BUILDING cement
Application#
Harnett Counly Central Permdbnpj ., . �- S Z
Each Won telowbfNOardaW PO Box M Wu NC 27619 —fes--�>-
work
e10es97526 Fax 9100932793 WeiWeillama y w e
M m bete ows or Aeanged
raw* nilil w company Asdloalwn for Residential Building and Turtles PsimS
OwnereName • '
Site Address _ � �_
Directions to Job ate from Langton plane �—I-
Subdivision
Lot
Description of Proposed Work #of Bedrooms
Heated SF__Unheated SF Finished Bonus Room'+ Crawl Space _Slab
pennat Contractor Intention —
Bulpsp Contractors Company Name Telephone
Address Email Address
nk �
License K
Description of Work f�^�Cantrador Information
Servos Sus _Amps T-Pols _Vea No
Electrical Contractor ae one
Address
Email Address
Lane s
�tn
DesalpkondWank n �\�� t, _
Mechsmal Contractor ��, Pdook[QcQ Telephone
Address v • \ _ Email Address
License S
ptumbma Contractor Inform
Deem on of Work /E = -the
oe tri
Plumbing Contractor a Compan 1' Telephone
Address casc(,(\ Email Address
License e
lftliligalagatagragjapag
Insufain Contractors Company Name&Address Telephone
'NOTE Gonad Contractor must fill out and sign the second paged this appt 0 01
I hereby cerbfy that I have the aulhomy to make necessary apphca on that the application is correct
and that-the caratrudcn will conform to the regulation in the Building EMdncal Plumbing end
Mechanical codes and the Harnett County Zoning Ordinance I state the mformebon on the above
mareelon is conict as known to me and that luitaniabthatalartain
permission to obtain these morns and if en changes occur ncludeg hated contractors site plan
number of bedrooms budding and trade pans Environmental Heath permit changes or proposed use
charges I cern a is my responsibility to notify the Harmer County Central Permitting Department of
any end all themes
EXPIRED PERMIT FEES-e Months to 2 yeah penia reissue fee a$150 00 Mer 2 years re-issue fee
a as per current lee schedule
1° cP�xy(i.///��,n 7
Air d OararMorttrador1011cer(s)d Carporalcn ��^
Afhdavtt for Worker's Compansabon NC G S 87-14
The underegned applicant being the/
_General Contractor Owner _Officer/Agent of the Contractor or Owner
Do hereby confirm under paralles of prNy that the person(s) firm(s)or corporation(s)performing the work
set forth in the permit
Has tree(3)or more employees end has obtained workers compensation insurance to cover them
Hae one(I)or more subcontractors(*)and has obtained workers compensation insuance to cover
them
_yG Hae one(I)or more subcontractors(s)who hu thaw own policy of workers compensation insurance
cevenng themselves
Has no more than two(2)employees end no subcontractors
Whitenarking on the*act for which this pant is sought t rs understood that the Central Perming
Department issuing the permit may require certificates of coverage of worker s compensation insurance prior
to issuance of the permit and at any time dump the permitted work from any person fern or corporation
carrying out the work // � � , / ‘
Company or Ne l 7 - (15eZ /t' &i�7
lean white Pate 5r—r/'7
Applicadon e
PO Box 66 Lilerpton.NC 276488 rnett 91Oa803-15ty .26611V x:l Permitting 73 - www.hameyag/pemws
Certification of Work Performed By Owner/Contractor
(Individual Trade Application)
Owner(s)of Structure: James Cady Wiliam Phone:9187967017
owner(s)Mailing Address:128 rose a Benson NC 27504
Land Owner Name(s): James Carlton Willem phone:919 7957017
Construction or Site Address:440
PIN a Parcel it
Job Cost: Desoniaion of wart to be done build house with detached gau ge and guest house
Mechanical: New Unit With Ductwork_ New Unit Without DucMpkGas Piping se Other,
Electrical': 200 Amp_<200 Amp L Service Change_ Service Reomnect_ Other
'For Progress Energy customers we need the premise number
Plumbing: Water/Sewer TapNumber of Baths_ Water Heater
. rtOkaetlora ro Joh from alkmoen:
ibwn
lake 401 towel*luauey vsdna tum left on wrd Mt driveway on left
Subdivision: Lot 0:
l James Carlton Whams wti provide the alectocal
(Contractors Name) labor on this structure.(Trade)
I am the building owner or my NC state license number is 12801U which entities me to
perform such work on the above structure legally. Al work shall comply with the Stab Building Code and all
other applicable Stab and local laws,ordnance.and regulations.
