DOCUMENTS if
Initial Application pate'. 3 Irl Application# I I ay-I4 11(43
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION CU#
Central Permitting 108 E.Front Street,Lillington.NC 27546 Phone.(910)893-7525 ext2 Far(910)893-2793 wwwbarnett.orglpermits
"A RECORDED SURVEY'� MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER: la( Deja Ve AFC - Mailing Address SaµG CS-C be.lb rJ
City- U C
Ci : State: rr Zip: r Contact No: t Email: ,OOn rx 0 r( I$ I 151 Q yethoD.
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APPLICIAANT•: Csw'frlBeg.cft-nn) 140Atic�AringAddress' P. O . j30x 'r2'1
City: Nu u State-NC Zip MU—Contact No 91D 892' 93 L/C-Email If
•Plea a fill out applicant information a different than landowner "�
CONTACT NAME APPLYING IN OFFICE: M t C lel-1t L Fye OIL -It
OC$I Phone# q 10 ' 8 11. • 93 4�
�PROPERTY LOCATION:Subdivision A 100.F 1'I4 LT1'V $A.f \ FAOtAJS � Lot#_ Lot Size: a
S /YT
yF�
State Road# 7 2 I State Road Name: (f c.N`,'I(— CElkin kL FED Map Book 8,Page:Zoo, 1014
❑ard 040 b42 0024 1)9 PIN- n(05-2-131.1#63, 000
Zoning: RA'11OFlood Zone: X Watershed: NIA Deed Book 8.Page:_p t is /�F tc ower Company'. DNI ILE
-New structures with Progress Energy as service provider need to supply premise number IS 07334 0 from Progress Energy.
POSED USE: ,
/ 41 ,# b>] Monolithic
SFD'.(Size 41 x Bedrooms 4.Baths.) BBa/asement(wlwo bath). y Garage_'Deck:_Crawl Space-v Slab. Slab'._
(Is the bonus room finished?(f/ )yes ( )no wl a closet?( )yes ( )no Of yes add in with#bedrooms)
❑ Mod:(Size x )#Bedrooms __#Baths_ , Basemen)Iwlwn bath)_ Garage_Site Built Deck:_ On Frame Oil Farre
ps the second floor finished?( 1 yes ( )no Any other site built adotions?( )yes ( )no
❑ 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- Hours of Operation #Employees'.
❑ soAddition/Accessory/Other:(Size x )Use: Closets in addition?( yes (J no
Water Supply: /County Existing Well New Well(#of dwellings using well )'Must have operable water before final
Sewage Supply: k New Septic Tank(Complete Checkllffi) 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 ((jno
Does the property contain any easements whether underground or overhead 1 1 yes (V)no
Structures(existing ori Single family dwellings: I Manufactured Homes: Other(specify))
Required Residential Property Line Setbacks:: Comments:
Front Minimum 3S Actual 40
Rear 2S IiI14-II_
Closest Side Io 2.0
Sidestreeummer lot 20 NIh
Nearest Building N IA NI k
on same lot
Residential land Use Appl.-almn no. . .�-
COLli
APPLICATION CONTINUES ON SACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: 11-11-C L{"W 2 t a `le Oat /V9/21£12-
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If permits are granted I agree to conform to all ordinances and laws of the Stale of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing statements
,`are a accurate d coned th best of my knowledge. Permit subl m to re location if false information is provided.
igniters of Owner or Owners Agent Date 1
"'I Is the ownerhppllcants 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 its employees are not responsible for any
incomct or missing information that Is contained within these applications."'
"This application expires 6 months from the Initial date If permits have not been issued"
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1SiTE PLAN APPROVAL —j�
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AL=108'-7 13/16" E 1 21 )1�h� a (-4
h u. i � �m��� a�--_
FARRAH SHEA WAY
THE \CUMBERLAND HOMES, INC,
tilORGA U WITH
3RD CAR GARAGE
LOT * 5 ROAN KEITH MEADOW
SCALE: 1"E4O'
NAME: Dr lu},F-fv)7) AA(> APPLICATION#:
'This application to be filled out when applying for a septic system inspection."
