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DOCUMENTS Initial Application Date: 3JiI l I7 Application# I 9SOOL1 I 19 r7 COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION cult Central Permitting 108 E. Front Street,Lillington,NC 27546 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 www.hamett.org/permits '•A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION— LANDOWNER: LANDOWNER: ( ?01-C, L(o .& s 1N(/ Mailing Address: Set Po-e- c.c.s 6e.1D t..) 1r1 City: State: Zip: r' Contact No: 1` Email: 1 oaA r•p r ri s I 1 57 @ L 4hoD• C� n .'-_ ,/F- TI.�L J GOAL APPLICANT*: BEA-C-AIJD ort bailing Address: ?. ° • Sow- '7 21 City: hu N�,1 State:K C Zip:2 V 33SContact No:d 1 D e 72 ' 43 t S 0Email: • 'Please fill out applicant Information it different than landowner ' t, CONTACT NAME APPLYING IN OFFICE: M t C Yi E L 0 -313 fro.1 Phone# 9 119 • 9 Z • q3`1 S PROPERTY LOCATION:� Subdivision: N I A _ Lot#: I Lot Size: '19 ( f State Road# 1 �l {S State Road Name: rf L�F�c� IQ_P Map Book&Page: 2017/ S2. Parcel:_O &(PS3 009- / PIN: 04•53 • lel • Di3I . 000 Zoning: RA',3OFlood Zone: >C Watershed: NIA Deed Book&Page:34 73/32() Power Company': Du kL.E 'New structures with Progress Energy as service provider need to supply premise number from Progress Energy. PR9POSED USE: 1111( SED:(Size_� x fid 2 . /Monolithic f 1 )#Bedrooms) #Baths:2-13aasement(w/wo bath):__Garage Deck: Crawl Space: Slab: V Slab._ (Is the bonus room finished?( V)yes ( )no wi a closet?(V)yes ( )no(if yes add in with I bedrooms) O Mod:(Size___-_.x_ _ _. )#Bedrooms __I Baths_Raspment(wry,^bath) Circ Cullt:lea. On France Off rrame •_ (Is the second floor finished?( )yes ( )no Any other site built additions?( )yes (_J no D Manufactured Home: SW_DW_TW(Size x lit Bedrooms: Garage: (site built? )Deck: (site built? ) O Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit: D Home Occupation.I Rooms: Use: Hours of Operation: *Employees: O Addition/Accessory/Other:(Size x )Use: Closets in addition?U yes ( )no Water Supply: %soCounty Existing Well New Well(#of dwellings using well )'Must have operable water 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 hundr d feet(500')of tract listed above?( )yes ( V)no Does the property contain any easements whether underground or overhead 1 U yes ( )no Structures(existing o •ropose• .Single family dwellings: ‘ Manufactured Homes: Other(specify) Required Residential Property Line Setbacks: Comments: Front Minimum 35_ Actual 50 Rear 25.- 2451 f)1 — Closest Side 10 I o rj-M Sidestreet/comer lot 2 D N I i,- Nearest Nearest Building N I Q Nil Pc on same lot Residential Land Use Application Page 1 of APPLICATION CONTINUES ON BACK • • SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: -rkvot -- '( L( ( 'ro(,tf 0 Ps Fuc. ,A t/ FiLoitA LAA ,t►..�(,ia'J ` i.1J R& o iJ O t..-4A1 or (,o-r i s or..1L- .), 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 statements are accurate d correct th best of my knowledge. Permit subj ct to revocation if false information is provided. 3 ignature of Owner or Owner's Agent D "`It is the owner/applicants responsibility to provide the county with any applicable information about the subject property,including but not limited to:boundary intormatlon,house location,underground or overhead easements,etc.The county or its employees are not responsible for 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 60T21661t1 OVOE .B.AV 4V c a * .0' H3E104 NR2d3S ]4JJM ONV )WO n. °O M 6SENCH QV13 Ai/1.