BUILDING Application # ✓b 5 /
• Each section below to be filled out Hamett County Central Permitting
by whomever performing work. p0 Box 65 Lillington, NC 27546
Must be owner or licensed 910- 893 -7525 Fax 910 - 893 -2793 www.harnettorg/permits
contractor. Address, company
name & phone must match
l / Application for Residential Building and Trades Permit
Owner's Name: )JJ eMtf, 67'IS4LlCJo 1 Date: 7 .20 1 6
Site Address: in 2CP Colo WI at b1 O` Phone: Q/0 977-;5; 2 -
Directions to job site from Lillington: TAK£ /kJ .2 k1 7T . %L A R 014 ^ .".zeta J
Subdivision: & /on/a. / Hi //s / //__ Lot: 3a
Description of Proposed Work: ,f w t ✓154tio7 # of Bedrooms: 3
Heated SF: / ?moo Unheated SF: Yip Finished Bonus Room? Crawl Space: Slab:
General Contractor Information
g 6ms,,,, Norialg 9/0 9?/ -2
Buildin Contractor's Company Name Telephone
6511 Ram 9 6+. 1SIA 300 9ryeel Aa ni56)rhere,
A• •ress mail Address
t �/ (075
Sign re of Owner /Contractor /Officer(s) of Corporation License #
/ Electrical Contractor Information
Description o Work u£w (0`n5t T ek Service Size: 0 Amps T -Pole: Yes No
�nL ici f ElFc -iPir 9/0 32 3 -.2 5/51? Electrica Contractor's Company, Name Telephone
957( & h ;Ithgell K2
re Email Address
Aie 10 LA.
Signature o Owner /Contractor /Officer(s) of Corporation License #
Mechanical /HVAC Contractor Information
Description of Work 14f w Gom14 -4 i rv,
au Qeou.inp 0 A-n. I L," 9ro ;ILi 9 511
Mechanical Contractor's Compaq Name Telephone
gal< lD Fac(F tkk.;(It RA
A• • -ss Email Address
/_ � 9a #
ignature of • ner /Contractor /Officer(s) of Corporation License #
/� Plumbing Contractor Information
Description of Work Mt'ry LaY1St/1 # Baths 3
Bass 7? iw 6/tet. 9/a p237- 7`9910
Plumbing Contractor's Company Name Telephone
lt(( ka4cs5 LA la
77 As Email Address
re of, er /Contractor /Officer(s) of Corporation License #
Ina lation Contractor Information
Ili �.� 3/41, 2 k 1 WO a3l 0 VS7
Insulation Contractors Co pany Name & Address Telephone
*NOTE: General Contractor must fill out and sign the second page of this application.
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 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
•
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. 1 state the information on the above
contractors is correct as known to me and if all 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 FEE Months to 2 years permit re-issue fee is $150.00. After 2 years re -issue fee
is as p& current ee sc le. �/\
fAUI 7- 22.--/
e
Signatur Owner /Contractor /Officer(s) of Corporation Date
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.
VHas 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. //']� /7/3)77A52
Company or Name: V r' , k , /,� /�v <L/�60Y)
Sign w/Titie:15 I /� — Date: 7' 2 2- le )
IL Residential &��itriirG r�pulictili�x� 2 of 2 0':i ?:;
Plan Box Number fo7 Job. Name
_At
Date:. 7 rb
Required Inspections for SFA/SFD
Appl. # - a S is-Ts?)
Valuation 4 ( y3, /97
Sequence Sq. 0 2,74y
10 i/ R• Bldg.. Footing
10 -30 R"' Elec. Temp Service Pole
20 R• Building Foundation.
20 v Address Confirmation
30 -999 z Open Floor
30 -999 R* Bldg. Slab Insp.
30- 999 R' Elec. Under Slab
30499 R *Plumb. Under Slab
40 Four Trade Rough In
40 Four Trade Rough In> 2500
40 Three Trade Rough In
', Ice '' 40 Three Trade Rough In> 2500
40 Two Trade Rough In
40
Two Trade Rough In> 2500
40 One Trade Rough In
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