DOCUMENTS PI
Initial Application Date: .7) . 1 I I
Application# - IL4 1 1 g
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION CU#
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 E/E'D�(�OFFER f CHASE)8,SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER: WA,►�t4 14, • -1 Mailing Address: Sa‘\AC Ct,s be lb c)
it
City: �1 State:/- Zip: f• Contact No: ,, Email: j 0 Q(\ r or r I S 1957 @ t/Q,ioD.
APPLICANT': CA.WI'1 Q eft-C/�tJ� HO4 .gvhng Address: ?. O • Bose '7 227
f �'�`•�
city: b u t,'r.) State:K C Zip:2g33SContact No 91 D 912 . 113 et Cie I
'Please fill out applicant information if different than landowner Email:
CONTACT NAME APPLYING IN OFFICE: M t C(rtEL'Le; 0 1R, Phone# 9I.0 • i9 i • 143'1 r-
PROPERTY LOCATION:Subdivision: I Ar�
Lot t 2 Lot Size: ' 7
State Road#___.l'14 3_.__State Road Name. 1.-A'FA-y GTI ',LD
(�
2 Map Book&Page:20( 1 / 52•
Parcel: n d S D(P5 7 001 rl ( I PIN: 0(p S S • (P`T/� . 017 . coo
Zoning: RA'1OFlood Zone: )C Watershed: u'A Deed Book&Page: 3 473/ 3 2(� Du KE'
Power Company':
'New structures with Progress Energy as service provider need to supply premise number
• from Progress Energy.
PR OSED USE:SiIQ
SFD:(Size t I x �+)#Bedrooms:1#Baths:21/�asement wtwo bath): / / Monolithic
� ( ) Garagge:V Deck: Crawl Space: Slab: Slab:_
(Is the bonus room finished?(V)yes ( J no w/a closet?(V)yes ( )no(if yes add in with#bedrooms)
❑ Mod:(Size x )#Bedrooms #Baths Basement(w/wo bath) Garage: Site Built Deck: On Frame Off Frame
(Is the second floor finished?(_J yes ( )no Any other site built additions?( )yes ( )no
❑ Manufactured Home:_SW_DW__TW(Size x )#Bedrooms: Garage: (site built?. )Deck: (site built?
D Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:#Rooms: Use: Hours of Operation:
*Employees:
❑ Addition/Accessory/Other:(Size x )Use:
/ _- Closets in additions l�yes ( )no
Water Supply: /County 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 hundred feet(500')of tract listed above?( )yes ( 1/)no
Does the property contain any easements whether underground or overhead( )yes (,.L no
Structures(existing otoposec3 Single family dwellings: I Manufactured Homes:
Other(specify):
Required Residential Property. Line Serh+..L, Comments:
Front Minimum 3 . Actual 5e
Rear
25- ti
Closest Side 1 0 aft
Sidestreet/comer lot 7 0
Nearest Building N 1 A
on same lot
Residential Land Use Application ''?.3e 1 _
APPLICATION CONTINUES ON BACK 33r11
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: --544-t, 4D l —tc W kQ S
F ( ii
Z u Ill (A l.Jl.1'3 0-1-0 4 --i-tit. c-^( k-t&'6YT o Ks-ry l4 CL4A k
t-0 1- l S o K1 f0 LSF��( t�'Ifi� 12-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 statements are accurate d correct th best of my knowledge. Permit subject to revocation if false information is provided.
13
ig�Owner or Owner's Agent 3 (,
Dateti
"`It is the owner/applicants 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
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`,
0311 1
CUMBER--AN HOMES [INC9O
THE AVA1O WL] SCIREE PCIC I
* 2 I AFAYET E ROAD
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LAFAYETTE ROAD
NAME:OAAPAADCYL SND 4 W-trS
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 v is;ble. Place"pink p roperty flags" o n each corner iron 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.
❑ 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.
SEP'T'IC
If applying for authorization to construct please indicate desired system type(s): can be ranked in order of preference,must choose one.
{ } Accepted { } Innovative {%/ Conventional 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 { NO Do you plan to have an itt ation system now or in the future?
{_)YES { NO Does or will the building contain any tJraitys? Please explain.
{_}YES { V'O Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
{_}YES { vr O 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 { 1,410 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) 1ATE
E-Heatth Checklist : ,f f
•Each section below to be filled 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 8 phone must match
/� Application for Residentialr1Building and Trades Permit
Owner's Name: (AAMft'j L#'��D `�9 AA-ES r-rt)S C� 3 f?I (
VA�� Date:
Site Address: `7 E (LP Phone:gib •g 52 • ci,Nr-
Directions to job site from Lillington: ` Pc 1-h.i'( t.40 I --r Ik_5 RA,
u Lut'J (f1-b -t-t•,r„g.N o krrt.Df Acat re D
Is kJ CP- y
Subdivision: AS IPr
Lot: Z.
