DOCUMENTS Initial Application Date: "1 S' in Application# I I Jl_C,14- I { R J
Cu#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Ellington,NC 27546 Phone:(910)893-7525 ext.2 Fax:(910)893-2793 www.harned org/permits
'A RECORDED SURVEY MAP,RECORDED DEEDp (OR OFFER TO PURCHASE)/4 SITE PLAN ARE REQUIREDI/ WHEN SUBMITTING/A LAND USE APPLICATION'
LANDOWNER: 411,1 I Reba.!, Lire)C J1(t y/ Mailing Address: 7z 4(3-+1"Ai((A�(
City:s 4r-4-Q / stete/V Zip:277)J4-Contact No:940-46 Y-S z-5Y Email:
n
APPLICANT':SNr"S/Au/ Toµel Saco Mailing Address: 2-b" S /?grrn erg u 4e A.
City: Ber1S slate.UZ- Zip:2-x d-04 Contact No.5/5-917--7r(/ Email:/2194onC4-xc4fAAjrm.1l<cn�
'Please fill oW applicant Information if different than landowner /
CONTACT NAME APPLYING IN OFFICE: /2*-s Ac-�I /J h,'J°'• Phone# %/c'YLd7 - 7//J
PROPERTY LOCATION:Subdivision: (t't;Ir ill
LF-4C S Lot e: /2 'U LotoSize: r/.?�3�F
Stale Roa/Ad-�# State Road Name-# UH ��I 0 2 w/c e_ ,Vi('G r 1 ('Map pBBook&P7agge7K /"I /
Parcel. EJ3 C1 Y0� WOI ate PIN: q S !I SJ �t a -SC / /' 0 o
Zoninc gfood Zone. X. Watershed '- T Deed Book&Page:.al Si Cc Power Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monolithic
❑ SFD:(Size_x )#Bedrooms._it Baths: Basement(w/wo bath): Garage: Deck: Crawl Space: Slab:_Slab:
(Is the bonus room finished?( )yes ( )no w/a closet?( )yes (_)no(if yes add in with it bedrooms)
❑ Mod:(Sizex )#Bedrooms_#Baths Basement(w/wo bath)_Garage'._Site Built Deck:_ On Frame Off Frame_
(Is the second floor finished?(_)yes ( )no Any other site built additions?(_)yes ( )no
Q Manufactured Home:_SW DW TW(Size x )#Bedrooms: Garage:_(site built? )Deck:_(site built? )
❑ Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation.#Rooms Use: p Hou�rs(of Operation' #Employeeees.
Addition/Accessory/Other.(Size x )Use:AI/� C€&t2C^� b.J1.-4 BE'44S Closets in addition?( (_)no
�(:)‘,SA r 15454:-KS
Water Supply: r/ County Existing Well New Well(#of dwellings using well )'Must have operableopwater before final
Sewage Supply: New Septic Tank(Complete Checklist) Existing Septic Tank(Complete Checklist) ✓ County Sewer
Does owner of this tract of land,own land that contains a manufactured home within five hundred feet(500)of tract listed above?( )yes (`''--)no
Does the property contain any easements whether underground or overhead(� (_)yes ( no
Structures(existing or proposed):Single family dwellings: LQ,yc. Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:n $6 )(k:
ry- (2� r-�
Front Minimum Actual C cJ..I 5J . 1 y '
Rear '(\IW�
Closest Side \S J�Y� 1 4 IJO1`.S
Sidestreetcorner lot
Nearest Building
on same lot
Residential Land Use Application Page I of 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: M✓Y Z 1 r..9 �/L Cti pu'F'(-L�(Oe pei
�L <4 742.4o 7 . ! T L/ c�
/Y7"✓'t Y/ T�L cw .(//y..r /y .-� LI 7 f dam' eerp c� `
If permits are granted I agree to conform to all ordinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing ar cc e and correct to the hest of my knowledge. Permit subject to revocation if false information is provided.
