DOCUMENTS SInitial Application Date'. I I I 1 (7 Application# IV t'(l Q lists
CUP
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillington, NC 27546 Phone:(910)893-7525 ext.2 Fax:(910)893-2793 www.harnett.org/permits
"A RECORDEDSURVEY MAP,RECORDEDDEED(OR
1OFFER
ITO PURCHASE)&SITE PLAN AREREQUIREDE7WHEN SUBMITTING A/LAANNDD USE APPLICATION"
LANDOWNER: A LVA 9 L'11�5 a. / �' `e-' ""--1//� Mailing Address: lb [ V Bol! k I /
city: tinily��iployS State:VC Zip275 OContactNo. Email: a1! 1)1 ng-ASA ya(�L�:;Lai
APPLICANT`:: SMW-12---- Mailing Address.
City: State'._Zip: Contact No: Email'.
'Please nil out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE: Phone
/ r, ` k�1 -_ 1 ^Phone# G s�
PROPERTY LOCATION:l / Subdivision: f ref/ l . "V i '1_9-ar Ct z_t - Lot#: � Lot Size:,,• 0 "19C--
State
1 7C'
State Road#1�45 0 State Road Name'. Li � I V4-x �S l 1 /� tf.Map lBackk&Paga)(4/ 53 O
Parcel``�O,�r� x� b co r?Y ( ti apt Y PIN':h�P�l —icCt — `GtLj O C?
Zoning: 12 food Zone'. (C- Watersheds 7 Deed Book&Pag47/ .</Power Company":
*New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monolithic
❑ SFD:(Size xI#Bedrooms:_#Baths._Basement(w/wo bath). Garage: Deck: Crawl Space:_Slab:_Slab._
(Is the bonus room finished?( 1 yes ( 1 no w/a closet?( )yes ( )no(if yes add in with#bedrooms)
❑ Mod'.(Size x it/Bedrooms_#Baths_Basement(w/wo bath) Garage: Site Built Deck: On Frame Off Frame
(Is the second floor finished?( 1 yes ( )no Any other site built additions?(_)yes (_J no
❑ Manufactured Home: SW DW TW(Size x 1#Bedrooms: Garage: (site built?_)Deck: (site built? )
❑ Duplex. (Size x )No.Buildings. No.Bedrooms Per Unit:
❑ Home Occupation.#Rooms: .1 p �J, 1U�see: Hours of Operation: #Employees.
�4 •
ddition/Accessory/Other(5izei-kk - )Use: cC(' ,'r• atAStel.a✓ f
t Closets in addition?( )yes ( )no
1/ W/0(4- PM f-Er
Water Supply: County Existing Well Neth 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 ( )no
Does the property contain any easements whether underground oroverhead( 1 yes ( )no
Structures(existing or proposed):Single family dwellings: 0 if Manufactured Homes: Other(speuty)a % %
k 11.5
Required Residential Property Line Sethi ks: Comments: I7{{
Front Minimum Actu P V
Rear
Closest Side
Sidestreet/co mar lot
Nearest Building
on same lot
i iii ii i /4 . LIi
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FR/DM LILLINGTON: roil-1 v't ( 4"D/ lOI - /I/ s
/-'ipay. ,ern ( L) on it/six" jL �'f nN
Lek ey el fo�jf�rds //Wit IA? 1., I-e*i117O�/) pJCotes%Q#y d
tor 541 1€d e NpProx jr /i'�# CR Sal d peas& >s P/9
1- a t'. r
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 foregoin tements a urat n rrect to the best of my knowledge. Permit subject to rev cation if false information is provided.
