BUILDING •
SCANNED
_ — - -- Application # 1050024737
• Each section below to be filled out DA
by wtamever performing work. f amed County Central Permitting
Must be owner or licensed PO Box 85 Lillington, NC 27548
contractor. Address, company 910- 893 -7525 Fax 910 - 893 -2793 www.hamett.orgipermits
name 8 phone must match
Application for Residential Building and Trades Permit
Owner's Name: Edward Freeman Date: 8 - -10
Site Address: McArthur Rd. Phone: 919 774 - 1458
g Directions to job site from Lillington: 421 South, Left on McArthur Rd.
� Job on right 4.2 miles
co
x
CD
a Subdivision: Lot:
Description of Proposed Work: New Construction # of Bedrooms: 3
Heated SF: 1800 Unheated SF: 726 Finished Bonus Room? No Crawl Space: X Slab: _
General Contractor Information
Glenn Godfrey Construction 919 774 -9446
Building Contractor's Company Name Telephone
P 0 Box 2399, Sanford,_ C 27331 - 2399
Addr, - ' ��
.. a � Em5
• Signature of Owner /Contractor /Orcer( 7 4 Corporation License #
ectrical Contractor Information
Description of Work Service Size: 200 Amps T -Pole: X Yes No
Wicker Electric 919 - 258 - 9723
Electrical Contractor's Company Name Telephone
410 Womack Lake Circle, Sanford, NC 27330
Email Address
Signs a re of Owner /Contractor /Officer(s) of Corporation License #
Mechanical/HVAC Contractor Information
Description of Work
Center Heating & Air 919 - 775 - 2500
Mechanical Contractor's Company Name Telephone
511 E. Main St., Sanford, NC 27330
A _ /� Email Address
'- Co 3- - 7
Signature of Owner /Contractor /Officer(s) of Corporation License #
Plumbing Contractor Information
Description of Work # Baths 2
Cox Brothers Plumbing 919 - 258 - 3622
Plumbing Contractor's Company Name Telephone
958 Thomas Kelly Rd., Sanford, NC 27330
Address Email Address
Signature of Owner ntractor /Officer(s) of Corporation License #
Insulation Contractor Information
Insulating, Inc. 919 - 776 - 4138
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 Tedvddan 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 Ian• •n which this building will be constructed? _ Yes _ No •
2. Have you hired or intend • ire an individual to s •erintend and
manage construction of the proje• ? _ Yes _ No
3. Do you intend to directly control & s • ise construction activities? _ Yes _ No
4. Do you intend to schedule - • ntract, or direc .ay for all phases of
construction work to be d• e? Yes No
5. Do you intend • personally occupy the building for at -ast 12 consecutive
months followin • completion of construction and do you un. r.rstand 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 Hamett County Zoning Ordinance. I state the information on the above
contractors is correct as known to me and if as 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 Months to 2 years permit re -issue fee is $150.00. After 2 years re -issue fee
is as per current fee schedu .
tin\ • 8 -5 -10
Signatur of Owner /Contract s of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87 -14
The undersigned applicant being the:
X. 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:
X 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: Glenn Godfrey Construction
Sign w/Title: 0 010' f P Date: 8-5 -10