DOCUMENTS Initfal Application Date:1011111 AppIcalion N ► ,1 S W 1-1] 53O
1 Cu.
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,LXllnpbn,NC 27548 Phone:(010)8937525 ext:2 Fax:(910)893.2793 www hametaorplpennlis
'A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)I SITE PLAN ARE REWIRED WHEN Nl9MITTINO A LAND USE APPLICATION"
LANDOWNER:McKee Home*,LLC Mailing Address:109 Hay Skeet,Suite 301
Fayetteville Stele:NC 2p:28301 Contact No:(910)475.7100 ext 722 Email: ipedmemdteNgmeMt.com
APPLICANT':McKee NUMB*LLC Mailing Address:1 W Hey Street,Suite 301
City. Fayetteville Sista:NC Ly:28301 ConIa No: (910)475-7100 tort Email: 'WRDnemckeehomeenc.com
'mime Mout appi cat MMmMM M 01fferant than landowner
CONTACT NAME APPLYING IN OFFICE:/Jo Parton #(910)4755--]100 ext 722
PROPERTY LOCATION:Subdtkbn: OAk Mint
1 Lot*: /9 I Lot Size. •443 �C
State Road I/ 54 Stale Road Name: I4CAte/(WRPb be. Map Book&Page: ea.)fir / 47
parcel: 00�3�9584101 loll 24 1 PIN: oco9-0001-1-/3- a85S . 600
Zonk \eq)V r// T
Flood Zone: lam- Watershed: MP 7 Deed Book&Page: 13U /003 S power Company': Central Electric
'New structures with Progress Energy as service provider need N supply premise number from Progress Energy,
PROPOSED USE:
✓ MenW7
id SFO:(Sixe 4�1x4�1)#Bedrooms:_3 #B&ha:�e�ement(wlwo bow:-Garage: pa/_Crawl space: Skb:_ske:N_/
(Is the bonus room finished?( yes no w7 a dont?LJ yes (yaw(If yes add in with N bedrooms)
O Mod: Size_x 1#Bedroome_#Baths_Basement(w/wo bath) Garage:_Site Built Deck:_ On Frame Off Frame_
Os the second floor finished?(J yes L)no Any other site bust additions?LJ yes (J no
❑ Manufaclured Home:_SW_DW_TW(Size )p Bedrooms: Garage: (site built?_)Deck: (alta bull?_)
O Duplex:(Size_x )No.Bulidngs: No.Bedrooms Per Unit:
O Home Occupation:a Rooms: Use: Hours of Operation: #Employees:_
❑ AddlfoNAacessory!Other:(Size x 1 Use: Gimlets In addition?(J 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 ChecM/s0 _County Sewer
Does owner of this bets of Land,won land that contains a manufactured home within five hundred feet(500')of tract listed above?(J yes ( )no
Dues the pmpedy contain any easements whether underground or overhead Li yes U no
SWdurn(existing or proposed):Single family dweNnge: Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum Actual 3'6 (
Rear gill'
Closest Side 34.55
Sldesbeevcomer fat
Nearest Befitting Ulk
on same lot
les denial Lgrid Use ACn cation dna 1 of O3%,t
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINOTON:
bats Rd . to EX/,c.vtivt t r. -j, Awl-1.4r wood Er,
If permits are granted I agree to canbrm to all ordinances end laws of the Stab of North Carolina regulating such work and the spectratbns of plans submitted.
I hereby state that foregoing statements are accwate rad correct to the beet of my knowledge. Permit subject to revocation If fabs information Is provided.
Signetner or Owner's Agent Date
'^N is the ownarlaplionb responsibility to provide the county with any applicable Information about the subject properly,Including but not timitsd
to:boundary InformHlon,house location,underground or overhead easements,etc.The county or Its employees Sr.not responsible for any
incorrect or missing Information that Is contained within these applications.'"
