BUILDING Application # (4 nn , /15 9
`Each section below to be filled out Harnett County Central Permitting
by whomever performing work.
Must be owner or licensed PO Box 65 Lillington, NC 27546
contractor. Address, company 910 -893 -7525 Fax 910 - 893 -2793 www.harnett.org /permits
name & phone must match
v �� y Application for Residential Building and Trades Permit
Owner's Name: �J///a 5 57 C' >' Date: 7-20/
Site Address: 6,0 Cp Color iu.( - - 1)2 Phone: gib177;25
Directions to job site from Lillington: TAkr Moi r37t4i 7L, or Macs Prr 114.0 77 Om Collin 01$
Subdivision: Lc4n/al J/./A // Lot: 3/
Description of Proposed Work: NI us 6 is/vit aa/an # of Bedrooms: 3
:
/
Heated SF: 1227 Unheated SF: 4 2(O Finished Bonus Room? Crawl Space: L! Slab:
General Contractor Information
R hmsm ) H ams 9/0 922-2542
Buildin Contractor's Company Name Telephone
SCR S RQrft .9 84 , )IAbr f. 3z 9aryehb� *ernAamf5&rhaM
At . ress mall Address
I �{j 67.530
Sign; re of Owner /Contractor / Officer(s) of Corporation License #
/ Electrical Contractor Information
Description off�Worrk Mc (tTnq/ iTR Service Size: ,2 Amps T -Pole: ("Yes No
ino�y Kktgf RPC/?ir 9 32 -.9S/51?
Electrical Contractor's Company, Name Telephone
1 R 7 ( & )h � fr t,�D 1
Ad re Email Address ja_ Ne. I oo0C Lk
Signature o Owner /Contractor / Officer(s) of Corporation License #
Mechan /HVAC Contractor Information
Description of Work )t-(5 us GoMkQtac -4 im
au Q POLLAD 4£(P4 1 &Ln q 1 a ,Lc 9 5zy
Mechanical Contractor's Compan Name Telephone
Gozs to Fin cA .{ ku'dUt: R. , 6
A.. A ss Email Address
ai
ignature of •wner /Contractor / Officer(s) of Corporation License #
/t Plumbing Contractor Information
Description of Work gnu La✓1S12odm l # Baths 3
Ba 55 7/u wi b/149 9ia a37- 799
Plumbing Contractor's Company Name Telephone
IN ( kalc 5pu✓'
Ad s t//} Email Address
I n re of er /Co tractor /Officer(s) of Corporation License ��
1 In siIation Contractor Information
Insulation Contr ctor's Company Name & Address Telephone
`NOTE: General Contractor must fill out and sign the second page of this application.
IIt;7 ftih rt.
Homeowners Applying to Build Their Own Home
Please answer the following questions then see a Permit Techrddan 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
t
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 s�, it creates the presumption 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 constriction 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 Ely 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 PERMIT FEE � Months to 2 years permit re -issue fee is $150.00: After 2 years re -issue fee
is as prpr current ee sir le.
J 7- a 2 —i v
Signaturjf Owner /Contractor /Officer(s) of Corporation Date
vvv Affidavit for Worker's Compensation N.C.G.S. 87 - 14
The undersigned applicant being the:
✓General Contractor Owner Officer /Agent of the Contractor or Owner
Do hereby confirm under penalties of perjury that the person(s), firm(s) or corporation(s) performing the work
set forth In the permit:
_ Has three (3) or more employees and has obtained workers' compensation insurance to cover them.
Has one (1) or more subcontractors(s) and has obtained workers' compensation insurance to cover
them.
‘.7 one (1) or more subcontractors(s) who has their own policy of workers' compensation insurance
covering themselves.
Has no more than two (2) employees and no subcontractors.
While working on the project for which this permit is sought it is understood that the Central Permitting
Department issuing the permit may require certificates of coverage of worker's compensation insurance prior
to issuance of the permit and at any time during the permitted work from any person, firm or corporation
carrying out the work.
Company or Name: 6441Z. y t2//160Y7 2-5
Sign wmtle: _ /< j7 ` - Date: 7'2
F.rsldentiai Bulldi ( aIICNtiJ1 2 of 2 09,12
J
Plan Box Number (13 Job Name 6
Date: 726' / d
Required Inspections for SFA/SFD
Appl. # 6 'S -/67
Valuation c$ fen 965
Sequence Sq. Feet ,7 0
10 R* Bldg. Footing
10 -30, E/ R* Elec. Temp Service Pole
20 i R* Building Foundation
2 0 r/ Address Confirmation
a = ` 30 -999 l
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
Four Trade Rough In> 2500
Three Trade Rough In
A ' `0 Three Trade Rough In> 2500
40 ` Two Trade Rough In
" °- 40 Two Trade Rough In> 2500
One Trade Rough In
e 40
One Trade Rough In > 2500'
50 R* Insulation
60 Four Trade Final
60 Four Trade Final > 2500
60 Three Trade Final
60 Three Trade Final > 2500
60 Two Trade Final
60 Two Trade Final > 2500
60 One Trade Final
60 One Trade Final > 2500
999 Envir. Operations Permit
I ,.
1