County Health Department Application for Improvement Permit and/or Authorization to Construct
IF THE INFORMATION IN THIS APPLICATION IS FALSIFIED,CHANGED.OR THE SITE IS ALTERED,THEN THE IMPROVEMENT
PERMIT OR AUTHORIZATION TO CONSTRUCT SHALL BECOME INVALID. The permit is valid for either 60 months or without expiration
depending upon documentation submitted. (complete site plan=60 months;complete plat=without expiration)
910-893-7525 option I CONFIRMATION#
Environmental Health New Septic System Code 8 00
• All property irons must be made visible. Place "pink p roperty flags'o n each corner i ron of lot. All property
lines must be clearly flagged approximately every 50 feet between corners.
• Place"orange house corner flags'at each corner of the proposed structure. Also flag driveways, garages, decks,
out buildings, swimming pools, etc. Place flags per site plan developed at/for Central Permitting.
• Place orange Environmental Health card in location that is easily viewed from road to assist in locating property.
• If property is thickly wooded, Environmental Health requires that you clean out the undergrowth to allow the soil
evaluation to be performed. Inspectors should be able to walk freely around site. Do not grade property.
• All lots to be addressed within 10 business days after confirmation. 825.00 return trip fee may be incurred
for failure to uncover outlet lid, mark house corners and property lines. etc. once lot confirmed ready.
• After preparing proposed site call the voice permitting system at 910-893-7525 option 1 to schedule and use code
800 (after selecting notification permit if multiple permits exist) for En vironmental Health inspection. Please note
confirmation number given at end of recording for proof of request.
• Use Click2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits.
❑ Environmental Health Existing Tank Inspections Cod e 800
• Follow above instructions for placing flags and card on property.
• Prepare for inspection by removing soil over over outlet end as diagram indicates, and lift lid straight up (if
possible) and then close back down. (Unless inspection is for a septic tank in a mobile home park)
• After uncovering outlet end cab the voice permitting system at 910-893-7525 option 1 8 select notification permit if
multiple pe rmits, then a se code 800 for Environmental Health ins pection. Please note confirmation number
given at end of recording for proof of request.
• Use Click2Gov or IVR to hear results. Once approved, proceed to Central Permitting for remaining permits.
SEPTIC
If applying for authorization to construct please indicate desired� / system type(s): can he ranked in order of preference,must choose one.
{_} Accepted { } Innovative Lv}Conventional { } Any
{) Alternative { } Other
The applicant shall notify the local health department upon.subminal of this application if any of the following apply to the property in
question. If the answer is`yes",applicant must attach supporting documentation.
{ )YES j Li/NO Does the site contain any Jurisdictional Wetlands?
{ )YES { � / rrro
NO Do you plan to have an ' 'ea _[ now or in the fure?
{_}YES ( _'}N0 Does or will the building contain any drains?Please explain. _
{ }YES I /NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
{_)YES {4/ 0 Is any wastewater going to be generated on the site other than domestic sewage?
( )YES {✓}NO Is the site subject to approval by any other Public Agency?
{ }YES { ) NO Are there any Easements or Right of Ways on this property?
( )YES { VNO Does the site contain any existing water,cable,phone or underground electric lines?
If yes please call No Cuts at 800-632-4949 to locate the lines. This is a free service
I Have Read This Application And Certify That The Information Provided Herein Is True,Complete And Correct. Authorized County And
State Officials Are Granted Right Of Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules.
