BUILDING • Loch suction below lu bu lillud uul by Applicnliun 11
whuinuvur pudunninrank. y wk. rylusl bu uw ui
n
al IIUUIisetl cuutlaelul. Address, CUIIIpuily
I wino & phw io inusi I l latch I IIluullation v,l I Ia jie I County Central ul Pn
Unllhny
license. P0 Dux 65 1 140 27546
910- 09:1 -7525 fax 91U- 099.2793 www.hanlelrmy /punnils
Application lur liesitlenlial Building and "Hades Permit
Owner's Name: CDn1 er/ acrofeaS d'fe Dale:
Site Addless: 't5 /1t' sme., Cor . .t Pllunu:(q /[) 5 ,2
53
Directions lu job site hone Lillinylun: -/ 0/ Nar / c /1/4. 1...e1
.. •2/1 a,L S/? fief / •
R 54t 0/1 lI ir1Sprco k <:4r' /e R.4/a WiclOokc Canal. l0
Iyi COU A-r ? Subdivision: Fres I 77- /S ,/ q Lot: ( 7
Description ul Pluposud Wails: Cnm1/44 !f'tI af t /e Yan. ; ce5J/ Jutlluulns: 3
Floated SF /'(•R 1 Unheated SP 616 Fir ishot] Roc 19uoiii? h Cl awl Spacen ( )
General Con hactor lido) nuUion
(or ,7- _(.7 53 - 3-? (6 ::R
Building Contractor's Company Nato I olupllune
P,o, t30x .367 C',; /ar /VC ✓", t5' _ 33 / EN • Addiess p Licunso 71
____�1 4 - -ca :z u�J Ivlusl sign & till uul, suuuntl page
Signature of Ownel /ConlractultL011ic6r(s) el Collimation
Electrical Permit Inlurnlalion
Desciiplion 01 Wollt /I oufel. /.f din:a ey Size: A/v oo All IV; I I uledh'nu •
r° _
64/rrntr /' S /ec7 � y n S ` 7
Electrical Connector's Cul Name Teleplluuu
705 Mail lisi is,;,, 1 /[/q%srr 1; ;*< i JFl , I/ e 2 _ - S- 6? 51co •
Ad s., License II slyrlaluie ul Oilicer(s I Culpor ' I
_ Mecllallical /FIVAC Pennil Inlurnlalion
Uescliplion ul Wotk / // loo ; /•t ' oa /1& e Ili re- P cal itZt.
5`c p 1 1Ca.5e L /77'a.I.•r, - ,45 Tr e 1- odE
Mechanical Contractor's Coiupaiii Name Telephone
343 540tou /2
s/ -. LJarlf•er / YE
%. e 732 t f g!S ei Y
A t s / / e l C� i Lice! Ise !7
Signature ul 011icer(51 ul I;
I'Iunlllintl Permit Inluinrrtiun
Duselipli0n ul Wok 110'.a /Pt `1' l f:tc i € t J. � 11 baths JP R.
•
Marta rt Phi •rch tr l (e l / 0 7 3 _ . 2 LS 2z .R
I'lunlbIliiy Cuutraulur's Colilpaily Name ) /
Telepliune /
IDS Meta pr. Clor1/a/ r((C 2 I() J -t �' -?1-? c. ..—
Addie y License 11
/,vr; ( .
) � -�c� .
Siyualule LH 011icet(s) ul Colpuratiun
/'; ,[ lusulaliun Permit Inlunnalioti /
7c/ ti_ipi.-- �il2_474I /6vl 5 /`f G� &�14$ - na G Lrnar �!� ( – G�9�
Insulation Contractor's Company Name & Addiess Telupiloue
Page 1 ul 2 'J /Uli •
Application it
Homeowners Applying to Build Their Own Home
Please answer the following questions then see a Permit Technician to determine II 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? _ 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 stale 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 II changes.
./7- Gtr444vr 0 — /0 - 10
Signature of Owner /Contractor /Officer(s) of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87 -14
The undersigned applicant being the:
•
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' compensatioriinsurance to cover
them.
)( Has one (1) or more subcontractors(s) who has their own policy of workers' compensation insurance
coverg themselves.
Has no more than Iwo (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: ( . 4 1-7 Lt tf ..
Sign w/Tille: Gene a,(� i ecucfrtDate:I( -0
Page 2 of 2 3/08
•
7 ,,
J Name
l � L
Date: l
y ngox�urob `./
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Inspections for SF�
Valuation
Required Insp Scif eet
Sequence ‘
R* Bldg. Footing
10 R* Elec. Temp ServicePole
R* BuildingFoundation \ 10 30_ Address Confirmation
20� Op enFloor �,
20 — R* Bldg. Slab Insp.
30 -999 Sla Is R *plumb, Under Slab
p.
30 -999—
30-999----,--_ R* Elec. Four
30 -99 > 2.
40 Trade Rough In
Four Trade Rough In 1
40 Three Trade Rough In 2
�
40
40-7,---____ Three Trade Rough In
Two Trade Rough In \
40 Two Trade Roug
h> 250
40 One Trade Rough In > 2500
40 One Trade Rough In
40 50— ✓ R* Insulation
50
60 Four Trade Final
> 2500
60 Four Trade Final Three Trade Final
60-60 Three Trade Final > 2500
60 Two Trade Final
60 _� Two Trade Final > 2500
60 �� One Trade Final
60 �— One Trade Final > 2500
60 ��
Envir. Operations Permit
999___---_________
2
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