Description of Proposed Work:
• S ' • #of Bedrooms: 2
Heated SF:2. Unheated SF: Finished Bonus Room? .yEs Crawl Space: Slab: V
General Contractor Information
C.-t vt Ba c-1k?,J, No rK-c�c �- o • 84/2 . Y3�f S
Building Contractor's Company Name Telephone
P • 0 • Boy_ rj2r7 1>U. i � - 2Es335 ' oeme)Drr'is I TS76) Yaiioo. coM
Address
594 q3 Errnail Address
License#
Electrical Contractor Information
Description of Work ti 1 S.F Service Size:top Amps T-Pole: V Yes_No
W ES-i sr Pik c-E 919 • 19 . 53€q
Electrical Contractor's Company Name Telephone
64 (, L-E5UC p , SkIF , ►vL ( A
Address
12.001 -
2C 33v Email Address
License#
Mechanical/HVAC Contractor Information
Description of Work r4 . s . F.
Pt€ iJ 0 s WS-A-71 N cr rt L q let • 3 21 • 0 6 8(0
Mechanical Contractor's Company Name Telephone
313 cSH IPwhsH• L2 •axii uC N A
Address
' 13 (s)4� 2751 Email Address
License#
ll tt Plumbing Contractor Information
1/
Description of Work Iv , s • r #Baths .4-- �-
6i-ov 11L Co Wr12A Cr 1'LU ./0 r Al Cr 919. SCo S• 0959
Plumbing Contractor's Company Name Telephone
30�{ 0.14.E c14DL,L.dt,1 wk y sA--tJFD r21), ^Ic 1 A
Address 2 7 3 3 2 Email Address
License#
Insulation Contractor Information
= N St.t.L. A-T1 Ns 6- -T_Ai L 5902 FAyEarl I u.F AD 919 . 772 -I coo
Insulation Contractor's Company Name & Address LEl G-!f 1.3 L 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 fee sch ule.
v
Sig :ture of Owner/Contra or/Officer(s) of Corporation at
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.
LZ Has one (1) or more su
bcontractors(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 an
carrying out the work./�CA
. y person, firm or corporation
Company or Name: 15e12-1.-A- 0 D •L415 -T-N.J. c___--.
Sign w/Title: Ott. f
Date: 3 31
Appointment of Lien Agent:Details-LiensNC Lien Service haps://apps.liensnc.com/scr/filing/detaile.html7entryNumher-647880
DO NOT REMOVE!
Details: Appointment of Lien Agent
Entry it: 647880 Filed on: 05/05/2017
Initially filed by: cumberiandhomea
Doigneted Lien Agent Protect Property
Print & Post
Investors Talc Insurance Company Loi 2 Lafayette Road PIN 0653-64-0176 000 f• r�
258 (yl Road p
y 4 y V ,NC 27526 /
Address: W.}boom .Sane 507 Nalogh N1' Harrell Cowny
P601
Phone:sus W0.2R1 Contractors:
Please post this notice on the lob Site.
Fn'.Sts-Ia4i_ll Prop Rly
Type
Emmb.aeoorvn 6enmssane... �.„, __ Supplien and Subcontractors:
Scan this imago with your smart phone to
I-2 Family Dv.ening view Otis filing.You can then file a Notice
lo Lien Agent for this project.
Owner Information
Cummberland Homes.Inc.
PT Box 727
Dunn NC 28335
united Stale
Email:nortisbutdinggroap4vyaboo.com
Phone.910-892-4345
View Comments Int
Technical Support llotlinn1888)690-7384
loft
5/5/2017 10:49 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 17-50041178 Date 5/05/17
Property Address 258 LAFAYETTE RD
PARCEL NUMBER 08-0653- - -0097- -01-
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 #2
PO BOX 727
DUNN NC 28335
(910) 892-4345
--- Structure Information 000 000 74X48 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 1189968
Issue Date . . . 5/05/17 Valuation . . . . 0
Expiration Date . 5/05/18
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 17-50041178 Date 5/05/17
Property Address 258 LAFAYETTE RD
PARCEL NUMBER 08-0653- - -0097- -01-
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 1189968
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 Bill R*BLDG SLAB INSP/TEMP SVC POLE / /_
30-999 309 P309 R*PLUMB UNDER SLAB
30-999 205 E205 R*ELEC UNDER SLAB / /_
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 / /
Date S/t-t I 1
Plan Box ft Al Job Name Ct , vv.ts- .a.. .ct
APP# 41 t 1S( Valuation a 1Oi L SQ Feet (9-5-3 2--
Garage
Garage 6 4' 6
X3.2 2 8'
Inspections for swam /
Crawl_ Slab ✓ Mono_ Basement_
Footing Footing Plum Under Slab Footing
Foundation Foundation Ele. Under Slab Foundation
Address Address Address Waterproofing
Open Floor Slab Mono Slab Plum Under slab
Rough In Rough In Rough In Address
Insulation Insulation Insulation Slab
Final Final Final Open Floor
Rough In
Insulation
/ Final
Foundation Survey_ Envir. Health 1/ Other
Additions/Other
Footing
Foundation_
Slab_
Mono_
Open Floor_
Rough In
Insulation_
Final