I Understand That I Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Site Accessible SSSo That
tAA CCompleteSitteEEvvaallyplion Can Be Performed.
ss *AIL
PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) Ap TE
E Hearth Cheddisl
*Each section below to be filled out Application #
by whomever performing work. Harnett County Central Permitting
Must be owner or licensed PO Box 65 LtlLngta4 NC 27546
contractor- Address,company 910-893-7525 Fax 910-893-2792 www.Karnes orglpermits
name&phone must match
/` Application tor Residential Building and Trades Permit
Owner's Name:num,im, a.x,ry ry D 440 A.c c /�13 C- Date 2'l CI
Site Address: FA-12-RAtt SL*EA- t Phone: • Q ,7tic
Directions to job site from Lillington: -T4 - y 2-t o WictLD 3 A-tdcnE y _
* 1.4.11-w O frb N7hp-1.4FL( Cf f t 4f. 'RP S.-a . L5 Owl
Subdivision: lb f2-t ka (G 1 114 Wt-EA-pO 6.1.3 Lot 5-
Description of Proposed Work: N. S . V . #of Bedroom2: 4
Heated SF:241(0 Unheated SF: Finished Bonus Room? -YES Crawl Space: V Slab:
General Contractor Information
Gu.4v111aOh/JD 4oac.6S 1110c 910 • 892 • Y3I(S
Building Contractor's Company Name Telephone
P . O . 3054 '72-1 PIAM / �1 C- 24335-
rDIV inDrrrg f 157 € yot,60. coin
Address ail Address
5-9493
License#
Electrical Contractor Information
Description of Work N r S.F Service Size:100 Amps T-Pole: /Yes No
WGSTF - * PAct rc2C2-jam 9jq • 919 • s 3Eq
Electrical Contractor's Company Name Telephone
S4 (. L-C-3tiI 172. SA-PJ Fa?DNc— NJ A
Address 2t 330 Email Address
12.o0'l - -4
License#
Mechanical/HVAC Contractor Information
Description of Work P . 5 • F•
SIEPHENsof.1S ks &- et Ma_ 9/9 . 329 • o48 ,
Mechanical Contractor's Company Name Telephone
313 5HIPwksH• v2 6gp.40- uc N A
Address 2176.7.1 Email Address
� BLI.44
License#
t Plumbing Contractor Information
Description of Work • S S . F # Baths 3
�r4 oUc-R.- C6 JnAcT' pLuavo 14J Cr- 919• R(nQ• 0959
Plumbing Contractor's Company Name Telephone
304 Cid/F — U -'-dtJ LIP( LA-uro ), Jc uJA
Address 27332 Email Address
231 L. D
License#
Insulation Contractor Information
a NA--rt -r iC._ 5902 Fmcur itu.cw 919 • 772-.40oo
Insulation Contractor's Company Name &Address tic LEI64f tJ G Telephone
'NOTE:General Contractor must fill out and sign the second page of this application.
Homeowners Applying to Build Their Own Home
I Please answer the following questions then see a Perm,Technician to determined you qualify 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
1 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? i Yes i 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 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 I affirm that I have obtained all listed contractors
permission to obtain these permits and it 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 P RMIT FEES - 6 Months to 2 years permit re-issue fee is $150.00. After 2 years re-issue fee
is as per rr nt fee sch ule.
3�� , ( , �
Sig tura of Owner/Contra or/Oftfcer(s) of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87-14
Theun rsigned applicant being the:
General Contractor Owner Officer/Agent of the Contractor or Owner
Do hereby confirm under penalties of perjury that theperson(s), firm(s) or cot orations
p l y P Operforming the work
set forth in the permit:
Has three (3) or more employees and has onta,ned workers compensation insurance to cuver 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 a; any time during the permitted work from any person, firm or corporation
carrying out the work.
Company or Name. Tj61-10 Npa.l.t=S /--r-Kr [�
Sign w/Title' — _ / r 3 \ rt 1 11)
_Date. o� I1
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 17-50041143 Date 5/10/17
Property Address 175 FARRAH-SHEA WAY
PARCEL NUMBER 04-0662- - -0024- -09-
Application type description CP NEW RESIDENTIAL (SFD)
Subdivision Name BRIAN KEITH MEADOW 25LOTS
Property Zoning RES/AGRI DIST - RA-30
Owner Contractor
BARCO DEVELOPMENT INC CUMBERLAND HOMES INC
PO BOX 65 PO BOX 727
FUQUAY-VARINA NC 27526 DUNN NC 28335
(910) 892-4345
Applicant
CUMBERLAND HOMES INC #5
PO BOX 727
DUNN NC 28335
(910) 892-4345
--- Structure Information 000 000 61X47 4BDR CRAWL W/ GARAGE/PATIO/SCRPORC
Flood Zone FLOOD ZONE X
Other struct info # BEDROOMS 4000000 . 00
PROPOSED USE SFD
SEPTIC - EXISTING? NEW TANK
WATER SUPPLY COUNTY
Permit BLDG,MECH, ELEC, PLB, INSU PERMIT
Additional desc .