'Thio application expires a months from the Initial dela If permits have not been issued"
deneel Land Jae AFnl cal ren - s n [ C3r1
Er
HOUSE PLAN: TUCKER W/COfWEO PORCH - LH
gc Op10
505'42'11.WI
104.51'
1 I
I I (192
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(19())
I I
I I
I I
p N I PROP. o o
o i°
PORCH C ;e
WI r
P i co
-
I. 11.0' In r
36.63'—y 34.55'
30.7' '^.11.3'
1 1
I PROPOSED I
N HOUSE M
v
I r6.0"F 5. .
L . _ . 200' I< 11.o N _ J
Lb PROP. S/W
L
0 60 SF
ES u A
o.o"Loi
— _ n
HEATHERWOOD DRIVE(50'R/W)
PRIVATE & UTILITY ACCESS (30' BC-BC)
-___________ _ _
PLOT PLAN ,oczt"E s'AR9<,•••;
RI IRnio.coM neVILnnIT CI Iannnclnnl .QpoF oy� , .Z
NAME: \Le\Ca- "NtrYn'S-4 U-'1- APPLICATION R:
*Mils applleadoo 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 Slit 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 documenmtion submitted. (Complete site plan=60 months;Complete plat=without expiration)
910-893-7525 option I CONFIRMATION a
UI Environmental Health New Spotty System Code 800
• All properly Irons must be mads visible. Place "pink property flags' on each corner iron of lot. All property
lines must be clearly flagged approximately every 50 feet between corners.
• Place"orange house corner fags'at each corner of the proposed structure. Also flag driveways,garages, decks,
out buildings,swimming pools,etc. Place lags 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 dove after confirmation.,$25.00 return trip fes mar be incurred
for failure to uncover outlet lid mark house corners and property lines.etc.once lot confirmed ready.
• Atter preparing proposed site call the voice permitting system at 910-893-7525 option 1 to schedule and use code
800 (atter selecting notification permit it multiple permits exist)for Environmental Health inspection. please note
confirmation number given at end of recordina for oroof of reuuest.
• Use CIlok2Gov or IVR to verify results. Once approved,proceed to Central Permitting for permits.
C Environmental Health Existing Tank inspections Code 800
• Follow above Instructions for placing(lags and card on property.
• Prepare for inspection by removing soil over outlet end of tank as diagram indicates, and lift lid straight up (if
possible)and then put lid beck In piece. (Unless inspection is for a septic tank in a mobile home park)
• DO NOT LEAVE UDS OFF OF SEPTIC TANK
• Atter uncovering outlet end call the yoke permitting system at 910-893-7525 option 1 8 select notification permit
it multiple permits, then use code BOO for Environmental Health inspection. please note confirmation number
given at end of recording for°root of recuesi.
• 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 (Di Innovative {gg/l Conventional (DI Any
{pgi Alternative (Dl 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:
(DIVES PIEan/NO Does the site contain any Jurisdictional Wetlands?
(❑}YES IL91 Iy'O Do you plan to have an iniacrjou avamm now or in the future?
I DYES I y0 Does or will the building contain any Amiga?Please explain.
inYES IYJJ)NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
(DYES (�NO Is any wastewater going to be generated on the site other than domestic sewage?
(DYES :IMO Is the site subject to approval by any other Public Agency?
(D}YES i Are there any Easements or Right of Ways on this property?
(DIYES 1 NO Does the site contain any existing water,cable,phone or underground electric lines?
If yes please call No Cuts at 800632-0909 to locate the lines. This is a free service.
I Have Read This Application And Certify That The Information Provided Herein le True,Complete And Correct. Authorized County And
Slaw Omdab 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'death:Radon adon And Labeling Of All Property Lines And Conan And Mating
The Site Accessible So Th�attAA CompleteCSite Evaluation Can Be Performed. /,
CaryJT torn- S/ ATE
PROPER OWNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
10/10
& c•11132010 4 34 27P
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SOUTHEASTERN SOIL& ENVIRONMENTAL ASSOC., INC.
