ctly pay for all phases of
construction work to be done? Yes.. No
5. Do you. intend to perso . occupy the building for at-least .12 consecutive
months following com • - Ion of construction and do you understand that if
you do not do so, • reates.the presumption under law that you fraudulently
• secured the • = , it? , _ Yes No
I hereby •=rtiy that I have the authority to make necessary application, that the application,ls correct
and that the construction ••will conform to the • regulations in the Building, Electrical, Plumbing and
Mechanical codes, and the Hamett County Zoning Ordinance. I state the information, on the above'
contractors is correct as known to me and if e3y 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 Hamett County Central Permitting Department of
any and all changes:
EXPIRED PERM FEES 8 Months to 2 years pemrit re -issue fee is $150.00: After 2 years re -issue fee
is as r c urre a ule.
CMrfi 6L l Q/
Signature of er /Contractor /Offlcer(s) of Corporation Da
Affidavit for Worker's Compensation N.C.G.S. 87 -14
The undersign plicant being the:
General 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 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. /J /
Company or Name W YA/7 &r+S�s
Sign w/Title: / S% a r
- -: SiNRntigl r zib7in,r 2 or 2 0311';
Plan Box Number. Ark ' f E Job Name L4 aati SS l
Date: (o r ie 'VC
Required Inspections for SFA /SFD
Appl. # /69 - aN /33
Valuation,
c, Sq. Feet : 440S
e-
Sequence
10, a R* BIdg,;:Fooring~
10 -30 R* Elec Temp Service Pole
R* Building Foundation
20 Address Confirmation
30 -999 c/ Open Floor
30 -999 R* Bldg. Slab Insp.
30 -999 R* Elec. Under Slab
30 -999 R *Plumb. Under Slab
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
60 Four Trade Final
60 Four Trade Final > 2500
60 ' [tree Trade Final
60 [Three Trade Final > 2500
60 'Iwo Trade Final
60 'Iwo Trade Final > 2500
60 One Trade Final
60 One Trade Final > 2500
999 Fnvir. Operations Permit