BUILDING Application # /0 a 24 /
• 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/pemits
name & phone must match
Application for Residential Building and Trades Permit
Owners Name: Milton Enterprises, Inc. Date: 07/22/2010
Site Address: Lot 32 The Vistas - 192 Braddock Dr., Lilington, NC 27546 Phone: 910.303.1967
Directions to job site from Lillington: Take 421 S. Towards Dunn. Tum Right on Hwy 27! Old Stage Rd. Approx. 1 milt
tum right onto Braddock Dr. (The Vistas). Will be the sixth house on the right.
Subdivision: The Vistas Lot4 3 oZ
Description of Proposed Work New Constructio /SFD # of Bedrooms: 3
Heated SF: 2210 Unheated SF: 936 Finished Bonus Room? I Crawl Space: 1 Slab: _
General Contractor Information
Thomas Construction 910.893.8950
Building Contractor's Company Name Telephone
229 Oak St., Lillington, NC 27546
Address r - �� Email Address
17963
Signature of Owner /Contractor /Officers f Corporation License #
Electrical Contractor Information •
Description of Work New Construction / SFD Service Size: 200 Amps T - Pole: Yes No
Dawson's Electric 919.897.5501
Electrical Contractor's Company Name Telephone
3754 Cokesbury Rd., Fuquay Varina, NC 2726
Address Email Address
259484.
Signature of Owner /Cont or /Officer(s) of Corporation License #
MechanicaUHVAC Contractor Information
Description of Work New Construction / Heat Pump
J & M Heating & Air 910.897.5501
Mechanical Contractors Company Name Telephone
724 Turlington Road, Coats, NC 28334
Address 9H Email Address
� � /.n� of Owner /C 17164
Signat re ractor /Officer(s) of Corporation License #
Plumbing Contractor Information
Description of Work New Construction / Sewer # Baths 2.5
Wagnor Plumbing 910.8933050
Plumbing Contractor's Company Name Telephone
PO Box 494, Mamers, NC 27552
Address Email Address
07674
Signature of er /Contractor�f Corporation License #
) nsulation Contractor Information
TriCity Insulation - 334 East Mountain Dr., Fayetteville, NC 28306 910.486.8855
insulation Contractors Company 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 Pent Technician to determine it you qualify tor 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 8 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 Aux 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 scheeeeQdddu
d ( r j/ 07/22/2010
Signature of Owner/Conttrractor!Office4s of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87 -14
The undersigned applicant being the:
General Contractor Owner 1 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.
1 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.
Company or Name:
Sign wlTltle: ( Thomas Construction /f
'. / ° Z , �V _ /`7 Date: 07/22/2010
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