DOCUMENTS 09109/11 rA�ppClicahtion'�# `
Harnett County Central Permitting I 1 1 SC)Ci -1-U aL1
PO Box 65 Leinpton NC 27546
Each Becton below to be Oiled out 910 693 7626 Fax 910 893 2793 www hamah org/permits
by whomever performing work
Must be owner or licensed
contactor Address company Application for Residential Building and Trades Penult
name&phone must match
Owners Name erne ill- d r/e7Ye ✓s" -s Date 9 -'/7
Site Address 2/90 fre3 .-e /2.1, a01n / Nl 2e37Y Phone 9/9 -S-'7V- 66,13
D tions to job site from Lillington o77 C �e��a-,C't Re-. in,_ 71/22rn_ ceyeS
c am, r•% ,, w 1 J`oi 2P. cA70 ` .
Subdivision win Lot N/h
Description of Proposed Work k,v4,441 4.1 ' 14.11, f n Jr #of Bedrooms
Heated SF Unheated SF Finished Bonus Roomy Crawl Space _Slab _
General Contractor Information
/%9vs/e // 5� eM Cv,-s-(que r« T�-c 1'2' 7- 7711
Building Contractors Company Name Telephone
2-83 -'-< 2
ark /Yep- $e sc- 1 C list, / !QM rum., �P a�Icc
Address (�c3 ,tom M�{- (�Address ✓
65-2-7c/ n _ —c . et , pep
License
O
License# ,� M
or Infonnatron
Description of Work f✓cr7.,A-� k 1.,e39ervice Size 2 c- Amps T-Pole —Yes�o
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g, 1 . 7A -/iso E/ec v c Pd 09-3-.3
Electrical Contractor s Company Name Telephone
926/ e<tie /2- R¢<y.c m.. ,lX 17r'0y ro-/a o..elaeA,.B<...Ger6,,.�;(,e`rn.
Address Email Address
License#
MechantcallHVAC Contractor Information
Description of Work N/
Mechanical Contractors Company Name Telephone
Address Email Address
License#
Plumbing Contractor Information
Description of Work /Q,. It c eira f?a IL ArmYrn.. sac-Ago-4 Baths .�
5-ernenisiI24 r Wi//, r.," -9/ x ' 195.3 ?
Plumbing ontra or s Company Name Telephone
3Dr9 . itl-cPrnsSRPaQs ��s. Ak -27fit
Address / Email Address
3o7'/ 7
License#
Insulation Contractor Information
Insulation Contractors Company Name 8 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 stoma below I have obtained all subcontractor%
permission to obtain these termite 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 FEES-B Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
is as per current f sc ule
signature
erlContraontrectorlOSicer(s)of Corporation Date
Afhdavttfor Worker's Compensation NC 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 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 workers 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
Sign w/Tille Date
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Bldg Insp scheduled before 2pm available next business day.
Application Number 17-50041104 Date 4/05/17
Property Address 490 NEIGHBORS RD
PARCEL NUMBER 02-1528- - -0114- - -
Application type description CP ADD & ALTER RESIDENTIAL
Subdivision Name
Property Zoning RES/AGRI DIST - RA-30
Owner Contractor
JONES ERNEST 0 JR & CHARLETTE MARSHALL JOHNSON CONST INC
490 NEIGHBORS RD 283 BANNER ELK ROAD
DUNN NC 28334 BENSON NC 27504
(910) 892-1763 (919) 894-2064
Applicant
MARSHALL JOHNSON CONSTRUCTION
283 BANNER ELK RD
BENSON NC 27504
(919) 427-7111
--- Structure Information 000 000 REMODEL KITCHEN & BATHROOM
Flood Zone FLOOD ZONE X
Other struct info SEPTIC - EXISTING? NA
WATER SUPPLY COUNTY
Permit RESIDENTIAL PLUMBING PERMIT
Additional desc .
Phone Access Code 1185867
Issue Date . . 4/05/17 Valuation . . . . 0
Expiration Date . 4/05/18
Permit RESIDENTIAL ELECTRICAL PERMIT
Additional desc .
Phone Access Code 1185859
Issue Date . . 4/05/17 Valuation . . . . 0
Expiration Date . . 4/05/18
Special Notes and Comments
T/S: 04/05/2017 02 : 03 PM JBROCK ----
27 E TOWARDS BENSON R ON HODGES CHAPEL
RD R ON NEIGHBORS RD 490 ON L
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Bldg Insp scheduled before 2pm available next business day.
Page 2
Application Number 17-50041104 Date 4/05/17
Property Address 490 NEIGHBORS RD
PARCEL NUMBER 02-1528- - -0114- - -
Application description . . CP ADD & ALTER RESIDENTIAL
Subdivision Name
Property Zoning RES/AGRI DIST - RA-30
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
Permit type . . RESIDENTIAL PLUMBING PERMIT
999 131 R131 ONE TRADE FINAL- _/ /
999 125 R125 ONE TRADE ROUGH IN --/--/
Permit type . . . . RESIDENTIAL ELECTRICAL PERMIT
999 131 R131 ONE TRADE FINAL / /
999 125 R125 ONE TRADE ROUGH IN / /