DOCUMENTS 09109111 Application*
Harnett County Central Permitting
PO Box 66 Liibngton NC 27546
Each section below to be Bled out 910 893 7525 Fax 910 893 2793 www harnett orglpermie
by whomever performing work
Moat be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name 8 phone must match
Owners Name Royal Oaks Building Group Date
Site Address Phone 919-233-3886
Deectidns to job site from Lillington North on 401;Right onto Rawls Church Road; Right onto Atkins Road
left onto Atkins Village Court
Subdmslon Atkins Village Lot 48
Description of Proposed Work Single Family Home #of Bedrooms 5
Heated SF 2666 Unheated SF 666 Finished Bonus Roomo Crawl Space X Slab _
General Contractor Information
Royal Oaks Building Group, LLC 919-233-3886
Building Contractor s Company Name Telephone
1210 Trinity Road, Suite 102 Raleigh,NC 27607 amaciaseroyaloakshomea.com
Address Email Address
49775
License#
glee%neat Contractor Information
Description of Work Electrical Rough n and Final Service Size 200 Amps T-Pole %Yes No
Ideal Electric 734-927-7448
Electrical Contractors Company Name Telephone
PO Box 969 Farmington, MI 48332
Address Email Address
27078U
License#
MechamcaliHVAC Contractor Information
Description of Work Install HVAC and duct system
Carolina Mr Conditioning Co 919-683-2421
Mechanical Contractors Company Name Telephone
105 International Dr, Morrisville, NC 27560
Address Email Address
22084
License#
plumbing Contractor Information
Description of Work Plumb single Family home if Baths
Barnes Plumbing,Inc 919-422-2133
Plumbing Contractors Company Name Telephone
239 Millwood Lane,Angler, NC 27501
Address Email Address ISI
17735
License#
Insulation Contractor Information
Tatum Insulation II 919-661-0999
Insulation Contractors Company Name&Address Telephone
*NOTE General Contractor must fill out and sign the second page of this application ��,
I hereby candy 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 Budding Electncal 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 that pv swine below I have obtained all subcontractors
permission to obtain these marmite 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
EXPIRED PERMIT PEES-0 Months to 2 years permtt re-issue fee is$150 00 After 2 years re-Issue fee
is as per!ant fee hedule
G 20-September-2017
Sig lure o a�rf'era o =clorloffmer(s)of Corporation Date
Affidavit for Worker's Compensation NC G S 87-14
The undersigned applicant being the
X General Contractor Owner Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of perjury that the person(a) firm(s)or corporation(s)performing the work
set forth in the permit
X 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
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 Ro _1 Oaks Building Group
•
Sign w/Title • {/_� • rector of Operations Date 20-September-17
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed on: 09/08/2017
Entry #: 7l7777 Initially filed by: ROBG
Designated Lien Agent Project Property
Print & Post
Chicago Title Contpanb,LLC 48 AV
21Dot Ct 6, _0
(}lint: vfl nnuoeconi Fuquay Varna,NC 27526 ?}�
Hamel(Count)
Address:
Atltl :le\Y lh,atll SI SIMS 507 RolunR_\C
Pont Q' ' 844
lime:add-C.)04384 Property Type Contractors:
rats:913-459.51U Please post this notice on the Job Site
Emnl:ypbSfibl p e oru. _ - 1-2 roma,Dwelling Suppliers and Subcontractors:
Scan this image with your smart phone to
w this filing.You can then file a Notice
Owner Information to Lien Agent foe this pmlen.
Royal Oaks Ruddily,Oroup.1.I C
1210 Tnnin Rd suite 102
Raleigh, NC 276117
United States
Fmeil khe Cre/nt atoalshomes colt,
Phone 919-233-3886
Via%Comments 101
Technical Support Hotline:18881690-7384