BUILDING 9111r■. .
Application #
Mail In application
Please note if this application Harnett County Central Permitting
is part of ajob in progress PO Box 65 Lillington, NC 27546
with open permits. 910- 893 -7525 Fax 910 - 893 -2793
/ www.harnett.org/permits
V yes no
/ Certification of Work Performed by Owner /Contractor
�tu �aoj A.l'-mat (Individual Trade Application)
# /0- 50025070 Contractor Information
i Michael Chisholm will complete the Heating & Air Conditioning work on the project or
(Name) (Trade)
structure herein described. My state license number is 06327 . All work shall comply with the State Building
Code and all other applicable State & Local law, ordinances and regulations.
Company Name:
Chisholm Service, Inc. -- - • `-
Mailing Address: P.O. Box 1977, Burlington NC 27216
Street Address: 1527 Industry Drive, Burlington NC 27215
Business Phone: 336 - 228 -0571 Email Address :Inca @chisholmservice.com
*Company name, address, 8 phone must match information on license.
Job Information
Land Owner's Name:
VP Sprout Springs, LL Phone:
Tenant/Building Owner (if different): Food Lion - Shops Phone:
Construction or Site Address: 1655 Buffalo Lake Road
PIN or Parcel # from GIS:
Specific Directions to Job from Lillington:
Description of work to be done: Install Heat & Air Cond, Ex Hoods Ex Fans Job Cost: 122,520.00
Mechanical: New Unit With Ductwork ✓ New Unit Without Ductwork _ Gas Piping
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other
Plumbing: Water /Sewer Tap _ Number of Baths Water Heater
Permit Cost
Permit Fee: $1610.0 (calculated from fee schedule)
Mail In Processing Fee: $3.00 per lob For Electrical Permits with Progress Energy we
need the premise number provided.
Total Enclosed: $ 1613.00
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: Date: 11 - 2010
* *DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED **
Individual l"rade Mail In Application 1 of 1 04113
•
Application # / 0 -SD 0 7 0
Harnett County Central Permitting .E
PO Box 65 Lillington, NC 27548 f
910- 893 -7525 Fax 910 - 893 -2793
www.harnett.org/permits
Certification of Work Performed By Owner /Contractor
(Individual Trade Application)
Owner (s) of Structure: Petri L. an Phone: vtif
Owner (s) Mailing Address:
Land Owner Name (s): Phone:
Construction or Site Address: /b sC Rri sr, Arc' d r e n,73a
PIN or Parcel # from GIS:
Job 'Cost: 3 M tp Description of Work to be done in 5 lidnti 4) Twns/er
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping
Electrical': 200 Amp _ <200 Amp Service Change _ Service Reconnect _ Other
For Progress Energy customers we need the premise number
Plumbing: Water /Sewer Tap _ Number of Baths Water Heater _ t
Soeciflc Directions to Job from Lillinatort:
Subdivision: Lot #:
I t7heer ( )pew 6 Tiro y�� f will provide the l�tf.r/; labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is Uri D 1- 11 , which entitles me to
perform such work on the above structure legally. All work shall comply with the State Building Code
and all other applicable State and local laws, ordinances and regulations.
Structure owner(s) signature: Date:
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Company Name: PotoerSe _Teo Phone: 1 1 i - Sre
Address: /4 04 ijer;4 Anne" c CT Ai Ake Rre$tI1C
County: /J4kc ractor's License #: /4 7CI- f
Contractor's Signature: £ ? t om/ Date: /.) /9l.10r0
'Company name, addr, & e mu Fitch Information on license.
TRADE 4/08