BUILDING 'Each section below to
in Hamett County Cen
be filled out Application # ! 0 �vs Y 9j
tral Permitting
Must owner r o
by whomever performing g work. Pp Box 65 Lillington, NC 27546
contractor. Addreesss, , licensed company 910- 893 -7525 Fax 910 - 893 -2793 www.harnett.orglpermits
o
name 8 phone must match
Application for Residential Building and
� q Trades Permit
Owner's Name: • "
I 4 C3 � � S � / ?� ��� / ` "' Es Date: /4/W
r
Site Address: 3 7a a'� %cl c . "be N2_ q Phone: / 9/ 0 fl7 �Z
Directions • 'ob site from� Illington: 7/4-is / �w y ;la 5 it /hk S4 hd�y15/ - 1
i Tacf c lc De/at
Subdivision: 674.rili/ Qzk.s //� -- Lot: 511
Description of Proposed Work: /t/FecJ (a77S rren't # of Bedrooms:
Heated SF: /770 Unheated SF: ¥Z Finished Bonus Room? t iff Crawl Space: 'Slab:
General Contractor Information
R b m5arr - 5 9/0 977-0
Buildin Contractor's Company Name Telepho
5511 Barn ,9 6+. .St 3 :� garyrebm>7sl rfserixo,c
A ress mall Address
67530 Sign re of Owner /Contractor /Officer(s) of Corporation License #
,Electrical Contractor Information
Description o Work u£w (cn M C rn Service Size: aao Amps T -Pole: Yes No
c rrali lc f ilfciP'r 9/0 32 3 - , VSR
Electrical' Contractor's Compan, y Name Telephone
1 /S7/ lJti;hlici D K2
re Email Address
NcI000tp u
Signature oOwner /Contractor /Officer(s) of Corporation License #
Mechanical!HVAC Contractor Information
Description of Work Pew Gore Ux-4 inn
au aeou.lnD ski s &� 9noovu 9 siti
Mechanical Contractor's Compaq Name Telephone
q 0/S t D I O o f TkrAi; (if- ?..t( Email Address l/
A ss 9; #3 e.s1
ignatu a of ner /Con Officers) of Corporation License #
/� Plumbing Contractor Information
Description of Work Thu aWS /> fd/27)1 # Baths 3
Ra S5 ?Atwl /VI" 9 /0 a37 7 9
Plumbing Contractor's Cdmpany Name Telephone
IN l kralcs. 5 urr` lia Email Address
i mire of er /Contractor /Officer(s) of Corporation
License #
Ins lation Contractor Information
1? (Ai 3/1 ,, b. O0237o5fs7
Insulation Cont tor's Co pany 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 mni 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.
EX ED PERMIT ES - 6 Months to 2 years permit re -issue fee is $150.00. After 2 years re -issue fee
is a s�er currrpnt f;r.chedule. p
JC Jr /9 //D
Signatu of Owner /Contractor /Officer(s) of Corporation Dat
Affidavit for Worker's Compensation N.C.G.S. 87 -14
The undersigned applicant being the:
t. 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
as 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 Na ` //
" " g 04185 � ec 5
Sign wITitle: JZ h. 9 Date: -/ 9 0
/OS'o 24 /9Z ..//
h . 2 p i he�R
Application # Z 47 7/ i0 44�. f
Harnett County Central Permitting z 4 791 1 : - .5 , 6 -
PO Box 65 Lillington, NC 27546 /4----,a/L/ ', ' " :.
910- 893 -7525 Fax 910- 893 -2793 ,,
www.hamett.org/permits L'1 112
Certification of Work Performed By Owner /Contractor Z 4, q y .
(Individual Trade Application) _ e t
Owner (s) of Structure: Phone: Zh ���� L ` � ( ;
i ,,
Owner (s) Mailing Address: ;
,
Land Owner Name (s): Phone: ,, ,
Construction or Site Address: ,,,,:
PIN or Parcel # from GIS: -'
Job Cost: Description of Work to be done
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping
Electrical': 200 Amp _ <200 Amp Service Change _ Service Reconnect _ Other
' For Progress Energy customers we need the premise number
Plumbing: Water /Sewer Tap _ Number of Baths Water Heater
Specific Directions to Job from Lillinaton:
Subdivision: Lot #:
I DeiI i-11ii t f� e- will provide the 1'i u in k1rfaN5 labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is 1' 72 V ' P"s(which entitles me to
perform such work on the above structure legally. All work shall comply with the State Building Code
and all other applicable State and local laws, ordinances and regulations.
S ct Lee ner sign re: NW' _ a _ % ate:
Au if b 47
Company Name: m m d iwre ?B 1311 M cPhone: 910 4 /=9 .515g
Address: 7'6/2— &Cc. isen-tilfrey AQ R. Far, AC. 1 34 6
County: f o k-t 134 r A-a Contractor's License #: 2- 210`7 p
Contractor's Signature: sins -j Date: / Y(D
*Company name, address, & phone must match Information on license.
TRADE
4/08
•lA VV IV V 1.1.4, 47QI rWlNl la,Il 1 IVI1100. LLV VIWV p.L
Gary Robinson Homes, LLC.
5511 Ramsey Street, Suite 300
(910) 401 -5505
October 6, 2010
Harnett County Central Permitting
108 E. Front Street
Lillington, NC 27546
Attn: V.C. Brown
Re: Plumbing Subcontractor Changes
Gary Robinson Homes authorizes that the following plumbing permits need to be changed to Dale Haire
Plumbing:
• Gwen Oaks, Lot 14C
• Gwen Oaks, Lot 20 / t
• Gwen Oaks, Lot 23'
• Gwen Oaks, Lot 52
• Gwen Oaks, Lot 53✓
• Gwen Oaks, Lot 54/
• Gwen Oaks, Lot 55-
• Gwen Oaks, Lot 58�
• Kenlan Farms, Lot 32
If you have any questions regarding these changes, please contact me at (919) 441 -5556.
Thanks,
Billy Elmore
Gary Robinson Homes, LLC,