BUILDING • Each section below to be filled out Application # /9 5 .--",,, �(p U /
b9 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 w#w.harnett.orglpermits
name & phone must match
Application for Residential Building and Trades Permit
Owner's Name: ( r net -t- Re k r h &n akt rs. Date: al AL ?6149
Site Address: CO I rsnt,00t) Dom Phone: 1(9 4/5-4/ S6
Directions to job site from Lillington: H 1 t-t T R 0440 4.63)4 r'L 8.t /wits)
Subdivision: 4'111 7. r ) P Fol.., 5 Lot: S $
Description of Proposed Work: toe" alit-, anb CarGOrf eftat Imn # of Bedrooms: 3
Heated SF: 112 1 Unheated SF: MI Finished Bonus Room? pa Crawl Space: V Slab: _
r General Contractor Information
or:ttkIn4,Y I Conlrtcid (*nett 1.‘C Rho e2 /, tile F'
Building Contractor's Co t zany N . Telephone
- P.0 P.0(Zp ■ • add N -- $395 dr4n00 et/ 4. pad, too)
Address Email Address
4 I 4 - _ rodeo
Si�natur f Owner /Contractor / Officer(s) f Corporation License #
Electrical Contractor Information
Description of Work 90 c..t..4,t mow eIdP, Lrn..Service Size: , CO Amps T -Pole: Yes !410
1 91,145/ kYO1$ 1iartil,c tam ib• 3;3
Electrical Contractor's Company Name Telephone
iIS4 k24 rr�'ddwAD L� f ill 4 . �4)3t . 4jtN Q S i4 / a14GEJ. rut, Lom
`\1
Addres Email Address
1Qpe.� I b b0 (o U
Signature of Owner /Contractor /Officer(s) of Corporation License #
Mechanical /HVAC Contractor Information
Description of Work gI /((/ a MJY CUYQ rams
CL„ --r,-1-4,,,.., L / 4S qF 1.A&. y'1 i .4 40 - 70G3
Mechanical Contractor's Company pame Telephone
14 Ado(. 'b&cnii atc33
Address , , Email Address
J am:` A LI50$
Signature of Owner /Contractor /Officer(s of Corporation License #
Plumbing Contractor Information
Description of Work ' ft. ( taf N - . t, # Baths Z
, • L c, ' . f , ,u - I. g (0, °6ie <i9or
Plumbing Contractor's Com: -any Name Telephone
?e : 1. -'i r /, N L aIS3 - C deQn down /n' Qt�irtar1
Adm. ersa Email Address
Sign!.,:ure of Owner /Contractor /Offic: r(s) of Corporation License #
Insulation Contractor Information
iRAnC *24 - , LLL ), _ - It t o '4qa
Insulation Contractor's Compa , Na - & Address Telephone
4.9 N c 0 1‘59c
*NOTE: General Contractor must fill out and sign the second page of this application.
Rcsid. n 3 Idu,g , , ca! 'on 1 of 2 03110
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
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 Hamett County Zoning Ordinance. I state the information on the above
contractors is correct as known to me and if a_y 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 m responsi• ity to notify the Harnett County Central Permitting Department of
any apd all c ge
EXPIR • - r I ES - 6 0 to 2 years permit re -issue fee is $150.00. After 2 years re -issue fee
is as = ee s.hedul=
2� NmJ 2eot
Sign4ture o Owner /Contractor /Officer(s) of Corporation %
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.
✓ 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 • ring the permitted work from any person, firm or corporation
carrying out the work.
Company or Nam • : i_.L
4 . a ■ / • ' 4.4Z
Sign w/Title: • . _ ' • au -.. r/I Date: 24 Ned Zin
Residential Building Application 2 of 2 03110
Plan Box Number iSa Job Name -tL
Date: \Z -Ti- CO'
Required Inspections for SFA/SFD
Appl. # 1 sod R- SG o
Valuation_ 3 4 7
Sq. Feet ) 7 . Y
Sequence
10 tV R* Bldg. Footing
10 -30 R* Elec. Temp Service Pole
20 ✓ R* Building Foundation S 1 -(Tc
20 Address Confirmation
30 -999 •✓ Open Floor r
30 -999 R* Bldg. Slab Insp. V 2. 6 3
30 -999 R* Elec. Under Slab
30 -999 R *Plumb. Under Slab 7 0 6
40 ✓ Four Trade Rough In
40 Four Trade Rough In> 2500
40 Three Trade Rough In
40 Three Trade Rough In> 2500
40 Two Trade Rough In
40 Two Trade Rough In> 2500
40 One Trade Rough In
40 One Trade Rough In > 2500
50 ✓ R* Insulation
60 ✓ Four Trade Final
60 Four Trade Final > 2500
60 Three Trade Final
60 Three Trade Final > 2500
60 Two Trade Final
60 Two Trade Final > 2500
60 One Trade Final
60 One Trade Final > 2500
999 Envir. Operations Permit