DOCUMENTS Initial Application Date P _ Application# i —75C014- I 8-;P
1 1 COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION C
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Central Permitting 108 E.Front Street,Lillington,NC 27546 Phone:(910)893-7525 ext2 Fax:(910)893-2793 www.harnett.org/permits
"A RECORDED SURVEY MAP,,�P,�RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
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LANDOWNES I-I2naruc#arspt- lilt/die.Mailing Address: d 9/9 bete e d Z 1:610(1/4(4', PC' WO
City:E¢!_Q. NIQ (('- state:AA Zip:ab 3D 3 Contact No: 9/0•
yfit: y6ENEmau:tetulrxLhnirQhhhomeS.l`all
APPLICANT*: SAME AS (14k)OMLJA) --.._..-- --
Mailing Address:
City: State:_Zip: Contact No: Email:
'Please fill out applicant information if different than landowner (�/1
CONTACT NAME APPLYING INOFFICE:/i . ,II erk-nota. . flo� r /Cid/v-Yf(.,-c�f(c(/!�p
PROPERTY LOCATION:Subdivision: /'/ ' rrlai)QA (ex//)?fol Ail)`((/' Lot#:- l58 Lot Size:
�.1pL7jacreS
State Road#/�-n/(,) State� Road NNamme:^ -1 / (, /� ''LMaapp Book&Page:tOI //1j{
Parcel: U'L�L5Lo5I9 oQ8da3 1 PIN:615'15G Li11 �54 a /�
Zoning:fUQ^ZOI Flood Zone: A WatershedNA Deed Book&Page:. SI I / ` -1 ower Company': l PPl/,7//LA(
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
GnL _ ?QI" Monolith
� W SFD:(Sizex -1 #drooms: :#Baths Basement(w/wo bath):AW Garage:✓Deck:FL Crawl Space_Slab: Slab: V
(Is the bonus room finished?( )yes (_)no w/a closet?( )yes (_)no(if yes add in with#bedrooms)
❑ Mod:(Size_x_)#Bedrooms it Baths Basement(w/wo bath) Garage: Site Built Deck: On Frame Off Frame
(Is the second floor finished?( )yes ( )no Any other site built additions?( )yes ( )no
❑ Manufactured Home:_SW_DW_TW(Size x )ti Bedrooms: Garage: (site built? )Deck: (site built? )
❑ Duplex:(Size_x )No.Buildings: No. Bedrooms Per Unit:
❑ Home Occupation:#Rooms: Use: Hours of Operation: //Employees'
❑ Addition/Accessory/Other:(Size x___)Use:
Closets in addition?( )yes I 7 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 Checklist) ✓County Sewer
Does owner of this tract of and,own land that contains a manufactured home within five hundred feet(500')of tract listed above?( )yes (/)no
4 Does the property contain any easements whether underground or overhead( )yes (to<
Structures(existing • propose• . .Ingle family dwellings: L ' 1 Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:
1 /
Front Minimum 35 Actual)�I -
Rear r)S 3l
1^10
Closest Side h 110 /V I
Sidestreet/cornerat
- 1 lot �� ti
Nearest Building `—
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
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If permits are granted I agree to conform to all ordinances and laws of the State of North Carolina regulating such work and the specifications of plans submitted.
I hereby state that foregoing state nts are accurate and correct to the best of my knowledge. Permit subject5, to revocation if false information is provided.
ature of�� Ownerittill
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"'ll is the owner/applicants responsibility to provide the county with any applicable Information about the subject property,including but not limited
to:boundary information,house location,underground or overhead easements,etc.The county or its employees are not responsible for any
Incorrect or missing Information that Is contained within these applications.'••
"This application expires 8 months from the initial date if permits have not been issued"
•
•
Residential Land Use Application Page 2 of 2 03/11
t MICHAEL P. GRIFFIN • certify that ands,my d`emO. and
eprwlon this map was drawn from an actual Held sunny that the n o/
halm. of Me survey as calculated by coordinates S D r4[CL#; that the N
area dhow hereon do al ti calculated by coordinates. `�y5Q6 �. -0\-‘2,-c1\14
Softness my none and dad rnle day of uavm 1Ol).
