BUILDING P ,
Application # /D 2 5
• Each section below to be filled 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
/1 Owner's Name: / I / J t G i(H7 Date: //7/
Site Address: 7/6 5I -t 4:7 MI- Pi/tic �Q /' ZPhone: 9/O- $ - O.SG�
Directions to job site from Lillington: /70 / ,t 775 n- /t8 ? S "7/16- GL
e7/ T Z. /�ti %a 5 � V<S /ate , -7 Pt 4`'e-rS — oil/
Subdivision: Lot:
Description of Proposed Work: # of Bedrooms:
Heated SF: Unheated SF: Finished Bonus Room? Crawl Space: Slab:
General Contractor Information
,/YC C 0'7 /�i�7 9
Building Contractor's Company N Tele ho e
/S r/� ' Y�'F il�ir�% 9- ,��,
Addr n -- Emai /aress
Signature of Owner /Contractor/ icer(s) of Corporation License #
Electrical Contractor Information
Desc iption of Work 14-(86: Am u. Service Size: Amps T -Pole: Yes No
e � z ;21(C S -- 9/-
Electrical Contractor's Company Name / Telephone
Addre�ss��. / / Email Address
' ✓J` "" ;% ILA, 4. 2 2 35 5-
Signature of Owner /Contract r /Officer(s) of Corporation License #
Mechanical /HVAC Contractor Information
Description of Work /2-57 9 t // v4t ( 1 .09 .� / d✓ /i�c- ` /1 CI
4(t C1/4-7;€6L- /7 1 6nr -- dt/4lir 9lc) 7t7 7G
M echanical Contractor's Company Name Telephone
/1 ) 514 C-i - j ✓�{ /L t , Olt% i / al) 2 -e 2
Address Email Address
, �� Z-/ 3 /y
Signature of Owner /Contractor /Officer(s) of Corporation License #
Plumbing Contractor Information
Description of Work # Baths
Plumbing Contractor's Company Name Telephone
Address Email Address
Signature of Owner /Contractor /Officer(s) of Corporation License #
Insulation Contractor Informatio 7 ..t- c_-
/�54 my- .Insulation Contractor's Company Name & Address 7 7 a _ 7C
*NOTE: General Contractor must fill out and sign the second page of this application.
Residential Building Application 1 of 2 10/10
o c
Homeowners Applying to Build Their Own Home
Please answer the following questions then see a Permit Technician to determine if you qualify for permit under Owners Exemption.
Questionnaire .er G.S. 87 -14 Regulations as to Issue of Building Permits (Memo available upon request)
1. Do you own the - •d on which this building will be constructed? _ Yes _ No
2. Have you hired or inten• • hire an individual to superi : d and
manage construction of the proje 7 _ Yes _ No
3. Do you intend to directly control & su• - : construction activities? _ Yes _ No
4. Do you intend to schedule - .ntract, or directly pay *call phases of
construction work to be d• e? -„, -. Yes No
5. Do you inten• • personally occupy the building for at least 12 consecutive
months folio - ng 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 state the information on the above
contractors is correct as known to me and if a� 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 Hamett County Central Permitting Department of
any and all changes.
EXPIRE MIT FEES - 6 Months to 2 years permit re -issue fee is $150.00. After 2 years re -issue fee
is as r curr nt fee sc ed
6,i i lb' 7 //
Signature of Owner /Con c or /Officer(s) of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87 -14
The and rsigned applicant being the:
General Contractor Owner Officer /Agent of the Contractor or Owner
Do hereby confirm under penalties of perjury that the person(s), firm(s) or corporation(s) performing the work
set forth in the permit:
Has three (3) or more employees and has obtained workers' compensation insurance to cover them.
Has one (1) or more subcontractors(s) and has obtained workers' compensation insurance to cover
them.
I Has one (1) or more subcontractors(s) who has their own policy of workers' compensation insurance
covering themselves.
Has no more than two (2) employees and no subcontractors.
While working on the project for which this permit is sought it is understood that the Central Permitting
Department issuing the permit may require certificates of coverage of worker's compensation insurance prior
to issuance of the permit and at any time during the permitted work from any person, firm or corporation
carrying out the work. `
Company or e 5 / Gnti Gni F.S J
Sign wrntie.r , (C , / - — Date: >/ / / / 1'46
Residential Building Application 2 of 2 IC/10
Plan Box Number —PE Job Names t 5 04:2
Date: / /- /( -/D
Required Inspections for SFA/SFD
APPI. # 7,, -S .$)s 9 7
Valuation 4S,Ait4L
Sequence Sq. Feet 0 201
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. tinder Slab
30 -999 R *Plumb. Under Slab
40 Four Trade Rough In
40 Four Trade Rough In> 2500
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