PROPOSED SUBSURFACE WASTE DISPOSAL SYSTEM DETAIL SHEET
SUBDIVISION: OAKMONT LOT /84
way ri+ ?use to
INITIAL SYSTEM: APPROVED 25%RECUCTION REPAIR A PPH✓t0 W'b ,CE.ae-cr.w
DISTRIBUTION: Q- ®or DISTRIBUTION 00-d•y
BENCHMARK: 100.0 LOCATION Pr •... c.,"re /84/37
NO. BEDROOMS: V LTAR O, R GPO/Pr '—
LINE FLAG COLOR ELEVATION LENGTH
I o 99, /.T S° 1
• I-3
899. /7 r, r
7.:•,714 it 3 a 9B.r8 ,To '
4 a 5'7, 9y Sa
r o 99.2r .re `
6 A 'L.9L co '
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BY • t E:7/CE/t DATE 03/.'it
TYPICAL PROFILE THERE SHALL BE NO GRADING,
a - Yd i/u [/vn/_ wr,1 CUTTING, LOGGING OR OTHER SOIL
r^ A //M > a6 `' DISTURBANCE IN SEPTIC AREA
0-174a- „4-7- /B -LL '
SOUTHEASTERN SOIL& ENVIRONMENTAL ASSOC., INC.
PROPOSED SUBSURFACE WASTE DISPOSAL SYSTEM DETAIL SHEET
SUBDIVISION: OAKMONT LOT /9/
INITIAL SYSTEM:APPROVED 25% RECUCTION REPAIR l9PPf-✓<r Zf?. F£a.cfiaAJ
DISTRIBUTION: o-Q°x DISTRIBUTION i,-a"(
BENCHMARK: 100.0 LOCATION /"T •N c,r£ /f/ll L
NO. BEDROOMS: °/ LTAR 0. S'GPe/Pr c
LINE FLAG COLOR ELEVATION LENGTH
l 0 96.9r 6' '
Y a.. - 6 0 '
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fry+" Y Y 9r. ay • '
-740
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4 y f6 ,re 6, '
9 o 96 . t.r 6.• l
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BY .4.4 EAs0- DATE O VY it
TYPICAL PROFILE THERE SHALL BE NO GRADING,
0 - Lt LJ (W.; wel. J CUTTING, LOGGING OR OTHER SOIL
21- yY *f t c (Fl/, I4ZJ DISTURBANCE IN SEPTIC AREA
ey 1 /Pa. > 36
/0-17 44- 4 I is ••
reaves law. pile
December 22, 2015
VIA U.S. MAIL
Patrick McKee
McKee Homes/Oakmont Development Partners
101 Hay Sheet
Fayetteville,NC 28301
Re: Oakmont Subdivision,Harnett County—Purchase of Future Phase 2 Acreage(51.37
acres)
Dear Pat:
Enclosed please find a copy of the Special Warranty Deed electronically recorded
yesterday in the Harnett County Registry.
The final title policy should be mailed to you by West Title in the next couple of weeks.
I am glad we could assist.
Merry Christmas.
Y,'ts , y,
Hol, Re:( s
LHR: mds; enclo es
Email Reply to: holden@reaveslaw.net
UL Winn an v„
01•Ar,an,l Annu L Fay. Irr IIb.IC28208
MaIIf.plyIn PO.am021ll.Fsynt•vllba0211200
910-458-4•3811“10-485-7113311x
For Registration Kimberly S. Hargrove
Register of Deeds
Harnett County, NC
Electronically Recorded
2015 Dec 21 01:21 PM NC Rev Stamp:5 1173.00
HARNEIT COUNTY TAX ID t Book: 3384 Page: 108 Fee: 28.00
o/of 039589 1021 Instrument Number 2015017842
12-21-2015 BY: HT
NORTH CAROLINA SPECIAL WARRANTY DEED
haslet Tax: $1173,00
Parcel Identifier No.Portion of0507-53-6196 Verified by County on the day of 20
By: —
Mail/Box to: Reaves Law,PLLC,PO Box 53187.Fayetteville.NC 28105
This instrumont was prepared by: L, Holden Reaves Esq.!Title Insurance with West Title AEencv Raleigh.NC)
Brief description for the Index: 51 37+/-Acres(Phase B.Section One Acreage,Oakmont S/D)
THIS DEED made this 15th day of December 20 Jj,by and between
GRANTolt - - -GRANTFF
M&JM(NC)LLC,a North Carolina limited liability company Oakmont Development Partners LLC,a Delaware
limited liability company
2580 Hanford Lane 5112 Pine Birth Drive
Aurora,IL 60502 Raleigh,NC 27606
&ter in appropriate block for each party: name, address, and, ii uppiuprgtic, character of entity, cg. corporation or pwlnerahip.