� Da
S gnat of ner ner's Agent Pat
"'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"
09109111 Application #
Harnett County Central Permitting
Each section below to be tilled out PO Box 65 Ldhngton NC 27508
910 893 7525 Fax 910 893 2793 www hornet org/permits
by whomever penorming work
Must be owner or licensed
contactor Address company Application for Residential Buildina and Trades Permit
name 8 phone must match /I 1. NT?.ALVA L, A lE4d�) N1/. �r Dale
l51Q P2211 Ed 1- Iy 5 -;.y V Phone 9?199 yY71-410Y
��aaG a54
e Address / ✓
Directions to Job sit m Lillington `y 4/of
Subdivision _ Lot
Description of Proposed Work `e y\A%\ z ee -1.✓v4-' #of Bedrooms
Heated SF Unheated SF Finished Bonus Room9 Crawl Space _Slab
General Contractor Information
Building Contractors Company Name Telephone
Address Email Address
Out_ANL(
License#
Blectncal Contractor Information
Description of Work Service Size _Amps T-Pole _Yes_No
Electrical Contractors Company Name Telephone
Address Email Address
Li iY---
License#
Mechanical/HVAC Contractor Information
Description of Work
Mechanical Contractor s Company Name Telephone
Address Email Address
5f�✓
License #
plumbina Contractor Information
Description of Work #Baths
Plumbing Contractors Company Name Telephone
Address Email Address
License#
Insulation Contractor Information
Ins ation 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 wanino below I have obtained all subcontractors
permission to obtain these permits and if]ay 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-0 Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
is as per c rrent fees edul, �is� 175y0/�/7
S ure of Owner/ polio oil r(s)of Corporation AC
Affidavit for Worker's Compensation N C G S 87-14
The undersigned applicant being the
General Contractor 1 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 N-ye
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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 17-50041272 Date 5/01/17
Intersection
Property Address 1570 BALL RD
PARCEL NUMBER 05-0624- - -0014- -03-
Application type description CP ADD & ALTER RESIDENTIAL
Subdivision Name
Property Zoning RES/AGRI DIST - RA-40
Owner Contractor
NICHOL ELISA M & ALVA OWNER
1570 BALL ROAD
HOLLY SPRINGS NC 27540
Applicant
NICHOL ALVA JR
NICHOL ELISA
1570 BALL RD
HOLLY SPRINGS NC 27540
(919) 649-5226
--- Structure Information 000 000 41. 9X32 . 6 FINISH BASEMENT W/OUT PERMITS
Flood Zone FLOOD ZONE X
Other struct info SEPTIC - EXISTING? NA
WATER SUPPLY COUNTY
Permit RESIDENTIAL BUILDING PERMIT
Additional desc .
Phone Access Code 1189364
Issue Date . . 5/01/17 Valuation . . . . 0
Expiration Date . 5/01/18
Permit LAND USE PERMIT
Additional desc .
Phone Access Code . 1189372
Issue Date . . . . 5/01/17 Valuation . . . 0
Expiration Date . . 10/28/17
Special Notes and Comments
T/S: 05/01/2017 12 : 37 PM JBROCK ----
401 TOWARDS FUQ TURN L ON CHRISTIAN
LIGHT L ON COKESBURY RD TOWARDS HWY 42
L OFF COKESBURY RD ONTO BALL RD APPROX
1/2 MILE ON BALL RD HOUSE IS 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 17-50041272 Date 5/01/17
Property Address 1570 BALL RD
PARCEL NUMBER 05-0624- - -0014- -03-
Application description . . CP ADD & ALTER RESIDENTIAL
Subdivision Name
Property Zoning RES/AGRI DIST - RA-40
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
Permit type . . . . RESIDENTIAL BUILDING PERMIT
999 429 R429 FOUR TRADE FINAL _/_/_
999 425 R425 FOUR TRADE ROUGH IN _/_/_
999 131 R131 ONE TRADE FINAL / /_
999 125 R125 ONE TRADE ROUGH IN / /_
999 329 R329 THREE TRADE FINAL / /_
999 325 R325 THREE TRADE ROUGH IN / /_
999 229 R229 TWO TRADE FINAL / /_
999 225 R225 TWO TRADE ROUGH IN / /_