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BUILDING (2) • Each section below to be filled out Application # / U .j 2gJ by whomever performing work. Harnett County Central Permitting Must be owner or licensed PO Box 65 Lillington, NC 27546 contractor. Address, company 910 -893 -7525 Fax 910- 893 -2793 www.harnett.org /permits name & phone must match Application for Residential Buildi n and Trades Permit Owner's Name: (1 h'y l i 1 � / ° "' S Date: 9/ Site Address: / k - , !�/ 1 Phone: / 9 97 Directions • 'ob site from // Lillington: TA y ;la 5 TL- ,' w4 s ihd�,,5ir ,01-1 ` 7; ' ct /f Pt/di Subdivision: 6tipn9 ikLs / Lot: col, Description of Proposed Work: NFG-J 1 , 7,5hZtte II__ 8). # of Bedrooms: Heated SF: 1127 Unheated SF: YDO Finished Bonus Room? if Crawl Space: 'Slab: _ General Contractor Information R 6/v154), h 5 00 972 -2662 Buildin Contractor's Company Name Telephone 5511 Barn C 64 ,SI.Ljt 3D0 99ryediblr AOMISerhea, n As a ress Email Address 41/ �/ 6753 Signs re of Owner /Contractor /Officer(s) of Corporation License # ,Electrical Contractor Information Description of Work JISw >7 (G'St n'n Service Size: .2 Amps T -Pole: tYes No c.na ci Kfciq s RGC74PW 9/ 32 3 -.,Z 5A57? Electrical' Contractor's Comp_ any, Name Telephone c /St' &Jh ;# 4 tD a Ad re Email Address Nc I 000c u.. Signature oOwner /Contractor/Officer(s) of Corporation License # Mechanical /HVAC Contractor Information Description of Work Pew Co ns L*t 4 tnn au, aeou.leth 1-1-€0,4-72,.., ni, 9/o 2IL 9 5 % Y Mechanical Contractor's Compan Name Telephone 8 1 01 L b Factf.fkAil( c( 7 tLsA Ema il Address j 9r?/13c 2 ature of nerlContractor /Officer(s) of Corporation License # /��r Plumbing Contractor Information Description of Work jlpw elYZ5 //__ urlbvl # Baths 3 Pass 7luivibm°J 9/0 0237- 7`9910 Plumbing Contractor's Company Name Telephone `q ( kajes. s •r J3 Ad s Email Address i mire of ner /Contractor / Officer(s) of Corporation License # Insulation Contractor Information 7?./ & X3/4 ReOL,.t5 9/0 n7 o 9Sl Insulation Contr ctor'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 m 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. EXPII}ED PERMIT ES - 6 Months to 2 years permit re -issue fee is $150.00. After 2 years re -issue fee is aster cum nt f /chedule. k I/9/0 4 . 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. 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. {�� / [/ J l Company or Na J � ,(//// /�1 �U7 n�� / , ��e 5 Sign w/Title: a `°'u, / 2 Date: 9© 0 Plan Box Number " 9 Job Name a s'li Date: q "6) Required Inspections for SFA /SFD Appl. # /D-S -aSQ 9 Valuation 4 ( 6,1 961 Sq. Feet 104i Sequence 10 R* Bldg. Footing 10 -30 I.e..- R* Elec. Temp Service Pole 20 R* Building Foundation 20 c_. Address Confirmation 30 -999 2— 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 v" R* Insulation 60 Four Trade Final 60 Four Trade Final > 2500 60 Fhree Trade Final 60 Fhree Trade Final > 2500 60 Two Trade Final 60 'Iwo Trade Final > 2500 60 One Trade Final 60 ( )ne Trade Final > 2500 999 Lnvir. Operations Permit -_,� , y.