The designation Grantor and Grantee as used herein shall include said parties,their heirs,successors,and assigns,and shall Include
singular,plural,masculine,feminine or neuter as required by context.
WITNESSETH,that the Grantor,for a valuable consideration paid by the Grantee,the receipt ofwhichishereby acknowledged,has and
by these presents does grant,bargain,sell and convey unto the Grantee in fee simple,all that certain lot or parcel of land situated in
Harnett County,Nor0r Carolina and more particularly described as follows:
Sea ExhibitA attached hereto and incorporated herein by reference.
The property hereinabove described was acquired by Grantor by Inennment recorded:Book 2881 Page 145.
All or a portion of the property herein conveyed does not include the primary residence of Grantor.
NC Bar Assn'.rinn m,.....Na s n 1(pi inn
Rrinted hyAsubmitted electronically by "Reaves Law, PLLC•'
ln compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Harnett county Register of Deeds.
A map showing the above described property is recorded in [See karat description for plat reference.if awl.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and allprtvileges and appurtenances thereto belonging to the Grantee in
fee simple.
And the Grantor covenants with the Grantee,that Grantor has done nothing to impair such title as Grantor received,and Grantor will
warrent and defend the title against the lawful claims of all persons claiming by,under or through Grantor,other than the following
exceptions: all easements,rmtrictiona,covenants and conditions of record,if any,and taxes which are not yet due and payable.
IN WITNESS WHEREOF,the Grantor has duly executed the foregoing as of the day and'ymr first above written.
M&JM(NC7 LLC MEAL) (SPAM
(EndtY27:t_
Title: Manager %YI I that 1 none
z e
Wb,a« Title:
<se
1) Wld)
YLL� Eg TINe:
LLLa
NO['E0 f�,�
Ile of ' 1111•10i;� -County of'bi Y -r�P hap s g 1,the undersigned Notary Public of die County and Mite aforesaid,certify that rat(`., ait mute[ personalty
�.• • before me this day end acknowledged the doe execution of the foregoing instrument for the purposes therein expressed.
; I ens my hand and Notarial stamp ur scat this_15 day of ms - r- 20
• Commission Expires:ll I1C1 ph11,6 ria Lt cin LU
Notary Public
Sone of -County of
1,the undersigned Notary Public oftlre County and State aforesaid,certify that personally
came before me this day and aclmowledged that he is the Manager of M&JM(NC)LLC,a North Carolina limited liability company,
and that by authority duly given and as the act of such entity,he signed the foregoing instrument in its name on its behalf as its act and
decd Witness myhand and Notarial stamp or seal,this day of _,2015.
My Commission Expires:__
Notary Public ---- — -
State ofNorth Carolina-Cmmty of
I,the undemigned Notary Public of the County and State aforesaid,certify that
. Witness my hand and Notarial stamp aseal,this day of 20
My Commission Expires: __
NotaryPublic
The foregoing Certtcate(s)of_._ is/am
ratified to be correct. This instrument and this certificate are duly registered at the date and time and hi the Book and Page shown on the
fust page hereof.
