Loading...
BUILDING © Application # /12 5 2 374 `Each section below to be flied out Harnett County Central Permitting by whomever performing work. 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 Building and Trades Permit Owner's Name: MR 12 Y I1 9 Air /J J H 4 L E y Date: 0 T, f ,) , act() Site Address: 5 791 Coos s PR_ (A- ffo.Ah RRCA110A'fphone:91? &5S'- Directions to job site from Lillington: TA-k / r -/ /tier 1 '� w an of ..oz /1- C/ Tu i- n r l c k f (73/4 eon( S pr,h5 t nni a'� /r1 1sec4i'm1 Jk1 ite f<eAts La. to SAd,c1 s- 7hmna_S FaAkv. SatJ3 n,L �' / KUe 02. sA IPs T // urn r 5 (^� crn dirk Subdivision: r cacL O f s Ma.IID PC I/O CJ hoc& (to- *Ca- r JdC9rl ° S: `Cuge 5 i UiSih i rtm` � t'� ro a of Descript ion a ion of Proposed # of Bedrooms: Heated SF: Unheated SF: Finished Bonus Room? Crawl Space: _ Slab: AA General Contractor Information !15 2107 Y/' Building Contractor's Company Name Telephone nal1ia eQ S � Gn 141L.: Cam Addr =: Email Address J .Je _ a✓ Signal ie of Owner /Contractor /Offs -r(s) of Corporation License # Electrical Contractor Information D escription of Work Service Size: Amps T -Pole: _Yes No 4 OX/n(r Electrical Contractor's Company Name Telephone Addre 9 Email Address natur of Owner/Contractor/Office s) of Corporation License # M h /H: AC Contractor Information Description of o 1 i . i. ,. /JS% i I e cI .I '- M i ctor's Leornpany Name Telephone Address Email Address . Signature of Owner /Contractor /Officer(s) of Corporation License # Plumbing Contractor Information Desch ' of Work # Ba r Own Plumbing Contractor's Comp- • , it : Telephone . Addre-= Email Address Si u 4 of Owner /Contractor /Offic s) of Corporation License # Insulation Contractor Information As OW/ Insulation Contractor's Company Name & Address Telephone *NOTE: General Contractor must fill out and sign the second page of this application. Residential Building Application 1 of 2 08110 Homeowners Applying to Build Their Own Home Please answer the following questions then see a Permit Technidan 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 DC No 3. Do you intend to directly control & supervise construction activities? EC Yes _ No 4. Do you intend to schedule, contract, or directly pay for all phases of construction work to be done? )X. 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? K 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 y 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. EXPIRED PERMIT FEES - 6 Months to 2 years permit re -issue fee is $150.00. After 2 years re -issue fee is as per urrent fee schedule. d� .�i /�4.. ma c . / cQO(6 Si atureof Owner /Contractor /Officef(s) of Corporation Date Affidavit for Worker's Compensation N.C.G.S. 87 -14 The undersigned applicant being t General Contractor ,it 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. • X 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. Company or Name: �� Sign w/ Title: /ial e/ ity ��� air.) /4//-lw,7 Date: OGL� /o� J/O Residential Building Application o 2 of 2 08/10 • 2010-10-12 19:29 BROADWAY FAX 9192589359» 9196620730 P111 !a ,� L Each season below 10 be riled our Application # / O J o z / 3 4 by whomever performing work. • Harnett County Central Permitting Must be owner or licensed PO Box 65 LIIIInglon. NC 27546 contractor. Address. company 910-893-7525 Fax 910-893 -2793 www. harnett argfpemYts name a phone must match • Aoollcatlon for Residential Buildino and Trades Permit Owner's Name: MR12f I'm A,iF 6 IHiItf=y Date: Ci< f ,l r :]. Site Address: B 7? Ce re •C r' r:L'r S k_c. 4f1 Bea' ' vT.14YPhone,al? ,. 5J' -2•? - y Directions to job site fromLilling /D ton: Tit /CC A /:a/ ,1._,ir T h -t cu« 1[. : 7 r ri r •t':) k 1 1 C061 S1^:.fir.`, Ai.r r.f 1 r lA44S'cr.11c'7\ u1 kL I.Ci1 A 0 41 ^r - Tit inn a retN Svt;.;rr oh. -kit u b.), Slt.r ) . Tu ( r, r k 4- C7\ el i r� Subdivision: r' C U i i 71 fa r : � 1 /y\:I,ikkx, f 1I0 r.J 6!1( & I r 4- iX. t�r/ L,!c'S 1-1-n: Le s t : 4ecCn PrO(ic ea w ) r } ' .nY t i.- C c ei p� of p # of Bedrooms: Heated SF: Unheated SF: Finished Bonus Room? Crawl Space: _ Slab: General Contractor Information • Al OL /,r /,- Building Contractor's Company Name Telephone Ca , \I rQ &E..)61)1iiIL... ( (r a\ Add!yd Email Address f /' . .a -. 7' 4 SignatWB of OwnerlContractorlOffl r(a) of Corporation • License # Electrical Contractor Information Description of Work Service Size: Amps T•Pole: Yes No 4 C,Gxt/- Electrical Contractor's Company Name Telephone A / // - / Email Address *'4r 2/6/e1.)2.2' )</,.t7- r. Si n turOof Owner/Contractor/Officer(s) of Corporation License # 11 VAC. Contractor information Description of Work 11VAC. 0 - s Cc )raC.. 91q-779 -41g Mechanical Contractor's ompany N: e Telephone aa u, ' (.ue•. L i. 4 NC; ' ,08 Add ,- e/ ear Email �Ad��d Signature of Owner/Contractor/Officer(s) of Corporation License # Plumbing Contractor Information Des ' • 'on of Work Se jl Our, m Plumbing Contractor's • . - Name Telephone Addre ,�rr Email Address a r i t�, i2�l4 Sin of Owner of Corporation License # Insulation Contractor Information A5 0Wn/'r Insulation Contractor's Company Name & Address Telephone *NOTE; General Contractor must VIII out and sign the second page of thls application. 1 4m9iden:id i Budding IvprlicNiin 1 :it 2 OM • Plan Box Number caC Job Nam W Date: 1 N 2 -1?) Required Inspections for SFA/SFD Appl.# r0-CobLS Valuation 21 ? 3 Sq. Feet 27 ,36 Sequence 10 ✓ R* Bldg. Footing 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 ir 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 ,� 1 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