S-1/ 7
S ure of Owner or Owner's Agent Date
"it is the ownerlapplicants responsibility to provide the county with any applicable information about the subject property,including but not limited
to:boundary information,house location,underground or overhead easements,etc.The county or ti employees are not responsible to}any
Incorrect or missing information that is contained within these applications.***
"This application expires 6 months from the initial date if permits have not been Issued"
Residential Land Use Application Page 2 of 2 03/11
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bonus room
08109/11 Application#
Harnett County Central Permitting L1 t k (Th-b
EWi section below to be tilled outPO Box 65 lAbneton NC 27598 -
by whomever Pxrtorm rail woM1 910 893 7525 Fax 910 893 2793 www barnaorb/permits
Must be owner or licensed
conbador Address company Application for Residential Building and Trades Perm
name 8 phone must match
Owners Name-1///1 * Re4t/c/c-,��m-linc/en „v � Date r-�=/ 7
Site Address 72 A/,veY
it if-eatark.- 5m 4.-e-( 31
r A)c 2 7L Phone 9/O -94 / 3Z9te
Directions to job site from Lullington fl,.,v z7 1,4-)ed 7/4_ tie.W*/P IMA e p.Q,
/// vna L4ro///rira Lrr4eS�.c /fen,(//2 c�� ///rain l"i..r. L.>m- -
/t s - A//;E /fettt_ 72 - e 4 "7 '
Subdivision C...-o l.,n Lw(<e S Lot / 2 -
Descnption of Proposed Work R di) -t t ( d+, el t o #of Bedrooms
Heated SF Unheated SF Finished Bonus Room', Crawl Space _Slab
��99 �t General� nContractor Information
Ploy(C.,71 /tns« Cts'(?-w �`. -T.c n/9_ z_7- 7/!/
Building Contractors Company Name Telephone
2(3 Bst.a., e:r- F/z- N c a;, -cy Mi &jnt4i/.cyst
Address Email Address
SS a 7 Yr
License#
glectncal contractor Information
Description of Work Ai'di 2- A-cae a Size aL°Amps T-Pole _Yes_/--"/NoR.Ml- 'Jr)�,6[0.. tJedrec c Snc ice 9/9' fS 1 - S367
Electrical Contractors CompanyName Telephone
`t'26( PS ell). p 2 fee, . Ac 1Zror/ raidtkmlele4fe12fC,cit6arfKs,/, te.�
Address Email Address
2l/ 9V
License#
Mechanical/HVAC Contractor Information
Description of Work /')1#1
Mechanical Contractors Company Name Telephone
Address Email Address
License#
plumbing Contractor Information
Description of Work n//9- #Baths
Plumbing Contractors Company Name Telephone
Address Email Address
License#
// insulation Contractor Information
Insulation C nhactor s Company Name&Address Telephone
*NOTE General Contractor must fill out and sign the second page of this application
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 that pv siamno below I have obtained all subcontractors
permission to obtain these permits and if my 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 F ES-6 Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
is as per f
Signature r/Contractor/ORicer(s)of Corporation Date
Affidavit for Worker's Compensation N C G 8 87-14
The undersigned applicant being the
kV-General Contractor Owner _ Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of penury 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 workers compensation insurance prior
to issuance of the permit and at any time dunng the permitted work from any person firm or corporation
carrying out the work r1 /� /�
Company or Name /4517 4-. 0v/i a j eh-- Ovr / vz .c
Sign wide VCWei ._ Date —3 "/7
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Bldg Inep scheduled before 2pm available next business day.
Application Number 17-50041103 Date 4/05/17
Property Address 72 NIGHT HERON CT
PARCEL NUMBER 03-9585-04- -0012- - -
Application type description CP ADD & ALTER RESIDENTIAL
Subdivision Name CAROLINA LAKES
Property Zoning RES/AGRI DIST - RA-30
Owner Contractor
VRENDENBERG JAN J & REBECCA S MARSHALL JOHNSON CONST INC
72 NIGHT HERON 283 BANNER ELK ROAD
SANFORD NC 27332 BENSON NC 27504
(919) 894-2064
Applicant
JOHNSON MARSHALL
283 BANNER ELK RD
BENSON NC 27504
(919) 427-7111
- -- Structure Information 000 000 ADD BDR IN BONUSROOM W/OUT PERMITS=4BDRS
Flood Zone FLOOD ZONE X
Other struct info # BEDROOMS 4 . 00
SEPTIC - EXISTING? SEWER
WATER SUPPLY COUNTY
Permit RESIDENTIAL BUILDING PERMIT
Additional desc .
Phone Access Code 1185834
Issue Date . 4/05/17 Valuation . . . . 0
Expiration Date . 4/05/18
Permit RESIDENTIAL ELECTRICAL PERMIT
Additional desc .
Phone Access Code 1185842
Issue Date . 4/05/17 Valuation . . . . 0
Expiration Date . 4/05/18
Special Notes and Comments
T/S: 04/05/2017 01 : 43 PM JBROCK ----
72 NIGHT HERON CT
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call: (910) 693-7525 Fax: (910) 893-2793
Bldg Insp scheduled before 2pm available next business day.
Page 2
Application Number 17-50041103 Date 4/05/17
Property Address 72 NIGHT HERON CT
PARCEL NUMBER 03-9585-04- -0012- - -
Application description . . CP ADD & ALTER RESIDENTIAL
Subdivision Name CAROLINA LAKES
Property Zoning RES/AGRI DIST - RA-30
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
Permit type . . . . RESIDENTIAL BUILDING PERMIT
999 131 R131 ONE TRADE FINAL _/_/_
999 125 R125 ONE TRADE ROUGH IN _/ /_
999 229 R229 TWO TRADE FINAL _/ /_
999 225 R225 TWO TRADE ROUGH IN / /