DOCUMENTS 00109111 Application#
Harnett County Central Permitting (4I t4sS
PO Box 65 Lillington NC 27546
Each section below to be filled out 910 893 7525 Fax 910 893 2793 www harnett cm/permits
by whomever performing work
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name&phone must match pp
Owners Name bila I/Mis/ Rea Zvi; • Date 7-/9-
Site Address 7// En/Ori/ /. r // Phone /
Directions to Job/site efrom Lillington ,Lean lr Anfr. 1O4 en/ Yat I '7/O4P a/ F,- . 7 n.,.- 1 I
0,A; 0lO/ silme is A // yot} e1)0550tier -Sill,* AOJ coh. ,2 m.' -5
ON /e (1/ `/Alesi/l'�(ne�ojaiCf4 ALOo/S5e1a� 2a4aCa,4,,._15'4r✓,.k Job .54,07�s &tient.
Subdivision OIK10(a PU04�i< Lot A /
Description of Proposed Work .750) #of Bedrooms _..3
Heated SF/4 Pr/e4 Unheated SF 444 Finished Bonus Room? Crawl Space Slab _
lit
��"� J� -7-' General Contractor Informati
[i'/4K4 /reef/1 —FNL . 06 - kg)."3/.2-3
Bu/1)ldln/g7 Contractors�s Comp y Name Telephone //
1 • u, -` 7 6 .IJNNN Al. L • ryy actions**w'ello.Rsrea�ry,lusn
Address E/nail Address /
777Hee at
License#
•i., Electrical Contractor Information
Description of Work c i 1, Service Size 200 Amps T-Pole Yes No
'IA ppeelet6,'cAi 9/9- , „2D - 9F39
Ayecttri/c al Contractors Company Name T /�/ /� Telephone / / / �/
d / &tger Ltee/C - lhi. —Da** /✓IL. �II h i�e%G77/c; �-C/7a]Mw,L 'ea.*,
Address mil Address
,17,22,Yci CL
License#
Mechanical/HVAC Contractor Information
Description of Work 5 FT)
�* m Nut 9/d -k>'7 s--e) i
Mechanical ContractorctetCpomppany Name �/ /' Telephoneo / / /
/72 t IHih /QW XV �NNN /U L' M MAt/I1 c'em4r,✓/xc,NeI
Address / 'mail Address /
j'7/G V
License#
�- Plumbing Contractor Information /
Description of Work 5F> . #Baths /.--
firr f/Nark 9ro• n0 79247?91
Plum g Contractors Comve Name �// Telephone
3-'SS TZ/?X rj L.'/Gvl-L/ N. C . mA,veiplunhkje6 e 91,9.lOm
Address d Email Aderess f et
3/-5W0
License#
� // Insulation Contractor Information v /// ell-
fi; C- � —1Nsu inh0.✓ fit) - 7611 - el
Insulation Contrac)(s 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 by swine below I have obtained all subcontractors
permission to obtain these permits and if say 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-6 Months to 2 years permit re issue fee is $150 00 After 2 years re-issue fee
is a per curr nt fe= schedule
. Y
nature of yf ner/Contractor/Officer(s) of Corporation Date
Affidavit for Worker's Compensation N C 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
(/HHas 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 Na - A . /IOus Aped_ it —LNG-
Sign w/Title / - „��. t+,1> ,.![, fr?I Date /-/4,-/ 7
Appointment of Lien Agent: Details- LiensNC Lien Service Page 1 of 1
DO NOT REMOVE
Details: Appointment of Lien Agent
Entry k: 619579 Hind on: 07/19/2017
Initially /lied by: Welionae
Designated Lten Agent Project Property
Print & Post
Investors Tine Insurance Company Lot n Oxford Wood Subamislnn 12.;:t. El
Onlire: III Eaton Dove
Angier,NC 27501
Abdrw:19 W.Hargett S1,Sum On/Raleigh,NC Harnett County 111..o'Z.1s•
27601
•
nom 814.690-7384
Pas:91H105231 Please post this notice on the Job Site.
Property Type
Eia&i 1prypplleemewin ...,,i ,.: Suppliers and Subcontractors:
Sean this image with you m
IS Family Dwelling view Ws filing You can then file leaa Notie
to Lien Agent for this proles!.
Owner Information
•
Date of First Furnishing
Wellen.Realty,Inc.
P.D.Box 730
Dunt,NC 28335 07131/2017
United Sola
Email:Nucasswellcnsconswctim coin
none:910-893.1123
View Comments(01
Technical Support Hotline:1888) 90-7384
haps://apps.liensnc.com/scr/appointment/details.html?entryNumber=689579&printable= 7/19/2017
PRELIMINARY 56.21'
NOT FOR RECORDATION, NO0'21'24"'N
CONVEYANCES.OR SALES.
SETBACK LINE
T 25
MAPJ/ 201 —147
I
REI
Z
Zr27
VI O
NI
I
Z
Cu
20 sc d I 21 N a 22
A
10
" NI BE
F 0.60 Acres
I
I
23 -
22 2e
I PROPOSED a Is'
I ^ FOUNDATION
I21.7 at
,2 J
SETBACK LINE
35 -
--15-1@!i 100.00'
Easement • .,
L=100.52'
R=285.00
EATON DRIVE 50' R/W
BEING ALL OF LOT 21 OXFORD WOODS SUBOMSION, MAP # 2017-147
PLOT PLAN FOR
Wellons Realty, Inc.
BLACK RIVER HARNETT CO.,
I. Ronnie E. Jordanunder TOWNSHIP NORTH CAROLINA
retry that survey PIN moyn a e[ mr SCALE: 1" = 40'
u n wm un laud male under my eLP•memn
(heel a boundan ,.[noel In males_ Pape _ em.)(aned: JULY. 19TH, 2017
that the boundaries not none..] on cloudyIndicated a. drawn
Imm Information found In Pwy., Pa�J That the ib
of pr.cltlon cm calculated number I. P'0.Wh+ day my original E. Jordan. PrWwional Land Surveyor
Mtn. Ikon., number and seal th4ay of_Ah.. I.
SRS, certify that Oil, plat Is a survey
2812. of an Writing rel or portas of land.
3126354%---- ` aomnr—
\ RONNIE E. JORDAN PLS
35 GLENFIELD DRIVE DUNN,N.C. 28334
PH.(910)897-6981 CELL(910) 237-5893