BUILDING E=ach section buluw lo be lilted oul by Applic;diurl II ! 7 J� 25657
whomover podonuing work. Must ba owner
ur licensed conlraclor. Address, company
name 8 phone mi ust welch Inlormalion on Harrell County Central Pennilliny
license. PO Box 65 Lillinglon, NC 27546
910 -893 -7525 Fax 910-893-2793 www.hamellorg /pencils
Application for Residential Building and Trades Perunit
Owner's Name: Coa 4rDSae dive Date: if -a
Site Address: '2.d 5n-/d / )3md �r -. / Phone:& /4) (553 L/
Directions to job site from Lillinpton A er� ii a ; 2 a c CAic. , 1
- ,mete /4 ,4tkens gel, SO eA R1,Y MOO t 1),(1 al,
Subdivision: t ;or ea _ / n Lot: E ta
Description of Proposed Worlc: enwt�rue /ian. e z 5 —/e f'an.� , V /963/sBodroums: 3
Heated SF 13,5g Unhealed SF 8iq Finished Roc Room? a /,4- Crawl Space Slab ( )
n General Contractor Information
Con r 7'nr -r h s rite NI?) 533-3-2 (e.
Building Contractor's Company Name Telephone
Po. 13ox 067 Clan Ale ,27.5:? .2, 33 1 ace
Address License 11
��i.,..,. s� Must sign & till out second page
Signature of Owner /ConlractoC011cel'(s) of Corporation
p E ectrical Permit Information
Description of Work Hot, - X .it #/nkr ce ervice Size: .7" 0 Amps TPule no •
Scioto/ £ /eeYr.L. C -6S 77
Electrical Contractor's Company Name ' Telephone
705 /kwlit!, iyh p/. /a, rr free 14 /1CLr Se/rntjA/C fi'-?S-S& • .
a Ad �
�_ Licenso 11
'1-a,.... ..i
a ture of Oflicer(s If Corpor r•!
Mechanical /HVAC Permit Information
Description of Work&Y-4 /•I '/ /'Zn oat ol //1/AC t oth Penliz. —
Stec enle., 140,2)9a 0- — (.' A ;• V3fi[ —O6S2
Mec ianical Contractor's Company Name Telephone
3 43 Slit toss/ Pr. Garn.er. Ale. 2732 /� ` /
A d � ` / Licenso 11
k. Signature of 011icer(4 of C I poralion •
DD Plumbing Permit Information
Descriplion oI Wolfe Recut r'n `) 7r,:, oc 11 Baths
Mor, Ph/nth/ay €777A7{3 ^StS.-Z-
Plumbing Contractor's Coltipany Name . Telephone
IDS Meer Or. ela / Ne 7.52 6 L.zl.z e
Addre License 11
. ,to(r.r_ 0. 6�cc( .
Signature o 011icer(s) of Corj5oration
/
Insulation PermiittInlormali (2r9) // c, 41 9, ap
"arum nseiXarc- / 64 �g5to't /A &irn Lam( - G! J /
Insulation Contractor's Company Name & Address / Telephone
Page 1 oI 2 3/03
Application If
Homeowners Applying to Build Their Own Home
Please answer the following questions Then see a Permit Technician to determine If you qualily 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 lo 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
an7 04 -e4-14 1 changes.
Z.r,> / 1- 2t /h
Signature of Owner /Contractor /011icer(s) of Corporation ate
•
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 thern.
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
cover g themselves.
Has no more than two (2) employees and no subcontractors.
While working on the project for which this permit is sough) 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.K4 rj gout 'e s Lit -
Sign w/Title: A � t E? e*zz ' /4e�c
� Date:
Page 2 of 2 3/08
4
Plan Box Number ) -3 Job Name ecrI to f- ,.-cs .7'
Date: //2/2)
Required Inspections for SFA/SFD
Appl. # /Qt -S .2S7as - I
Valuation .$ 17,..1„ Go 7
Sequence Sq. Feet aptf 1
10 f R* Bldg. Footing
10 -30 i/ R* Elec. Temp Service Pole
20 t/ R* Building Foundation
20 v Address Confirmation
30 -999 v-- 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 F---- 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