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r
Application # /0 are° 401: 7 , Co
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910- 893 -7525 Fax 910 - 893 -2793
www. harnett.orgipermits
Certification of Work Performed By Owner /Contractor
(Individual Trade Application)
Owner (s) of Structure: Aguinaga, Shvley. Phone: 919499 43236
Owner (S) Mailing Address: 488 Twin Pond Road, Sanford, NC 27332
Land Owner Name (s): game Phone:
Construction or Site Address: Same
PIN or Parcel # from GIS: PIN 9586 -24 -2185 Parcel It 03958501 0005
Job Cost: 65 Description of Work to be done Tub to
57.0 shower conversion with acrylic panels &
Valve. grab bars, shower door.
Mechanical: New Unit With Ductwork New Unit Without Ductwork _ Gas Piping
Electrical`: 200 Amp _ <200 Amp _ Service Change Service Reconnect _ Other
• For Progress Energy customer we need the premise number
Plumbing: Water/Sewer Tap_ Number of Baths _ Water Heater
Specific Directions to Jcb from Lillington:
E Front St to R 52110 St R E Killiegrey St L S Main SUDS 401 R W Old Rd /NC27 L Buffalo Lake Rd R Pine Wood Rd
R Twin Pond Rd.
Subdivision: Buffalo Estates Lot #: 15
Koehler Partners, Inc. will provide the plumbing labor on this structure.
(contractors Name) (Trade)
I arr the building owner or my NC state licerse number is 15816 , which entitles me To
perform such work on the above structure legally. All work shall comoly with the State Building Code
and ali other applicable Stale and local laws, ordinances and regulations -
Structure owner(s) signature: (Signature on signed contract) Date:
Company Name: Koehler Partners, Inc. Phone: (919) 210 -1173
Address: P.O. Box 689, West End, NC 27376
County: C ntr tors License #: 15816
Contractor's Signature: 1 Date: 910
'Company name, addre_ hone must match int ation on license -
TRADE Please mall all correspondence to our warehouse located at; 4/08
8817 Westgate Park Drive #112, Raleigh, NC 27617
•
•ep GO IV VN.I Ip neioeuI 011.1117 1 titaiiww It I V)rOC - IV I 1 p.o
r 1 Remodeling Agreement
ReBath of the Triad ReBath of Wilmington / ReBath of the Triangle i
2601 -B Battleground Ave. 6010 Oleander Dr. 6570 Glenwood Ave.
Greensboro, NC 27408 Wilmington, NC 28403 Raleigh NC 27612 !
336- 282 -2424 sales 910- 313.6868 sales 919 - 782 -9200 sales J
336 -286 -9880 service 910 - 313 -6869 service 919-782-7599 service /
Customer:� -J i�c. t � iPa A� /,N ¢!;. • Horne Phone: I/1 "7 ( t `oL� Work Phone (Mr):
Street: L I% ! r,J; err Alf i c m, Job #: 1 V ff V\ 1 Work Phone (Mrs.):
City, State. Zip, County: D. Or A, J Q I1 Email: -
Date: 6 1 9 Lin_ Job Location: pei(\ 13,z+), Email Newsletter: Y❑ r
WALL SURROUND /fqS CARPENTRY ACCESSORIES
❑ Durabath SSE* r
,K Eeo Bath y Fir out to the ceiling ❑ Fill window ❑
,2 - Wag System � y
(dg wall repair ❑OroMiamdiuWtvperwall ❑ Fl..
tit •
Panel height ( {�[��js i I'''. ❑ Other AFETY TUB •
Tmer ❑ Build Wall -
J 5 Wall shower blodeUSize
❑ Window DEMO ❑ LH 10 R.}.1 . 11inute.Dnin System
❑ Window lnmki ❑ Jet Mage SY• Line sn Heater
' ❑ Remove fiberglass unit Remove existing with kit
Color ❑ Remove rile shower n ❑ Aii Bath S - m ❑ a.. • , ..9 tJ#n
pa 0 pax removal
❑ Trim Type
❑ Remove ceraznic tile walls fill. ❑ A -.oy Fragrance System
Remove tub
❑ BouderTtm ❑ Remove & reinstall toilet handle tub filler wi [mortal shown
2 � 7 7{1{ Color r� ii ❑ Other TUB & SHOWER DOORS
sal styli C-) I `�t (c
❑ other DRAIN WORK .124 Mode e -
. I./IM.t R(iR(1/:•...74 e SI
FINISHUMane ❑ Gloss Drain & overflow cover FINTSH (. a` L) r V � r U:�vs.s�� ,� � _ ..� •} r
Drain Work ;Jdl Size _ __ _
SOAPJSHA2141'00 SHELVES ❑ odw FRAME COLOR
�y Tye 21 Silver ❑ Oil RubbedSmote
y TUB / SHOWER FAUCET, ❑ cold Br. Nickel
1}C Colo: 3" GLASS
❑ Reuse existing ❑ 911 sb C lear
BATH TUB LINER ❑ Wolverine 85666 Shower Beta 0
❑ W 667 Style ❑ Handle 0 Standard ❑ Gags
■ aft. ❑ 45 (t. ❑ 5.5 ft. 11'4 ❑LH j5Z ❑ Remove old door
❑ Open -• Inc/ we end • ste a 9 ❑ Reinstall old doer
(Almond/Whit WO GUARANTEE)
❑ Farmed t.- style - WHIRLPOOL TUBS . - ❑ Shower curtain rod
❑ Li - , m piece ❑ Seer- ❑ Options: ❑ Crescent Rod .
