BUILDING Application # /0 rPO 25 •
Each section below to be filled out Hamett County Central Permitting whomever performing work. tY 9
Must be owner or licensed PO Box 85 Lillington, NC 27548
contractor. Address, company 910 -893 -7525 Fax 910- 893 -2793 www.harnett.org /permits
name 8 phone must match
Application for Residential Building and Trades Permit
Owner's Name: S C n Tff — 3q). -e Date:
Site Address: Phone:
Directions to job site from Lillington:
Subdivision: Lot:
Description of Proposed Work: # of Bedrooms:
Heated SF: Unheated SF: Finished Bonus Room? Crawl Space: _ Slab: _
As 0 General Contractor information
n i-/ of
Building Contractors Company Name Telephone �/l�uQ—
,y1
AcKr s Email Address
Ignature of Owner/Contractor/Officer(s) of Corporation License #
Electrical Contractor Information
Description of Work Service Size: / Am T-
Pole: T p� Yes No
4 E � ctrical Contractor's Company Name Telephone ,
Addr ss Email dd ss
Signature of Owner /Contractor /Officer(s) of Corporation License #
Mechanical /HVAC Contractor Information
Description of Work
A i9 b t1
a nical Contractor's Company Name Telephone
\\ 1 \
Ad ess O* Email Address
\ l \
Signature of Owner /Contractor /Officer(s) of Corporation License #
Plumbing Contractor Information
Description of Work # Baths
fly Own l \ i \
Plumbing Contractor's Company Name Telephone .
t I 11
Addr Email Address
� � 1I ) I
Signature of Owner /Contractor /Officer(s) of Corporation License #
Insulation Contractor Information
M apply Lt. 3 W
Insulation Contractor's Company Name & Address Telephone
*NOTE: General Contractor must fill out and sign the second page of this application.
Residential Building Application 1 of 2 08 /ID
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. i
Qu- '• nnaire per G.S. 87 -14 Regulations as to Issue of Building Permits (Memo available upon reque t) - ----
1. Do you • . the land on which this building will be constructed? _ Y- _ No
2. Have you hired or • nd to hire an individual to superintend and
manage construction of the • , '-ct? _ Yes _ No
3. Do you intend to directly control & supe - co• z ruction activities? _ Yes _ No
4. Do you intend to schedule, contract • • irectly pay for - • ases of
construction work to be done? Yes No
5. Do you intend to pers. - - ly occupy the building for at least 12 consecutive
months following co • etion of construction and do you understand that if
you do not do it creates the presumption under law that you fraudulently
secured • - 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 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 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 as p r current fee schedule.
as petg o/6
Signature of Owner /Contractor /Officer(s) of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87 -14
The undersigned applicant being th
General Contractorwner 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 during the permitted work from any person, firm or corporation
carrying out the work. '
Company or Nam /J q
Sign w/Title: /�Q� --- Date: DOC O�O 10
Residential Building Application 2 of 2 08/10
.
Plan Box Number Job Name Q i0 11ct•Y
Date: 12 -Z— jD
Required Inspections for SFA /SFD
Appl. # (6 - 504 z CC 6 4
Valuation c. 5 S 5
Sq. Feet 1 `{
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