-,00L M „OOOO'L5 III( ran AWt&A10 1.-- 3Mhl 1M IOU 36101 A/115 1,13 Z ,1 �- 100, nava aiw I axn n" Z O CD O CD . . Ilk —..400.4.4441 U r. `, c � M SNO08039#' v ( iOU±1SIU w O rn lVAOHddtf Nd1d 3115 0 c;, U it NAME: C .AM4436A-M4D. ) SCS I If C--- 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. "['he 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 1 CONFIRMATION# Environmental Health New Septic System Code 8 00 • All property irons must be made v isible. 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. $25.00 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. 0 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 call the voice permitting system at 910-893-7525 option 1 & select notification permit if multiple permits, then u 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 be ranked in order of preference,must choose one. {_} Accepted {_} Innovative {VrConventional {_} Any {_} Alternative {_} Other The applicant shall notify the local health department upon submittal 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 { v}/NO Does the site contain any Jurisdictional Wetlands? {_}YES { NNO Do you plan to have an jrrigation system now or in the future? { }YES { ✓'NO Does or will the building contain any drains?Please explain. {_}YES {�NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property? {_}YES { VO 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 { le NO 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 So That A Complete Site Eval tion Can Be Performed. PROPERTY OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) AT E-Health Checklist , ,;t< 12/10 'Each section below to be tilled out Application # by whomever performing work. Harnett County Central Permitting Must be owner or licensed PO Box 65 Lillington,NC 27546 contractor. Address,company 910-893 7525 Fax 910-893-2793 www.harnett.org/permits name&phone must match Application for Residential Building and Trades Permit /� Owner's Name: ( A D 4-0 1,2•E S �*j L Date: 3(31 111 Site Address: L-A F y OW rz-P Phone:-1 i b •B /2 • ,t3(tg" Directions to job site from Lillington: -01-11-C; (•llA/LI ij b 1 1-7)t✓k 24 S F p Lo?.t tit LA,UN)cer-P4-4 .. () oN-r-t) LIQ-PAttc p L.oT I ) Btu Subdivision: Lot: I Description of Proposed Work: N. S . . #of Bedrooms: 3 Heated SF:X47 Unheated SF: Finished Bonus Room? .yEs Crawl Space: Slab: General Contractor Information C.u,m dell LA-MD E-k)K-t—S it 1.) -_ 91 o _ 8412 . '13c/5-- Building Contractor's Company Name Telephone p • c . 3oX r727 1>u-1J JJ A1C 2335 ✓)arr';s ?57 Yatlpo. IoM Address trInail Address 594fg3 License# Electrical Contractor Information Description of Work N t S.F Service Size:2-o0 Amps T-Pole: V Yes No 1J s- PAcc rLa.2-1c_ 9Ia • qc 9 • s3gq Electrical Contractor's Company Name Telephone 6-4 (o LC5L4E D& 5A JFoRD, NL NI A . . Address 2g&3p Email Address t 2 00''1 - License# Mechanical/HVAC Contractor Information Description of Work t4 . 5 • F 5'E P Ht-145.00S WS-A-71 tr 4 h(IL Nc- 91 ct • 3 29 . 0`86 Mechanical Contractor's Company Name Telephone 343 S 4 iPwkSH• Pe- mit- u kJ a Address 2x1529 Email Address 1 Bt 4.4 License# N Plumbing Contractor Information N Description of Work , s S . F # Baths 2- &7-D(t 1L Cb N'rRA cr P L.t4&M3 r rU G- 119. S(,g•Plumbing Contractor's Company Name Telephone 3011 Qi—tic cV i tA.ANJ uA-Y SA-,.1E6401 ',lc N/A Address 27 3 3 2 Email Address �3i (. o License# Insulation Contractor Information = N ArT1 ►s (:- t✓ 59 o f FAA/cirri f o•f AD 9 t 9 . 