Register of Deeds fa County
By: Deputy/Assistant-Register of Deeds
NC Bar Association Form No.6 O 1977,2002
Printed by Agreement with the NC Bar Association- 1981
EXHIBIT A
Oakmont Phase II Section I
Legal Description
The following described tract of land lies to the east of Dow Road in Barbeque Township
and being described as a portion of the deeds and plat duly recorded In Deed Book 2881,
Page 145, Plat Book 2009, Page 312, and Plat Book 2005, Page 703 all of the Harnett
County,North Carolina Registry, and is more Mb,described as fellows:
Beginning at an existing 1"iron rod, said iron rod being the northeastern most corner of
lot 14 of the Oakmont Subdivision Phase I Section I as shown recorded in Plat Book
2012 Page 22, thence with a new line for the following thittyone calls: N14°19'13"W
80.95 feet to a point, thence N56°51'23"E 632.50 fret to a point, thence N21°25'1 I"E
287.02 feet to a point,thence NS3°40'59"E 160.94 feet to a point, thence 889°55'25"E
103.58 feet to a point,thence SO0°04'20'6 39625 feet to a point,thence S38°32'42"W
393.49 feet to a point, thence S37°27'16"W 293.62 feet to a point, thence S83°00'22"E
200.20 fret to a point, thence with a non tangent curve as it curves to the right having a
radius of 600.00 feet and an aro distance of 90.82 feet, chord bearing and distance
N11°19'49"E 90.73 feet to a point, thence 574'20'01"E 274.38 feet to a point, thence
N38°32.42"E 343.89 feet to a point, thence N68°03'14"E 180.95 feet to a point, thence
S85°28'09"E 683.19 feet to a point, thence 861°23'53"W 353.47 feet to a point, thence
S62°40'06"W 441.27 feet to a point,thence N51°27'18"W 87.80 feet to a point,thence
S38°32'42"W 75.00 feet to a point,thence with a curve as it curves to the lea having a
radius of 205.00 feet and an aro distance of 117.51 feet, chord bearing and distance
S22°07'27"W 115.90 feet to a point, thence S05°42'11"W 16334 feet to a point,thence
S84°17'49"E 200.00 feet to a point, thence S00°12'03"W 200.93 feet to a point, thence
N84°17'49"W 219.27 feet to a point,thence S05°42'11"W 240.00 feet to a point,thence
with a curve as it curves to the lea having a radius of 25.00 feet and an arc distance of
39.27 feet, chord bearing and distance S39°17'49'6 3536 feet to a point, thence
S84°17'49"E 35.00 fret to a point, thence S05°42'11"W 260.00 fret to a point, thence
N84°17'49"W 100.00 feet to a point thence S58°3I'37'W 430.43 feet to a point,thence
S86°20'29"W 245.31 feet to a point, thence N84°17'49"W 100.00 feet to a point in the
eastern line of lot 131 of the Oelunont Subdivision Phase 1 Section Bi,as shown recorded
In Nat Book 2013 Page 346, thence with the eastern lot of said lot 131 N05°42'11"E
150.00 feet to the northeastern corner of lot 131,thence with the northern line of lots 131-
134 of the Oakmont Subdivision Phase 1 Section III, as shown recorded in Plat Book
2013 Page 346,N84°17'49"W 425.00 fret to the northwestern corner of lot 134,thence
with the eastern line of lots 153-155 of the Oakmont Subdivision Phase I Section III, as
shown recorded in Nat Book 2013 Page 346, continuing with the eastern line of lot 156
of the Oakmont Subdivision Phase I Section I,as shown receded in Plat Book 2012 Page
22, crossing Executive Drive and continuing with the eastern line of lots 24-22 of the
Oakmont Subdivision Phase I Section 1, as shown recorded in Pad Book 2012 Page 22,
N05°42'11"E 815.00 feet to the common rear corner of lots 22 and 21, thence with the
northeastern line of lot 21 of the Oakmont Subdivision Phase I Section I, as shown
recorded in Plat Book 2012 Page 22, N49°20'58"W 333.49 feet to the northern most
corner of lot 21, thence with the southeastern line of lot 14 of the Oakmont Subdivision
Phase I Section I, as shown recorded in Plat Book 2012 Page 22, N40°39'021'6 433.40
feet to the beginning,containing 51.37 acres more or less.