Fowler end Sons Inc 9197794330
Contractors Company Name Telephone
105 roped rd suite 2 nWlgh tic 27804 CedbmWl na12SQ9nui.00m
Address Email Address
12801u
License• ////n////1� /`/�/�
Structure Owner/Contractor Signature: ircr4l 1 Le—Vd4/ 'Date:
By signing this application you Sm you have obtained permission Rom the above eked Scans*holder to
purchase permits on their behalf. If the work a owner you understand that you cannot rent,lease or sell
the Iliad properly for 12 months after completion of the listed work
*Company name,address,&phone must match Information on license
Application e
ua Harnett County Central Permitting
PO Box 66 nglwl,NC 275443 - Ph:610-603-7525 - Fx:910-0632793 - .hap
gypermits
Certification of Work Performed By Owner/Contractor
(Individual Trade Application)
owner(e)of Strualae: James Carnal Mums
Plane:8187957017
Owner ON Malting Address:128 rosea.134°4°°74C 275°4
Laid Owner Name(a): James Caston Willem° per:919 7057017
Construction or Site Address:b10
PIN a Parcel a
Job Cost Description of Work to be done build holy 4451447142714d Garage and Weld house
Mechanical: New UMI With Ductwork L New Unit Wtho.r DucMak_ Gas Piping ✓ Other
Electrical': 200 Amp c200 Amp-_SeMWce Change Service Reconnect_ Other —
•For Progress Energy wstomsra we need the premise number
Plumbing: Water/Sewer Tap Number of Bettis_ Water Healer
S_oecifla DirsclW+a ins w, from la--• -�
take 401 towards Newry were tum Na an MIWm rd first driveway on left
Subdivision: Iota:
I James CMbn WMeny we provide the mwdlrlkY
(Contractors Name) labor an this atrutdrlro.
(Trade)
1 am the building owner or my NC state license number Is which entitles me to
perform such work on the above structure legally. AN work shall comply with the State Building Code and all
cher applicable State and local laws,ordinances and regulations.
Fowler and Sons Inc 9197754330
Contractor's Company Name Telephone
105 rupen M suite 2'Neigh nc 27604
8®gmellcomAddress Emal Address
6622013
License e
Structure Owner/Contractor SignatuBre: (0/2•11411.�/Allsri Date:
By signing this application you affirm have obtained permission from the above listed license holder to
purchase permits on their behalf. If the work as owner you understand that you cannot rent,lease or sell
the listed properly for 12 ironing after completion of the listed work.
'Company Mme,address,I phone must match Information on license
Application S
Harnett County Central Permitting
PO Box 86 UAlrgton, NC 27646 - Ph.910-893-7626 - Per:910-893-2793 - www.lumen.orp/permils
Certification of Work Performed By Owner/Contractor
(Individual Trade Application)
Owner(s)of Structure: 'NM"C6mun Wain / plane 9197957017
Owner(s)Mailing Address:128 rase d.Benyon NC 27501
Land Owner Name(a): 'ant Carbon Williams phone:919 7957017
Construction or Sita Address:110
PIN t Parcel t
Job Cost Description of work to be done build house with detached garage and guest house
Mechanical: New Unit With Ductwork New Unit Without Ductwork_ Gas Piping 1 Other
Electrical: 200 Amp_<200 Any_.Service Change_ Service Reconnect Other
•For Progress Energy customers we need the premise number
Plumbing: Water/Sewer Tap 1 Number of Batts 6 Water Heater 1
�rd5c uan�erw b b from vr.�.n.....
take M1 rewards fwuay very Ran ah on wlibwn rd first driveway on len
Subdivision: fit,
l James Carlon Mame wiy provide the pkrrM4q
labor on this e
(Contractors Name) (Trade)
I am the building owner or my NC state license number Is 882203 , which entitles me to
perform such work on the above structure legally. All work wen comply with the State Building Code and all
other applicable State and local laws,ordinances and regulations.
