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BUILDING Application # /0 5 2 5 ✓ 9 • Each section below to be filled out Harnett County Central Permitting by whomever performing work. PO Box 65 Lillington, NC 27546 Must be owner or licensed contractor. Address, company 910- 893 -7525 Fax 910 - 693 -2793 www.harnett.orglpermits name 8 phone must match Application for Residential Building and Trades Permit Owner's Name: Carl Mason Date: 08/23/2010 Site Address: 955 Sierra Trail Phone: 910-584 -8216 Directions to job site from Lillington: Hwy. 210 go 11 miles, tum right an Bill Shaw Road, go .6 mile, turn left on Overhills Road, go 1.3 miles, turn left on Sierra Trail, go .8 mile, house will be on the left. Subdivision: Sierra Villa Lot: 23 Description of Proposed Work: Finish Bonus Room Over Garag # of Bedrooms: 3 Heated SF: Unheated SF: Finished Bonus Room? Crawl Space: Slab: General Contractor Information Roger M. Bedsole Jr. 910 850 - 0223 Building Contractor's Company Name Telephone 4176 Legion Road Hope Mills, NC 28348 rbedsole333 @nc.rr.com Addre Email Address .28920 ignat e of Owner /Contractor /Offic of Corporation License # Electrical Contractor Information Description of Work Add receptical and light Service Size: Amps T -Pole: _Yes t No Sandy Ridge Electric 910 323 - 2458 Electrical Contractor's Company Name Telephone 454 Whitehead Road t evil e, NC 28312 Address Email Address E 09 134916 – Signature of Owner/ ontractor / Officer(s) dTCorporation License # Mechanical /HVAC Contractor Information Description of Work Install Ductless Split Heat Pump (1 ton capacity) Deon Arnold Heating and AC 910 -483 -1969 Mechanical Contractor's Company Name Telephone 3137 Pisg Drive Fayetteville, NC 28306 deonarnoldhvac©aol.com Addre , Email Address _ 10528 - Signature of Owner /Contractor /Office , Corporation License # Plumbing Contractor Information Description of Work # Baths Plumbing Contractor's Company Name Telephone Address Email Address Signature of Owner /Contractor /Officer(s) of Corporation License # Insulation Contractor Information RDP Enterprises P.O. Box 64985 Fayetteville, NC 28306 910 - 3160 Insulation Contractor's Company Name & Address Telephone *NOTE: General Contractor must fill out and sign the second page of this application. ?rsidgntial Fuiltlinn rAnnlir lion 1 of 2 03110 Homeowners Applying to Build Their Own Home Please answer the following questions then see a Permit Technician 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. I state the information on the above contractors is correct as known to me and if ay 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 ent fee hedule. 08/23/2010 Signatu e of Owner /Con ractor /Office . Corporation Date Affidavit for Worker's Compensation N.C.G.S. 87 -14 The undersigned applicant being the: 1 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. 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: Roger M. Bedsole Jr. Sign w/Titl i a _ _ } - - - _ ! _08123/2010 Residential Building .Application 2 of 2 03/10 Plan Box Number (-7 ie0 Job Name ra d f i ,.-._ Date: , 23- [ Required Inspections for SFA/SFD AppL # — Yon ? '705'S Valuatio /( g 92_ Sequence Sq. Feet 2 6 0 10 R* Bldg. Footing 10 -30 R* Elec. Temp Service Pole 20 R.* Building Foundation 20 Address Confirmation 30-999 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 Icre Three Trade Rough In 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 �.✓ 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 1 I f 1 1 i 1 � I I I. �_ I I %� I l /09 uy 1 ��,2 I • �._ . L _ 1 — , ' " 1 — • 'f H RNt t -COUNTY CENTRAL PERMITTING I 1 i ° h- V-5-012-25-0-9.57 g m { - A PPLICATION i # - I ' i - 08 NAME. 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