DOCUMENTS I
Initial Application Date: ! ✓"`�" ^ Application# 19 --S L01 v43
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Central Permitting 108 E.Front Street,Lillington,NC 27546 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 www.harnett.org/permits
**A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED'-/-).0
QUWHEN SUBMITTING A(LAND USE APPLICATION**
LANDOWNER: 5lig( 1 Gt Y , G(J Q Mailing Address: T O )< /8 C �j /
City: ,t9l t NF1 ) V Q I State:Zip:s3°°S3Contact No: 9/I2 'g 8•2-2 Email: 7�iC.+(L T . I ( /vi�(r/.re"
APPLICANT*: ,5 Q._ CLS C4 O AVIV Address:
City: State: Zip: Contact No: Email:
*Please fill out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICE: Phone#
PROPERTY LOCATION:Subdivision: ` , Lot#: Lot Size:
''cSLS C.-
State
State Road/ # t O rg State Road Name: \.J"O. 114-c-8,-- e ! ' Map Book&Page:
\Cr -l.�
Parcel: V I P54 5 �.S6 Q l PIN: S 4 5 -� u -4511. V0 O
Zoning::an Flood Zone: k Watershed: N t"( Deed Book&Page:J y 37 / 43b Power Company*:
*New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
Monolithic
❑ SFD:(Size x )#Bedrooms:_#Baths:_Basement(w/wo bath):_Garage:_Deck:_Crawl Space:_Slab: Slab:_
(Is the bonus room finished?(_)yes (_)no w/a closet?(_)yes (_)no(if yes add in with#bedrooms)
❑ Mod:(Size x )#Bedrooms_#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 )#Bedrooms:_Garage: (site built?_)Deck: (site built?_)
❑ Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
/❑ Home Occupation:#Rooms: Use: Hours of Operation: #Employees:
ll Addition/Accessory/Other:(Size x )Use: `(�► 1�L Closets in addition?(_)yes (_)no
l _ _ t ► N'S1
Water u I : Existing Well NewWell(�#Y of dwellings using well )*Must have operable water before final
Sewage Supply: ew Septic Tank(Complete Checklist) Existing Septic Tank(Complete Checklist) County Sewer
Does owner of this tract of land,own land that contains a manufactured home within five hundred feet(500')of tract listed above?(_)yes (_)no
Does the property contain any easements whether underground or overhead(_)yes (_)no
Structures(existing or proposed):Single family dwellings: Manufactured Homes: Other(specify):
Required Residential P operty Line Setbacks: Comments: cct1 1 t AA $
Front Minimum A � � nC% L
L{
Rear
Closest Side 2 `: LA
.. �►�
Sidestreet/corner lot
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Nearest Building
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
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NAME: APPLICATION#:
*This application 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 SITE 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 documentation submitted. (Complete site plan=60 months;Complete plat=without expiration)
910-893-7525 option 1 CONFIRMATION# 2
Environmental Health New Septic SvstemCode 800
d....
• All property irons must be made 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 flags"at each corner of the proposed structure. Also flag driveways, garages, decks,
out buildings, swimming pools, etc. Place flags 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 days after confirmation. $25.00 return trip fee may be incurred
for failure to uncover outlet lid, mark house corners and property lines, etc. once lot confirmed ready.
• After preparing proposed site call the voice permitting system at 910-893-7525 option 1 to schedule and use code
800 (after selecting notification permit if multiple permits exist) for Environmental Health inspection. Please note
confirmation number given at end of recording for proof of request.
• Use Click2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits.
Environmental Health Existing Tank Inspections Code 800
• Follow above instructions for placing flags 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 back in place. (Unless inspection is for a septic tank in a mobile home park)
• DO NOT LEAVE LIDS OFF OF SEPTIC TANK
• After uncovering outlet end call the voice permitting system at 910-893-7525 option 1 & select notification permit
if multiple permits, then use code 800 for Environmental Health inspection. Please note confirmation number
given at end of recording for proof of request.
• 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 {_} Innovative } Conventional (_} Any
{_} Alternative {_} 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:
{_}YES { .} NO Does the site contain any Jurisdictional Wetlands?
{_}YES { } NO Do you plan to have an irrigation system now or in the future?
{ }YES {_} NO Does or will the building contain any drains?Please explain.
}YES 1_I NO Are there any existing wells,springs,waterlines or Wastewater Systems on this property?
{_}YES {)NO Is any wastewater going to be generated on the site other than domestic sewage?
{_}YES {4,} NO Is the site subject to approval by any other Public Agency?
{_}YES IN NO Are there any Easements or Right of Ways on this property?
{ }YES {_} NO Does the site contain any existing water,cable,phone or underground electric lines?
If yes please call No Cuts at 800-632-4949 to locate the lines. This is a free service.
I Have Read This Application And Certify That The Information Provided Herein Is True,Complete And Correct. Authorized County And
State Officials 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 Identification And Labeling Of All Property Lines And Corners And Making
ZT $ite A essible So That A Complete Site Evaluation Can Be Performed.
