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DOCUMENTS 09109111 Application# Hameh County Central Permitting Each eschar beknvro be Idled out PO Box 135 LAMaim NC 27540 by whomever performing work 893 75P5 Fax 910 B93 2793 www Numb aril/permits Must be owner or licensed contractor Addmss company pagination for Residential Budding and Trades Permit name 8 phone must match Owners Name Liibte dee-ea';‘) t-S Date Site Address J 2'i Crdee_ �E�- eSels, - Plane 6149)f 7(/"-( it Directions to Job site from Lillington /� 4% 7 2 I b4., ,PA7 ed fn 4it " A .0 : to l e rt) qt ST Subdivision �,( Lot Description of Proposed Work f:2 E GAtµitse- deer-P Re i( #of Bedrooms 3 Heated SF /]Da Unheated SF i-34 Finished Bonus Roomy 0 Crawl Space " Slab General Contractor Information G'haeli;51 rifird ' (9 /00 r {7 6o,7' Building Contractors Company Name TelephoneI t b . 5 s 7 GI— 1drrswe yi�>7�, Address Email License# glectncsl Contractor Information Description of Work Service Size Amps T-Pole _Yes_No Electrical Contractors Company Name Telephone Address Email Address License# Mechanmel!HVAC Contractor Information Description of Work Mechanical Contractors Company Name Telephone Address Email Address License# Plumbing Contractor Information Description of Work P tars $H t"l.ego"71lGi'c�^#Baths "2- Plumbing Contractors Company Name _ Telephone 5y 1/ (� '.eeh tel rny, 4), c , Address 27.5o4-) Email Address Manse#13 Insulation Contractor Information Insulation Contractors Company Name&Address ephone 'NOTE General Contractor must fill out and sign the second page of this application 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 Electncal 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 that by*Janina below I have obtained all subcontractors permission to obtain these permits and if as changes occur including listed contractors site plan number of bedrooms bulding 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 6150 00 After 2 years re-issue fee is as per current fee schedule Signature of Owner/Contractor/Officer(s)of Corporation Date Affidavit for Worker's Compensation NC G S 87-14 The undersigned applicant being the 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 workers compensation insurance pnor 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 w/Title Date HARNETT COUNTY CENTRAL PERMITTING P.O. BOX 65 LILLINGTON, NC 27546 For Inspections Call : (910) 893-7525 Fax: (910) 893-2793 Application Number 16-50037867 Date 2/14/18 Property Address 133 CEDAR DR PARCEL NUMBER 01-0514- - -0457- - - Application type description CP ADD & ALTER RESIDENTIAL Subdivision Name ROLLING SPRINGS Property Zoning PENDING Owner Contractor SCALF JACKIE D & ELLEN R KILOWATTS ELECTRIC CO 6613 CEDAR DR 193 DARKWOOD COURT SPRING LAKE NC 28390 SPRING LAKE NC 28390 (910) 497-5454 (919) 842-7602 Applicant LIBERTY CREEK INVESTMENTS, LLC 173 SIERRA TR SPRING LAKE NC 28390 (910) 497-5978 --- Structure Information 000 000 FIRE DAMAGE Flood Zone FLOOD ZONE X Other struct info # BATHS 2 # BEDROOMS 3 . 00 SEPTIC - EXISTING? SEWER WATER SUPPLY COUNTY Permit TEMPORARY ELECTRICAL PERMIT Additional desc . Phone Access Code 1228840 Issue Date . . . 