d
66
Sil E PLAN APPROVAL
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10'JNOtKGROUND — -- Q
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600 1
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P 1 T T F I E L D RUN
50' PUBLIC/UTILITY KN✓
5ETBACKS
FRONT 5
REAR
SIDE(ONE,SIDE)
SIDE(ONE SIDE) I0'
CORNER SIDE 20'
CI R=25.00'L=39.29'N20°10'52"W 35.36'
I LEGEND
Application#
Harnett County Central Permitting
"Each section below to be filled out PO Box 65 Lillington,NC 27546
by whomever performing work. 910-893-7525 Fax 910-893-2793 www.harnetLorglpermits
Must be owner or licensed
contractor. Address,company Application for Residential Building and Trades Permit
name 8 phone must match
Owner's Name: H&H Construccrtors of Fayetteville, LLC. Date'
Site Address: Ar+l I. ler y tone. Phone: - -4g t/
Directions to job site from Lillington: NC Hwy 210 to Spring Lake. Turn Rt. On Overhills turn left to stay on
Overhills. Continue straight onto Nursery. Turn Rt. On 24/87. Turn Rt on Sawyer. Keep Straight.
Subdivision: The Manor(a) Lexington Plantation Lot: 953
Description��off,Proposed Work: New Single Family Dwelling #of Bedrooms:5
Heated SFAL.05 Unheated SF:LP43 Finished Bonus Room? Crawl Space: Slab: ✓'
General Contractor Information
H&H Constructors of Fayetteville LLC. 910-486-4864
Building Contractor's Company Name Telephone
2919 Breezewood Ave. Ste, 400 Fay. NC 28303 Leannahajthhhomes.corn
Address Email Address
74158
License#
Electrical Contractor Information
Description of Work Service Size: 200 Amps T-Pole: X Yes No
JM Pope Electric, Inc. 919-776-5144
Electrical Contractors Company Name Telephone
409 Chatham Street Sanford NC 27330 electricpopeOwindstream.net
Address Email Address
21326
License#
Mechanical/HVAC Contractor Information
Description of Work
Carolina Comfort Air Inc. 919-934-1060
Mechanical Contractor's Company Name Telephone
5212 US Hwy 70 Business, Clayton, NC 27520 carolinacomfortair(glvahoo.corn
Address Email Address
29077 H-3-I
License#
Plumbing Contractor Information
Description of Work #Baths
Dell Haire Plumbing 910-429-9939
Plumbing Contractors Company Name Telephone
PO Box 65048,620 Gillespie St. Fay, NC 28306 dellhaireplumbina hotmail.com
Address Email Address
32886P-1
License#
Insulation Contractor Information
Tricity Insulation, Inc. 418 Person St. Fay., NC 28301 910-486-8855
Insulation Contractor's Company Name&Address Telephone
*NOTE: General Contractor/owner 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 tome and that by signing below I have obtained all subcontractors
permission to obtain these permits and if any 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-fi Months to 2 years permit re-issue fee is$150.00. After 2 years re-issue fee
is as perecurrent fee schedule.
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Signature of Owner/Contractor/Officer(s)r/ of Corporation Date11:5) 0
Affidavit for Worker's Compensation N.C.G.S. 87-14
The undersigned applicant being the:
X 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:
X 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 Name: H&Ha..Constructors of Fayetteville, LLC.
Sign wiTitle t.D. .Q MOi /Permitting Coordinator
Date:/
�6j 1
Appointment of Lien Agent: Details - LiensNC Lien Service
Page I of 1
DO NOT REMOVE!
Details: Appointment of Lien Agent
Entry k: 601059 Wed
on: ed by:201)
Initially ed meaganbradshew
Designated Lien Agent Project Property
Print & Post
First American Tile Insurance Company MLP000753 Lot 751 Manor C Lexington Q p-� "Q
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i CORNER LOT AR1 ILLERYLANE AND o Vim;
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gh.NC PtITEI13 RUN O
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nowCnmaae NC 88326
hour:IMS-640-73144 !lamest/County Contractors:
gni 9134N-4231 Please post rho notice on the Job Sim.
EmN:yupg�nuLnwmm . .. _ Suppliers and Subcontractors:
Property Type Scan osis image with yourphone
w thiaabng You can then el e n Notice
to Lien Agent DOD,project.
Owner Information 12 Family nwelrmg
I Constructors ofeayenevlie.I.Lr. Orb of First Furnlahln
2919 Onezewood Avenue Ste 400 9
Fayetteville,NC 28303
United States
Inuit Itanne446611hhhvnler coin 05/73(L017
Phone 910.456-0864
View Commenle 10
Technical Support Hotline:teen)600.7384
https://apps.liensnc.com/scr/appointment/details.html?entryNumber681059&printable= 7/5/2017