BUILDING 'Each section below to he tilted out i Application # -17 3,R
by whomever performing work. Harnett County Central Permitting
Must be owner or licensee PO Box 65 Litlington. NC 27546
contractor. Address, company 910 -893 -7525 Fax 910 - 893 -2793 www harnetl arg /permits
name & phone MOST match
Application for Residential Building and Trades Permit
Owner's Name: Wynn Construction, Inc.
Date: 3 /0
Site Address: __ZG, _ Ct,. Phone: 9 /94 ?ye5
Directions to job site from Lilli gton: 27 l..J - T o $, ,at l..a.lL.es a.
ITT oM 13c19 Lakes RA. Let o it C Kero ft. Psi es,
•
lezzAkT n . {lcLkert
Subdivision: `
A 9-keX' OA P Z t1eS Lot: I /ft 6 L
Description of Proposed Work: New Construction ELe rl Ft" # of Bedrooms: 3
Heated SF gal • Inheated SF (p /y Thnished Bonus Room? N Crawl Space: Slab: /
General Contractor Information
Wynn Construction. Inc. 919 603 - 7965
Building Contractors Company Name Telephone
2550 Capitol Dr. Creedrnoor, NC 27522 edward @wynnconstruct.com
Address
" Email Address
'' / ,�j/ /ilic 46295
Signature of Owner /Contractor /Officer(s) of Corporation License #
Electrical Contractor Information
Description of Work New Construction Service Size: 200 Amps T -Pole: 1 Yes No
R. A. Jackson 919 730 - 1251
Electrical Contractors Company Name Telephone
9261 Raleigh Road Benson NC 27504
ddress ` Email Address
!IN ,tK" 2114
Signah{rb of Owner /Contractor / Officer(s) of Corporation License #
Mechanical /HVAC Contractor Information
Description of Work New Construction
Stephenson HVAC 919 329 0686
Mechanical Contractor's Company Name Telephone
343 Shipwash Dr. Garner, NC 27529
A�ress` k Email Address .
t i. neY .c,• -. ._^.` 18644
Signatur of Ow/Contractor /Officer(s) of Corporation License #
Plumbing Contractor Information
Description of Work New Construction # Baths 3
Thorton's Plumbing 919 669 - 8655
Plumbing Contractor's Company Name Telephone
3160 - A Omar Rd. Clayton, NC
Addr ss Email Address
.,,..6 v \\g, } -- 22152
Signatllte of Owner /Contractor / Officer(s) of Corporation License #
Insulation Contractor Information
Tatum Insulation . 919 661 -0999
Insulation Contractor's 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 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 ai 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 FEES - 6 M•nths to 2 years permit re -issue fee is $150.00. After 2 years re -issue fee
is as . curre t fe- - chedul
I : • , ,' / 8 ' ZS = /0
ture of Owner /Contractor i - icer(s) of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87 - 14
The undersigned applicant being the:
d 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.
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: Wynn Construction, Inc.
/ yy
y _ ��� ,� . - � ! � Date: b" ZS /�
SignwmTitle:
O
te,oe lRu ;pplicatian 2 rf 2 03110
11
Plan Box Number A i\ 13 Job Name
Date: - 'Z C. — f b
Required Inspections for SFA/SFD
Appl. # (D -S 2 L('73 2
Valuation ` / 6 6 479
Sq. Feet Z 40
Sequence
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 Three Trade Rough In
40 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