obtitlirliiiii
AO**dt aeaei' M!%$
siree° N %
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i;6FtiVHuirroiniia��d�``,``•
NORTH CAROLINA FARM BUREAU
P.O. BOX 27427
RALEIGH NC 27811-7427
RETURN SERVICE REQUESTED
LIENHOLDER NOTIFICATION
1222192859®8011329511.001208:001248.1/1
MCKEE HOMES LLC Visit https://partner.ncfbins.com
tri 101 HAY ST STE 2 to enroll 8 verify NC Farm Bureau
FAYETTEVILLE NC 28301-5649 policies on-line.
PAGE 1
POLICY NO: INCHRISTOPHER PERRY INTERESTED
2170694 02 FAYETTEVILLESNCS283110-7616 101
C228301 -5649
AGENCY/X46
GENCY AGENT: 0474928 910-875-4091 INSURER:
REINSTATEMENT PORBOXJ846S , FSS,LUTCF MNORTH UTUALCINSURANCEACRM OMPANYAU
RAEFORD NC 28376-0846
POLICY EFFECTIVE DATE: 12/05/2015 PROCESS DATE: 12/21 /2015
CONTINUOUS CHANGE EFF DATE: 12/21/2015
VIN: CAFBOI 2015 CAFBO 1 CC
COVERAGE: CSL 1 ,000,000 PER OCCURRENCE LIMIT
POLICY NO:
POLICY NO:
Correspondence or Inquiries directed to the Insurer must Includes copy of this notification.
09/09/11 Application#
Harnett County Central Permitting 41 5 3o
PO Box 05 L4hngtan NC 27546
EM WWI Glow lo WNW out 910 8e3 7525 Fox 810 883 2793 www hornet oryprmm
by wtmnne perrprminp won
MM G owner or homed
conhaor Address company &pollution for Residential Budding and Tredea Perms
name&phone must:mak
Owners Name McKee Homes, LLC Date 7/11/17
Site Address 154 Heatherwood Drive phone 910-475-7100
Directions to job site from Edlington 127 to Docs Road, development on the left
Subdivision Oakmont Valley View Let 191
Desmption of Proposed Work Single Family Home #of Bedrooms 3
Heated SF 1672 Unheated SF 585 Finished Bonus Room' yes Crawl Space _Slab X
Skondkinientwinistandign
GML Development. Inc 910-475-7100,727
Building Contractors Company Name Telephone
109 Hay Street,Ste 301, Fayetteville,NC 28301 krivera@mckeehomesnc.com
Address Email Address
63970
License#
Ehetrtnt Contractor Infermaaon
Dasmpam of Work Single Family Home Service Size 200 Amps T-Pole Litres No
J.M. Pope Electric 919-776-5144
Electrical Contractor a Company Name Telephone
409 Chatham St.,Sanford,NC 27330 jmpopeeleciric@gmail.com
Address Email Address
21326-L
License#
jdschamcal/HVAC Contractor Information
Description of Work Single Family Homes
Certified Heating 8 Air 910-858-0000
Mechanical Contractors Company Name Telephone
P.O. Box 1071. Hope Mills, NC 28348 certifiedheatair@embargmail.com
Address Email Address
20012-H3-1
License#
plumbinn Contractor Information
Description of Wyk Single Family Home #Baths 2
Dell Haire Pluming 910-818-4883
Plumbing Contactors Company Name Telephone
7612 Documentary Drive, Fayetteville, NC 28306 dellhaireplumbing@hotmail.com
Address Email Address
32886 P1
License it
Jnsulation Contractor lnfonnatiop
Cumberland Insulation 910-484-7118
Insulation Contractor a Company Name&Address Telephone
*NOTE General Contractor must fill out and sign the second page of this application
I hereby certify that I have the euthonty to make necessary application that the application is correct
and that-the construction will conform to the regulations in the Budding 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 lunainabistalbutatiattillatbsolactea
permission to obtain these oerrhlj{and if ENL 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
DOMED PERMIT FEES-d Months to 2 years permit reissue fee is 3160 00 After 2 years re-issue fee
is as per currentn` fee schedu �
Cr/12,he ( Il 7/11/17
are of Ownerentractor/Offlcer(s)of Corporation Date
��VAfkdavit for Worker's Compensation N C G 8 87-14
The undersigned applicant being the
X General Contractor _Owner _Othoer/Agent of the Contractor or Owner
