BUILDING • Each section below to he filled out by Application # • 5 24
whomever performing work. Must be owner
or licensed contractor. Address, company Harnett County Central Permitting
name & phone must match information an PO Box 65 Lillington, NC 27546
license. Phone 910 -893 -7525 Fax 910 -893 -2793 www.harnett.org
Application for Residential Building and Trades Permit
Owner's Name: I S ' l2✓en ears Date: e� /O
Site Address: ay ki t/ /ed Phone: 9 /c- 3 - /r /'re // 7/0-97 0.-- 0 720
Directions to job site from Lillington: Sae tlr 4 /f,o
Subdivision: gear tfwivi5 Lot: 5
Description of Proposed Work: JArt✓ftwoc.ae Fd #Bedrooms: -�
Heated SF f t3 Unheated SF 960 Finished Rec Room? Crawl Space (v7 Slab ( )
General Contractor Information
9T,k5.14 s By VR+rcTOatjcr 8/o— f37- 2- BScfr
Building Contractor's Company Name Telephone
3300 Sa- 4i•so4.1 Q .ns F `
Address License #
e /l, Must sign & fill out second page
Signature of Owner /Contractor /Officer(s) of Corporation
�_A //`` Electrical Permit Information
Description of Work 'G1 m o4 jr4 5r Service Size: 2.00 Amps TPale: yes /no
Ma 5467 844 9 /1- 770 -
Electrical Contractor's Compan Name Telephone
5 aaam 4. e—asN C.. 67202--c"
Address License #
Signature of Officer(s) of Corporation
Mechanical Permit Information /�
Description of Work �a - / 0%70 d 024 4.0.E
f t/ b/och /- iW L - 9/5 — 770- 9-510 Me hani 1 Contractor's Corr' me Telephone
) ox 3 tar X94, 5t tf/-- 2°V)
Address License #
k Ontsf il l 4.4
Signature of Officer(s) of Corporation
1� Plumbing Permit Information
Description of Work D tiJV # Baths
a AC , .• 9/ 7
P mbin Contractor's ..
tor's Comppany Na e-, � Telephone q
I 6J/7 C.1r170w 72 �9N!! L /v /2 �
Addre� License #
Signature of Officer s of Corporation
Insulation Permit Information
Insulation Contractor's Company Name & Address Telephone
Page 1 of 2 9/07
Application #
&4 vVff7
Homeowners Applying to Build Their Own Home
Please answer the following questions then see a Permit Technician to determine it you quality 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? rVes _ 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 any 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 Harnett County Central Permitting Department of
any and all changes.
® t< 0
Signa ure of Owner /Contractor /Officer(s) of Corporation Dat
Affidavit for Worker's Compensation N.C.G.S. 87 -14
The undersigned applicant being the:
L 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:
1- " -- rilas 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.
t/Aas 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: £n-ter 5'y Iowan) g o
Sign w /Title: eg .rT` Date: /a //O
Page 2 of 2 9/07
Plan Box Number k S Job Name EM3rv,; s
Date: / �
Required Inspections for SFA/SFD
Appl. # /D- Sod Z•s sr
valuation%,S G 35'
Sq.Feet ZIC
Sequence
10 R* B1dg.
10 -30 R* Elec. Temp Service Pole
20 R* Building Foundation
20 Address Confirmation
30 -999 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 R* Insulation
60 Four Trade Final
60 Four Trade Final > 2500
60 Three Trade Final
60 Three Trade Final > 2500
60 Two Trade Final
60 Two Trade Final > 2500
60 ✓ One Trade Final
60 One Trade Final > 2500
999 Envir. Operations Permit