BUILDING SEP -3 -2910 15:26 FROM: TOO :::125252229475 P P. 2/5
' Each section below to be filled out by Application # /v / 5 / Z'/ // 0O 1
whomever performing work. Must be own - r Harnett County Central Permitting
or licensed contractor- Address, eompen PO fax 05 Liuington, NC 27548
name & phone must match Information on 910.893 -7525 Fax 910 -893 -2703 www.hornetLorglpermits
license COMMERCIAL
A • • Heaton for Bultddin t and Trades Permit
Owners Name: Ol f_ / ._, rt.. Oft • Date: m x719 ?0o — /Pd S_
Site Address: a l S" Ki
4 rasrp e'r'r y r m f a t rd ' u Phone: 4f C- 17"11+
Directions to job site from LIIIIngton: AiLlvcl -in tin- 4 9-1 tti -oc01 S �cl
' 1 7�
L 1 - C•
+e-� v n 6 .^^P1 � o le• Ot i /gyp + J r r on r' enc -C 7nYdi '✓I ^ ,
1 _ r i rd
r a 44„, t O "i i ....,...-.. r r.�
-
Subdivision: ',AM 0 Lot: _ /
Description of Proposed olio: Install of Commercial Modular Building
Heated SF 1.2oo Unheated SF 0
General Contractor Information Building Cost $r9, ri f1F nn
Modular Technologies, Inc. 252- 522 -5770
- ,. , Building .Conlractor's.Corrrpany_Name _ .. _, - Telephone _. - _ ...
101- North Herr' -,- .'r •• l Riini
A r•• - License #
_
4 111•4 i ...„ Must sign & fill out second page
' Signatur: • • •_ /C: or•'ic - of Corporation
Electrical Permit Information Elec Cost $ POO • a
Description of Work _ Service Size: ps #TPoies
0.,R, 13/)- al‘ectsrl OP, gig— Ofg, r7QAS ll— 4_ 3S3 - 3 y /0
Electrical Contractor's Company Name Telephone
740 2c0'iwh r d . /9- Q5'` /GL
Addr -s / License #
___ / Lif. d 0 4.Li�
Signature of Officer(s) of r orporation •
M chanicai Permit Information Mech Cost $
Description of Work # Units
HVAC is intergated into Commercial Modular Building
Mechanical Contractors Company Name Telephone
Address License it
Signature of Officer(s) of Corporation //11,,x�//11
"` Piumbinpp rnit lnforma on Plumb Cost .$400 `
l a Wy ly -1- ✓n-t-
Description of Work $ ✓ 1 r r �t rn # Baths ?dam ?p8
77o4Pra.vel (rent- r9.2'6CI�$ 9 �;s �'� y
Plumbing Contractor's Company Name elephione
At'rl-u:c e A tibe r t i i a_ /bel sruc p�- --c-S1 •44 23537
Add sfg s ,( A ? 1 �' 4 33 License #
Signature of Officer(s) of orporation
Insulation Permit Information
N/A
Insulation Contractor's Company Name & Address Telephone .
R/21/08
SEP -3 -2010 15:27 FROM: TO:12525229475 P.3'5
/ Sprinkler System Information
Sprinkler Contractor's Corbpany Name Contact & Telephone
Address License #
Signature of Officer(s) of 4orporaton
Fire Alarm System Informatloq
Fire Alarm Contractor's Company Name Contact & Telephone
Address License #
Signature of Officer(s) of Wrporation
Driveway Acccs - NC Department of Transportation Driveway AcccwdPcrmit? Yes No
- • Thereby certify that 'the'authoritydo •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 kthown to me and if any changes occur including listed contractors, site plan,
number of bedrooms, buil ' ing and trade plans, Environmental Health permit changes or proposed use
changes, I certify it is my esponsibility to notify the Hamett County Central Permitting Department of
any and all changes.
Expired Permit Fees - B onths to 2 years permit re -issue fee is $150.00. After 2 years re -issue fee
is as per current fee schetule.
Signature of Owner /Contractor /Officer(s) of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87 -14
The undersigned applicant being the:
* General Contract r Owner Officer /Agent of the Contractor or Owner
Do hereby confirm under enalties of perjury that the person(s), firm(s) or corporation(s) performing the work
set forth in the permit:
Has three (3) or m e employees and has obtained workers' compensation insurance 10 cover them.
Has one (1) or mo subcontractors(s) and has obtained workers' compensation insurance to cover
- - -
** Has one (1) or mo subcontractors(s) who has their own policy of workers' compensation insurance
covering themselves.
Has no more than t4vo (2) employees and no subcontractors.
While working on the proj . ct 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: u. 111 AR TFCHNOIf1GTFS. TNC.
'
Sign wri _... _
. {: — 1 a T Date: / SEP 1 h
8/21/08