Fowler and Sons Inc 9197794330
ContraCofa Company Name Telephone
105 ruperl rd suis 2 aleph nc 27904 Celbnw8Yms1
Address 28Q9mu_oom
Email Address
License*
Structure Owner I Contractor Signature'I (-tZJ/4 w Date;
By signing this application you affirm have obtained permission from the above listed license holder to
purchase permits on their behalf If dddddd400000MNNNNN((((((9ppppp the work as owner you understand that you cannot rent,lease or sal
the listed property for 12 months alter completion of he listed work.
'Company name,address,i phone must match Information on license
STATE OF NORTH CAROLfNA
COUNTY N ^n n OWNER EXEMPTION AFFIDAVIT
PURSUANT TO G.S.87-14(a)(1)
Inspection Department
Parcel Identification Number and address where the building a to be unnstruuced:P8)_ClD 4 I tt '$j ea.(XX)
Address • - •
Type aconstruction:Aesidentlel ❑Commercial ^°Ina.hrl ❑Other
Intended use after completion(e.g.Personal residence):
RO-51
Building permit number
associated with this application:
I, �1b4 I 2e j!i/llii�c
(Pmt Full Name) —Lq�1 74 5_ 7p y'7
hereby claim exemption (Plmce Number)
from Reinsure under G.S. 87.1(b)(2)by MaWjg the relevant provision In paragraph /
and Irypag_ye paragraphs 2-6 belay
attesting b the following:
I artily I am the owner of the property sat forth above on whidu a building is to be constructed or
tiered end Br SSG,aPWication fora building permit is hereby made;
OR
�___ 'la legally authorized to sol on behalf of the firm that Is corporation corpbpcyag or altering this
bufdyq property owned by the arm acorporation as sal forth above:
^.CM'
(Nam of Finn or Corporation)
2, 11S I WS Personally suparaner d and manage all aspects of the oanstrucllon or alteration of the building
and that duty wit not be da egged Nor any person not duly incensed under the sums of Arlie 1,Chapter 87
of the General Statues of North Carolina.
3. 1 wlfi be on site regeISIY during construction end I will bs penmprlely Presets for all icapeutions required
by the Nath Carolina State Building Coda unless the plays for the construction or alteration of the building were
AaW�uwnn�end sealed by an architect licensed pursuant to Chapter 83A of the General Statutes of North Gamine.
4. CI understand that by executing this licensing exaaplcn AFFIDAVIT pursuant to G.B.87-1(b)(2),I am
required by law to occupy the building for with the licensing exemption Is granted br twelve monde after
completion,during which time It may not be offered Oar rant,lease or sale.
6. 4a I understand a copy of this AFFIDAVIT cog be transmitted to the North Carolina UcensIrg Board for
General Contndm for verMadlon I am valr8y entitled to claire en exemption wader GS.87-1(bX2)for the
buflhg construction or alteration specified herein. I furter understand liths North Canna Licensing Board
for General Contractors determines 1 am not entitled to claim this exemption the building permit Issued for the
construction or alteration specified herein shall be revoked pursuant to G.S 153A-362 or G.S. 160A-422.
/] r 7"--
Sworn or alarmed and lei bnrgsd Belo a me this the S day Of 20 I
Id
(NOISY Stamp or Bed)
40 /rat .44
(Reye Rs of Nd Putdc) _
(NOTEp It a Wee FSony b wglay mmnt perdury b any einem Eaton pwauwl to NC at I 4-700)
Acknowledgement
STATE OF 110.•
COUNTY OFRat nte _
I certify that WillI WPeigtnally appeared before me this da7i, acknowledging
to me that hr'or she signed the foregoing documeiu y-y yM uM`�. l a ime_4n1
or
I further certify that (select one of the following identification
ame options)p i�nranoihud documentGln
I have personal knowledge of the identity of the principal(s)
ILI have seen satisfactory evidence of the principal's identity, by a current stpte or
deral identification with the principal's photograph in the form of a
I
w or +
A credible witness,
has sworn or affirmed tom^
OH']c.Term,,;.'uIr.-s, •d to me the
identity of the principal, and that he or she is not a named party to the foregoing
document, and has no interest in the transaction,
Date:k n\ 4 201?-
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��,�(tI.ot•TQ�.ny�/ r,„,n reino-e•avn.uy
`y�/ �0js.0 s My commission expires uJf k� �IT
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April 4, 2017
To whom it may concern:
There are no borrowed funds being used for the construction of the house being
built at 540 Wilburn Road, Fuquay NC. This house Is being built for James Carlton
Williams and Sarah Cashion Williams.
Notary