7'72"I o o o Insulation Contractor's Company Name & Address ,Mikr.6.44 r. Telephone *NOTE: General Contractor must fill out and sign the second page of this application. Homeowners Applying to Build Their Own Home Please answer the following questions then see a Permit Technician to determine if 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 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 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 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 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 -2.12 1 7 Sig :ture of Owner/Contra or/Officer(s) of Corporation Date Affidavit for Worker's Compensation N.C.G.S. 87-14 The un rsigned 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 ootained 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 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: r ' T5 --Lk 0 4OLA,=S /--T,14 Sign w/Title: b `_ Date: 3 (31 ii Appointment of Lien Agent: Details-LiensNC Lien Service https://apps.liensnc.cora/scr/filing/details.html?entryNumber=647109 DO NOT REMOVE! Details: Appointment of Lien Agent Filed on: 05/04/2017 Entry #: 647109 Initially filed by: cumberlendhemos Designated Ll,n Agent Project Property Print & Post Imestars Tu be Insurance Company Lot K I Lafayette Road PIN 00653-64-0131.000 ❑ ❑ onwe.xuwtienancooim... ...._._� 235 -e ayette Road Fuquay Varina, N('27526 Address:tau.darter Sr_Suite 501 Raleio Nc Harnett County ❑ :7601 Contractors: Phone:a 1-6911-7384 Please post then mance on lie Job Site. Far:911-B9-523I Property Type Suppliers and Subcontractors: Scan this image with your sman phone to ew this filing You can then file a Notice 1-2 Family Dwelling to Lien Agent for this project. Owner Information Cummberland Homes,Inc. PO Box 727 On, NC 25335 United States -maim msbuildinggroup(wyahnncoiii Phone 910-892-4345 View Cmnmenm lit) Technical Support Hotline:1558)690-7384 1 of 5/4/2017 11:09 AM 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 17-50041177 Date 5/04/17 Property Address 238 LAFAYETTE RD PARCEL NUMBER 08-0653- - -0097- - - Application type description CP NEW RESIDENTIAL (SFD) Subdivision Name Property Zoning RES/AGRI DIST - RA-30 Owner Contractor CUMBERLAND HOMES INC CUMBERLAND HOMES INC PO BOX 727 PO BOX 727 DUNN NC 28335 DUNN NC 28335 (910) 892-4345 Applicant CUMBERLAND HOMES INC #1 PO BOX 727 DUNN NC 28335 (910) 892-4345 --- Structure Information 000 000 64X74 3BDR SLAD W/ GARAGE & COV PORCH Flood Zone FLOOD ZONE X Other struct info # BEDROOMS 3000000 . 00 PROPOSED USE SFD SEPTIC - EXISTING? NEW TANK WATER SUPPLY COUNTY Permit BLDG,MECH, ELEC, PLB, INSU PERMIT Additional desc . Phone Access Code 1188622 Issue Date . . . 5/04/17 Valuation . . . . 0 Expiration Date . 5/04/18 Special Notes and Comments T/S : 04/18/2017 04 : 08 PM JBROCK --- - LAFAYETTE RD 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 17-50041177 Date 5/04/17 Property Address 238 LAFAYETTE RD PARCEL NUMBER 08-0653- - -0097- - - Application description . . CP NEW RESIDENTIAL (SFD) Subdivision Name Property Zoning RES/AGRI DIST - RA-30 Permit BLDG,MECH, ELEC, PLB, INSU PERMIT Additional desc . Phone Access Code 1188622 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 / /_ 30-999 111 B111 R*BLDG SLAB INSP/TEMP SVC POLE _/_/_ 30-999 309 P309 R*PLUMB UNDER SLAB / /- 30-999 205 E205 R*ELEC UNDER SLAB _/ /_ 30 104 B104 R*FOUND & SETBACK VERIF SURVEY / /_ 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 / /_