BUILDING ' Each suction bolow to bo tilled out by Application 11
whomever perlorminy work. Must be owner
ur licensed contractor. Address, company
name & phone must match information on I Iarllell County Central 1 Permitting
license. PO Box 65 Lillinylon, NC 27546 .
910-893-7525 Fax 910 -893 -2793 www.harnetl.ory /permits
n/
Application for -- Residential Building and Trades Permit
• Owner's Name: Ctm4r77easteS Zi Dale: /(-/J -
Site Address:3 I SczrL / /e[,nvu- 0r , / Plione:(Yl4) 6553-32 L1Z
Directions to job site from Lillin ton: 4o/ , -Y% 1, 1 ; At n A , ACA- a
L' 2�� tn,C_ Atk*WS £0.1 . 0 en Lylt Ma & / ff n_.,
Subdivision: stc,4 '4'ew _ Lot: 38
Description of Proposed Work: Can-r7`rue/ /ac aG e .S4 /e /0n,., AEsjll3edroums: 3
Heated SF IT 2 ( Unhealed SF 751 Finished Rec Room? 41/,4 Crawl Spacep&Slab ( )
p General Contractor Information
Gb� 7n rrtionip 5 2ne • 07??) SS3 -3.Z ?
Building Contractor's Company Name Telephone
F?(). /30y 1/4367 ClQ iflC X 75,? a 33 / Efce
Address License 11
/�ru++r�. Must sign & fill out second page
Signature of Owner /Contractokaf11cer(s,) of Corporation
p E eclrical Permit Inlormalion
Description of Work l )nu -x : :f vin.r ( ervlce Size: .�o 0 Amps TPule9no
Sgmot , //,/ S /e&`r E ?1 Vg7S -OS 77
Electrical Contractor's Company Name Telephone
7o5 /47,11r.55 iv,'" 14 /4. /eer / lc i , /1 ' �, Set r� e zgfS' 'S -SRSFb • .
Ad Al � . License N
alure of 011icer(s Corpor ,4"i
Mechanical /I IVAC Permit Information
Description of Workfiesus4' ht '+f /'Thi oc..( ol` //I/,4C '+'— ather Uenlit- rr
St - , e ,. -. 21 e 065
Mec ianical Contractor's Company Name Telephone
31 13 54,0045/ 1/r, Gans er 2 732`( /be 4
AJrc y- / Licun !J
Signature of Officer(4of 9 1poration
pp Plumbing Permit Information
fl
Description of Work og( 1 4 7n:m. 64.7` it Baths 2.
Morgqan f /u„cd1� (/lf r3 Y -S6 '
Plumb)tSy Contractor's Colliparty Name Telephone
105 Meta 17r. C /Gy4n. lie � 752 a / ?l-7 ‘
Addre / • License I!
it�n {
Signature o 011icer(s) of Corporation
/ C Insulation Permit Information / �
Tctt4 #n `h�5 k7�%6v�- - 517OW -., S / aura or LI 19 W` // ` - 0( / /
Insulation Contractors Company Name & Address / Telephone i
Page 1 of 2 3/03
•
Application fi
•
Homeowners Applying to Build Their Own Home
Please answer the following questions Then see a Permit Technician to determine If 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 10 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 slate 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.
/_ .i.Y - - - / / — /U ^/O
Signature of Owner/Contractor/Officer(s) of Corporation Dale
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' compensation insurance to cover
them.
X Has one (1) or more subcontractors(s) who has their own policy of workers' compensation insurance
`rtn
cover 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: ( .o.427 n/J d k - Trga ,t e 5 Lit -
Sign w/Title: a 6 ernA t »mgc. Date: /7 (a '-7/?
Page 2 of 2 3/08
Plan Box Number 0 3 Job Name (4, k p o
Date: 1 t - ( Z • I
Required Inspections for SFA/SFD
Appl. # ' 0 -coo 83
Valuation! 3 G 1 I r
Sq. Feet 20 9 S
Sequence
10 >r 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 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