Do hereby confirm under penalties of perjury that the person(s) firm(s)or corporeson(s)psrkyming 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 mare subconhactors(s)and has obtained workers compensation insurance to cover
them
XHas one(1)or more subcontractors(s)who has thew own policy of workers compensation insurance
covenng themselves
Has no more than two(2)employees and no subcontractors
While workup on the project for which this permit is sought it is understood that the Central Permitting
Deperhmem issuing the permit may require certificates of coverage of worker a compensation insurance pnor
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 McKee Homes, LLC
sgnwrtme Kelsey Rivera o„:'>ok4'o,° °74,1?ttConstructionCoordinator Dae 7/11/17
Appointment of Lien Agent:Details-LiensNC Lien Service haps://apps.liensnc.com/ser/appoinlment/details.html?entryNumb...
DO NOT REMOVE!
Details: Appointment of Lien Agent
Filed on: 07/11/2017
Entry #: 684151
Initially filed by: jbuckweltar
Designated Lien Agent Project Preportg Print & Post
First American Tale Insurance Company Oakmont Valley View Lot 191 Hamen County K '0
NC
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Adder:19 W Hargett St.Suite 507 Raleigh,NC O h+0:
27601
Prepertg Tg#e Contractors:
Phone:1ee,690,73e4 please post this notice on the lob Site.
Fn:913489-5231
Suppliers and mnfaSubcontractors:
Emtll noliemne corn wMwrw.w. 1-2 Family Dwelling Scan this image with your smart phone to
view this filing.You can then file a Notice
to Lien Agent for this project.
Over InformationDate of First Feraistleg
McKee Homes,LLC 0]/25/201]
109 Hay Street
Suite 301
Fayetteville, NC 28301
United Slates
Email;krivem@mckeehomemacom
Phone:910-475-7100
View Comments(0)
Technical Support Hotline:(888)690-7384
I of 1 7/I1/17,9:02 AM
LIEN AGENT INFORMATION
Effective April I,2013
In accordance with North Carolina General Assembly Session Law 2012-158,
Inspection Departments are not allowed to issue any permit where the project cost
is $30,000 or more unless the application is for improvements to an existing
dwelling that the applicant uses as a residence OR the property owner has
designated a lien agent and provided the inspections office with the information
below:
Name of Lien Agent First American Title Insurance Company
Mailing address of Agent 19 VV. Hargett St., Suite 507
Raleigh, NC 27601
Physical address of Agent same as above
Telephone 888-690-7384 Fax 913-489-5231
Email support@liensnc.com
The information will be attached to the permit record and a copy provided to the
applicant. The applicant is required to post a copy on the construction site.
Excerpt from North Carolina G.S. 160A-417:
"(Effective April 1,2013)No permit shall be issued pursuant to subdivision(1)of subsection(a)of
this section where the cost of the work is thirty thousand dollars($30,000)or more,other than for
improvements to an existing single-family residential dwelling unit as defined in G.S. 87-15.5(7)that
the applicant uses as a residence, unless the name,physical and mailing address,telephone number,
facsimile number,and electronic mail address of the lien agent designated by the owner pursuant to
G.S.44A-11.I(a)is conspicuously set forth in the permit or in an attachment thereto.The building
permit may contain the lien agent's electronic mail address. The lien agent information for each
permit issued pursuant to this subsection shall be maintained by the inspection department in the
same manner and in the same location in which it maintains its record of building permits issued."
www.liensnc.com