Phone Access Code 1186881
Issue Date . . . 5/10/17 Valuation . . . 0
Expiration Date . 5/10/18
Special Notes and Comments
T/S: 04/11/2017 11 : 13 AM JBROCK -- - -
210 TOWARDS ANGIER L ONTO HARNETT
CENTRAL RD R INTO S/D L ONTO FARRAH
SHEA WAY LOT IS ON L - LOT 5
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
PERMIT INCLUDES BLDG, ELEC,MECH, PLUMB
INSULATION AND LAND USE.
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
Work must conform and comply with the
STATE BUILDING CODE and all other State
and local laws, ordinances & regulations
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 17-50041143 Date 5/10/17
Property Address 175 FARRAH-SHEA WAY
PARCEL NUMBER 04-0662- - -0024- -09-
Application description . . CP NEW RESIDENTIAL (SFD)
Subdivision Name BRIAN KEITH MEADOW 25LOTS
Property Zoning RES/AGRI DIST - RA-30
Permit BLDG,MECH, ELEC, PLB, INSU PERMIT
Additional desc .
Phone Access Code 1186881
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
10-30 814 A814 ADDRESS CONFIRMATION / /
10 101 B101 R*BLDG FOOTING / TEMP SVC POLE / /_
20 103 B103 R*BLDG FOUND & TEMP SVC POLE / /
30-999 105 B105 R*OPEN FLOOR / /
40-50 129 I129 R*INSULATION INSPECTION / /
40-60 425 R425 FOUR TRADE ROUGH IN / /
40-60 125 R125 ONE TRADE ROUGH IN / /
40-60 325 R325 THREE TRADE ROUGH IN / /
40-60 225 R225 TWO TRADE ROUGH IN / /
50-60 429 R429 FOUR TRADE FINAL /_/_
50-60 131 R131 ONE TRADE FINAL / /
50-60 329 R329 THREE TRADE FINAL / /
50-60 229 R229 TWO TRADE FINAL / /
50-60 209 E209 R*ELEC TEMP POWER CERT /
999 H824 ENVIR. OPERATIONS PERMIT / /
Appointment of Lien Agent: Details-LiensNC Lien Service https://apps.liensnc.eom/scr/filing/details,html'?entryNumber-650578
DO NOT REMOVE!
Details: Appointment of Lien Agent Plea on: 05/10/2017
Entry W: 650578
Initially filed by: cumber,endhomos
Duigneted Lien Agent Project Property
Print & Post
Investors Tale Insurance Company Lot P 5 Brian Keith Meadows PIN a ❑^i ❑
0652-93-6663.000
O L n195EamhShea
Way
AaW HkShawls
07 Raleigh,NC Angier.NC 27501 ❑
17601 Harnett County
Phone:',Hs-690-7364Contractors:
Please post this notice on the lob Site.
Fev'.9L3-4 -5211
Final::�nrom�i6m•oc..00m...„ Property Type Suppilen and Subcontractors:
Scan this image with yourart phone to
view this filing.You can then file a Notice
-2 Family Dwelling
Lien Agent for Oils project.
Owner Information
Cumberland Homes,Inc.
PD Box 727
Dunn, NC 28335
United States
Email:nnisbuildinggroupl yahoo_com
Phone'910-892-4345
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Techaleal Support Hotline:(888)690-7384
I of I 5/10/2017 1:29 PM