BUILDING " Application # f' P C --- Z5
• Each section below to be filled out Harnett County Central Permitting
by whomever performing work.
Must be owner or licensed PO Box 65 Lillington, NC 27546
. contractor. Address, company 910- 893 -7525 Fax 910- 893 -2793 www.harnett.orglpermits
name & phone must match
Aoolication for Residential Building and Trades Permit ]]]/
Owners Name: • • 1 , nit I Date: f / 6AD
Site Address: • tOk /IC �P• W a ♦ Phone: '' 1 ¢ y 7Ctip
Directions to job sit from Lillington: ' a' ist fir ' ' A. .'i
, 11 - to lair
Subdivision: '
V L � 3 n)t/r2._ ✓� Lot:
Description of Proposed Work: 41/115 &a/ 2J )✓Vk # of Bedrooms:
Heated
Paz ed SF: a en_ Unheated SF: - Finished Bonus Room? F) Crawl Space: G � Slab::
Bril�p) tl ./rr J C co r
ed %l0 C i9/ 9 t)
Building contractor's Company Name Telephone
/ f i i
Addr=it• �� / Email Address
r id . 'n `1' ) Lys
Sig ' . • e • Owner /Contractor /Officer(s) of Corporation License #
cal C c o 0
Des Iption of work Service Size: Amps T -Pole: �1Fes No
(OW c •e ( i/ () r4srFS-572
Electrical Contractors om any Name Telephone
17) 01A/1 [ ►• 5 i �; it
Address /)� Emajl /s�
Signature of Owne � Conntt / ractor /Officer(s) of Corporation Licenns #
Me // c ,^, l hanical /HVAC Contractor Information „/
Description of Work t^t A � vl ucS /v � � � �r
T Al tiv4c ` O. 197 - c
Mechanical Contractors Company ame Telephone
Addre$Is Mini"' Email Address
Signature of Ow ontractor/Officer(s) of Corporation License #
Contractor Information
Description of Work iLoi 4 # Baths p___ 5
it- x'11.,)
Plumbing Contractor's Co / / pany me / Telephone
/
Addre ss �V�1i /1 I / / I (h�(G�/ Email Address
gn�1 () Corporation 236 ��
Si na ure o Owner /Con ractor /O Icer s of Cor oration License #
Insulation Contractor ✓1 a P Information
j9 6g8_(
Insulation Contractor's mpany Name & Address Telephone
*NOTE: General Contractor must rill out and sign the second page of this application.
Residential Building Application 1 of 2 08110
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 if au 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 current fee schedule. QQ
.J� 9
S' natufe of Owner /Contractor /Offic ) of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87 -14
The undersigned ap . licant being the:
eneral 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-
s 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 cover -,ee of work- r's compensation insurance prior
to issuance of the permit an .t any time during the permitted fork from y person, firm or corporation
carrying out the work.
Company or Name: i / / Lad <1 lirm, se
Sign w/Title: / IA/0 v l \-1, Date: )02/0D
Residential Building Application 2 ()I 2 /// 18/10
Plan Box Number i ` L . Job Name
Date: 12 - &^ ( 6
Required Inspections for SFA/SFD
Appl. # I c_ Sd d ZSZC}G
Valuationc' 44-C Z
Sq. Feet 2 ' Co
Sequence
10 R* Bldg. Footing
10 -30 R* Elec. Temp Service Pole
20 R* Building Foundation
20 Address Confirmation
30 -999 Open Floor
30 -999 R* Bldg. Slab Insp.
30 -999 R* Elec. Under Slab
30 -999 R *Plumb. Under Slab
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