a olor ❑ Package ❑ Color
❑ Bashguard 0 Y ❑ No 0 Color
❑ Skirt CURRENT JOB CONDITION
GRAB BARS _ ❑ Electric (whirlpool) •
❑ Electric �oY -
`<iJ rnic(hnI• ¢) ;451 Crown molding?
ivy
la Size 1 7 ❑ W XH xD \ Loose Ceramic site? f■�4
6d White ❑ Biscuit ❑ Ceiling height 01,
1
❑ Bone ❑ Stainless g teel Floor buckled or rotted Afb -
Quantity Z- JET LOCATIONS [ Valve Condition tit
s,gi Drain Bow adequately
DURABATH REPLACEMENT TUB y ] shower floor-adequate slope
❑ Mani. s .�.� - .}y w Tub atts not out of arp Revel iv v4.
❑ Color � Pe.) Ex F T ' ,�, lum
� b
❑ w XH _ . HAND r ['Galvanized trPlatc
❑ • - • L.H fr 4 DRAIN f t1ou� Shut on valve
Cnwt ❑Eastman ❑Stab
SHOWER BASE Place to cur J /CZ
❑ Dueabmh,Z Custom Corian ❑ Paper Ventilation
RH t ( � LH Center [Min ❑ Ehr Panel Location
Size r ' t i x RIG • f 1 / ❑
Color Ri ( C(
*RAIN ( El Place to cut ❑ Attached ❑Duached
• r� 1 /
er 'f.9 i
Other r [ Phase I s !/)65 ...• 2 sat ve
Jet CO I V VY. 1 i p rswoatri pa UM 1 rlarlgle ty I a) /0Z-IV I I p.4
DEMO TOILET COUNTERTOPS
� e i.
1-�1 Remai &teinaolltoilet 0Remme r.. 3E nity &lop MFG. t•2 et
W Q Van \tiStone ._
❑ Reinaall vanity &lop ❑ Remove vanity top el Color t ❑ Hi Mlles
Q Trash removal ❑ Other rig Elongated bowl ROUGH IN ❑ oar
WAINSCOT PANELS ❑ Round bowl ❑ 10" 412" ❑ u" ❑ Size x Mr
2c Comfort height ❑ Color S
Nor - ❑ Bowl
❑ style WOODPRO VANITY
❑ Fat - ❑ •pl • Dill
Motel . ❑ •plash
Q Tam Collection • • Edge Detail
lit ' •order Trim Dom Style
II Other Rajah TILE FLOORS
SINK FAUCET Wood e`
Hardware ms
- a 1.1 ate Floor
Ha dre ❑ Ti 'ze
❑ R v xisting Fixtures Size W X r H ❑ Grout co
:A oc ❑roc
ME I DIE CABINET / TO l T TOPPER ❑ Standard side i ' • pattern
Model M Model ❑ Di:gon•
R
N ` Collection NEW
Finish'' .
v Dom Sryle '111.• Knish Standard grout Loins is 114"
• CCESSORIES - tomer agrees to point new • • • • seboord and
shoe m• ping
❑ TP Holder Wood Species
❑ 18 towel bar
1 41 1 rg a .•T:
❑ ?S' rowel bat
Size W XD XH Color
r eoop
t0 ' towel b Elc: Hook Up a: Customer - - to paint new baseboard and
L7 Towel - tg � Ligluxtem Finish shoe ding
❑ 01 r
❑ mish J
All Cabinets are snrfacemoruxed Phase II $
Additional work billed by time and materials 0 applicable ❑ not applicable
The following work will be billed @ $75 per hour plus materials. Plumbing work will be billed @ $85 per hour.
ADDITIONAL INFORMATION: (T) M id4 k r`i.: \ ,' 3 r 1 4 9 U tsTi
❑ Owner will replace flooring after ReBatha work is complete. Initial
SPECIAL SCHEDULING NEEDS:
THE FOLLOWING ITEMS ARE NOT INCLUDED IN THIS AGREEMENT UNLESS SPECIFIED: Replacement of existing supply
or drain lines. flooring, wall or wallpaper repair, electrical, painting.
Agreed price materials and/or labor as stated above:
Payments to be made in accordance with the following schedule: 7 0 J •
Total Project Cost $ l/ V •
Down payment - (Not Refundable) $ SLOG
Upon completion $ .3514.--
Upon completion of shower door S
Failure to make payments on time voids warranty.
This agreement also co ains Customer(s): he Terms and Conditions stated on pages 3 and 4 attached.
f (gyp
Customer(s): - l �� �Y (���` �'�` Date: W-1940 r„ V
Representative: l I � Dat e: ' — q `• h
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