,, ff 14 r A =1 -- 17
PROPERTY 5 vJNERS OR OWNERS LEGAL REPRESENTATIVE SIGNATURE(REQUIRED) DATE
•
10/10
Mail To:
X0012838
This Instrument was prepared by. Christopher B. Godwin (WITHOUT TITLE CERTIFICATION)
QUITCLAIM DEED—QD-1 Printed and for sale by James Williams&Co.,Inc.,P.O.Box 127,Yadkinyille,N.C.27055
STATE OF NORTH CAROLINA, CUMBERLAND County.
THIS DEED,Made and entered into this 1ST day of SEPTEMBER I 2000,bygand between
CLARENCE M. FERGUSON p 0 ism X33 IJUnl1lQUP NO, a83l�,3
of Harnett arias
aCounty and/ State of North Carolina,hereinafter ailed Grantor,and
SHEILA MCLAUGHLIN a !a5 11)11(i:et. ICo A L111�J tV (IaE3 S G
of Harnett County and State of North Carolina,hereinafter called Grantee,whose permanent mailing address
is
WITNESSETH:
HARNETT COUNTY NC
Book 1437
Pages 0430-0431
FILED 2 PAGE CS)
09/01/2000 10:34 AM
EDGERLY S. HARGROVE
Register Of Deeds
That said Grantor, for and in consideration of the sum of Ten Dollars ($10.00) to him in hand paid, the receipt of which is hereby
acknowledged,has remised and released and by these presents does remise,release,convey,and forever quitclaim unto the Grantee,his heirs
and/or successors and assigns, all right, title, claim and interest of the Grantor in and to a certain lot or parcel of land lying and being in
Township, Harne t t
County,North Carolina,
and more particularly described as follows:
BEGINNING at the northeast corner of the land recorded in Deed Book 564, Page 90, Harnett
County Registry, running thence South 03 degrees 00 minutes West 177.30 feet to an iron
stake on the northern right—of—way margin of N.C.S.R. 2039, thence with said right—of—way
margin the following courses and distances North 71 degrees 00 minutes 05 seconds
West 50.09 feet, North 73 degrees 23 minutes 32 seconds West 22.46 feet, North 74 degrees
25 minutes 58 seconds West 6.70 feet to an iron stake, thence leaving said right—of—way
margin North 11 degrees 30 minutes 16 seconds West 198.68 feet to an iron stake, thence
North 66 degrees 15 minutes East 142.28 feet to art iron stake the point of BEGINNING.
Containing 0.56 acres, more or less, and being a portion of the land recorded in Deed
Book 564, Page 90, Harnett County Registry.
ilafeinjw
gY
430
To have and to hold the aforesaid lot or parcel of land and all privileges thereunto belonging to him,the Grantee,his heirs and/or successors
and assigns,free and discharged from all right,title,claim or interest of the Grantor or anyone claiming by,through or under him.
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.
From:Brady Contracting / Retrofit 3363798893 08/11/2017 10:18 #284 P.001/003
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From:Brady Contracting / Retrofit 3363798893 08/11/2017 10;18 #284 P.002/003
Application#
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546 - Ph:910-893-7525 - Fx: 910-893-2793 - www.harnett.org/permits
Certification of Work Performed By Owner/Contractor
(Individual Trade Application)
Owner(s)of Structure: Campbell University Barker Hall Phone:910-893-1674
Owner(s)Mailing Address:260 Leslie Campbell Ave.Lillington, NC 27546
Land Owner Name (s): Campbell University phone:910-893-1674
Construction or Site Address::260 Leslie Campbell Ave. Lillington, NC 27546
PIN# Parcel#
Job Cost: 96,467,00 Description of Work to be done Like for like change out for HVAC 100 ton air cooled
chiller, 12,000 BTUs.
Mechanical: New Unit With Ductwork_ New Unit Without Ductwork ✓ Gas Piping_Other
Electrical*: 200 Amp <200 Amp_Service Change_ Service Reconnect_ Other_
*For Progress Energy customers we need the premise number
Plumbing: Water/Sewer Tap Number of Baths Water Heater
Specific Directions to Job from Lillington:
Jeff Shropshire will meet the inspector on site 336-362-4422
Marvin Batten will be completing the electrical.Batten Electric 336-382-4372 License number 25011-U
Subdivision: Lot#:
Brady Services will provide the HVAC labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is ,which entitles me to
perform such work on the above structure legally. All work shall comply with the State Building Code and all
other applicable State and local laws, ordinances and regulations.
Brady Services 336-362-4422
Contractor's Company Name Telephone
PO Box 13587 Greensboro,NC 27415 Jeff.Shropshire@Bradyservices.con
Address Email Address
20378
License#
Structure Owner/Contractor Signature: � -� Date:08/11/2017
By signing this application you affirm that you have obtained permission from the above listed license holder to
purchase permits on their behalf. If doing the work as owner you understand that you cannot rent, lease or sell
the listed property for 12 months after completion of the listed work.
*Company name, address, & phone must match information on license
From:Brady Contracting / Retrofit 3363798893 08/11/2017 10:18 #284 P.003/003
LIEN AGENT INFORMATION
Effective April 1,2013
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 ��t ci \ �-�-� Qativatt 1 h
_t
Mailing address of Agent (el W AcivgeJ-- c4- . Sup 5c)
C „,Q ,60 /
Physical address of Agent
Telephone FD. - 6qa' 73E 4Fax 9./5 / ? 5 �
Email r -.0r4 @ a G
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-11.1(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."
3
• www.liensnc.com