2/14/18 Valuation . . . . 0 Expiration Date . 2/14/19 Special Notes and Comments T/S: 01/19/2016 10 : 28 AM LBENNETT -- GO SOUTH ON HWY 210 - TURN RIGHT ONTO RAY RD - GO 1 1/2 MILES AND TURN RIGHT ON AZALEA DR - TAKE 2ND LEFT ONTO CEDAR ST - HOUSE IS ON THE LEFFT HARNETT COUNTY CENTRAL PERMITTING P.O. BOX 65 LILLINGTON, NC 27546 For Inspections Call: (910) 893-7525 Fax: (910) 893-2793 Page 2 Application Number 16-50037867 Date 2/14/18 Property Address 133 CEDAR DR PARCEL NUMBER 01-0514- - -0457- - - Application description . . CP ADD & ALTER RESIDENTIAL Subdivision Name ROLLING SPRINGS Property Zoning PENDING Permit TEMPORARY ELECTRICAL PERMIT Additional desc . Phone Access Code 1228840 Required Inspections Phone Insp Seq Insp# Code Description Initials Date 999 207 E207 R*ELEC TEMP SERVICE POLE / / 999 267 E267 C*ELEC TEMP SERVICE POLE / HARNETT COUNTY CENTRAL PERMITTING P.O. BOX 65 LILLINGTON, NC 27546 For Inspections Call: (910) 893-7525 Fax: (910) 893-2793 Application Number 16-50037867 Date 2/14/18 Property Address 133 CEDAR DR PARCEL NUMBER 01-0514- - -0457- - - Application type description CP ADD & ALTER RESIDENTIAL Subdivision Name ROLLING SPRINGS Property Zoning PENDING Owner Contractor SCALE JACKIE D & ELLEN R KILOWATTS ELECTRIC CO 6613 CEDAR DR 193 DARKWOOD COURT SPRING LAKE NC 28390 SPRING LAKE NC 28390 (910) 497-5454 (919) 842-7602 Applicant LIBERTY CREEK INVESTMENTS, LLC 173 SIERRA TR SPRING LAKE NC 28390 (910) 497-5978 --- Structure Information 000 000 FIRE DAMAGE Flood Zone FLOOD ZONE X Other struct info # BATHS 2 # BEDROOMS 3 . 00 SEPTIC - EXISTING? SEWER WATER SUPPLY COUNTY Permit RESIDENTIAL INSULATION PERMIT Additional desc . Phone Access Code 1228857 Issue Date . . . 2/14/18 Valuation . . . . 0 Expiration Date . 2/14/19 Permit RESIDENTIAL PLUMBING PERMIT Additional desc . Phone Access Code 1228865 Issue Date . . 2/14/18 Valuation . . . . 0 Expiration Date . 2/14/19 Special Notes and Comments T/S: 01/19/2016 10 : 28 AM LBENNETT -- GO SOUTH ON HWY 210 - TURN RIGHT ONTO RAY RD - GO 1 1/2 MILES AND TURN RIGHT ON AZALEA DR - TAKE 2ND LEFT ONTO CEDAR ST - HOUSE IS ON THE LEFFT HARNETT COUNTY CENTRAL PERMITTING P.O. BOX 65 LILLINGTON, NC 27546 For Inspections Call: (910) 893-7525 Fax: (910) 893-2793 Page 2 Application Number 16-50037867 Date 2/14/18 Property Address 133 CEDAR DR PARCEL NUMBER . 01-0514- - -0457- - - Application description . . CP ADD & ALTER RESIDENTIAL Subdivision Name ROLLING SPRINGS Property Zoning PENDING Required Inspections Phone Insp Seq Insp# Code Description Initials Date Permit type . . RESIDENTIAL INSULATION PERMIT 999 129 I129 R*INSULATION INSPECTION / Permit type . . . RESIDENTIAL PLUMBING PERMIT 999 131 R131 ONE TRADE FINAL / / 999 125 R125 ONE TRADE ROUGH IN / / 999 315 P315 R*PLUMB HW HEATER / / HARNETT COUNTY CASH RECEIPTS *** CUSTOMER RECEIPT *** Oper: JBROCK Type: CP Drawer: 1 Date: 2/14/18 52 Receipt no: 252633 Year Humber Amount 2816 58837867 133 CEDAR DR SPRING LAKE, NC 28398 B1 BP - PERMIT FEES PLU & INSU PERMITS $105.08 LIBERTY CREEK Tender detail CK CHECK PAYMEN 1878 4185.88 Total tendered $185.88 Total payment 4185.80 Trans date: 2/14/18 Time: 13:57:25 ** THANK YOU FOR YOUR PAYMENT **