DOCUMENTS Initial Application pale'. 8/28/17 Application I {S(J1'p�j f #7
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION CU#
Central Permitting 108 E.Front Street.Lillington,NC 27546 Phone:(910)893-7525 ext.2 Fax:(910)893-2793 www.hametl.orglpermits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER-Caviness Land Development 839 Executive Place Suite 202
Mailing Address'.
CityFayetteville State'.NC Zip:28305 Contact No: 910-339-6332 Email. janine@cavinessland corn
APPLICANT,:Caviness Land Development 639 Executive Place Suite 202
Mailing Address:
City: Fayetteville State:NC Zip:28305 Contact No- 910-339-6332 Janine@cavinessland.com
'Please fai out applicant information R different than landowner Email.
CONTACT NAME APPLYING IN OFFICE:Janine Lightner Phone#910-339-6330
PROPERTY LOCATION:Subdivision Forest Oaks 354
Lot it: Lot Size:'40
at oatl#1117 State Road Name'. Nursery Road ��
`` Map Book 8 Page: aolal544'
!�3
506-95-1640 S p 'P'1053608002873
Zoning RA2OR Flood Zone'. Watershed: 11''11
Deed Book 8 Page:34 l S /OI b 1 Power Company': South River Electric
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE:
SFD.(Size 52 x 50 )#Bedrooms:3 #Baths.2 Basement wtwo bath): Garage: ✓ Slab: le
( ) g Deck'._Crawl Space:_Slab:_Slab. ✓
(Is the bonus room finished?( ✓)yes ( )no wl a closet?(1)yes ( )no(if yes add in with#bedrooms)
❑
Mod (Size_x 1St Bedrooms_#Baths_Basement(w/wo bath)_Garage:_Site Built Deck:_ On Frame Off Frame_
(Is the second floor finished?( )yes ( I no Any other site built additions?( )yes I )no
❑ Manufactured Home:_SW_DW TW(Sizex )#Bedrooms-_Garage: (site built? )Deck: (site built? )
D 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 ( )no
Water Supply: ✓ County _Existing Well New Well(4 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 land,own land that contains a manufactured home within five hundred feet(500')of tract listed above?( )yes (✓)no
Does the properly contain any easements whether underground or overhead I )yes U no
Structures(existing o mposed}. - gle family dwellings: Manufactured Homes. Other(specify):
Required Residential Properly Line Setbacks: Comments:
Front Minimum 25 Actual 26 Address' 67 Burr Oak Circle
Rear 20 185.98
Closest Side 10 18.08
SidestreeUcorner lot
Nearest Building
on same lot
] LanJL � I.a'ion Page 1 cf 2 , :I
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: From 87S make a left onto Nursery Road and then continue to the left
on Nursery road. Make right into Forest Oaks subdivision.
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 statements are . ,to and correct • • • my knowledge. Permit subject to revocation if false information is provided.
8/28/17
Signature of • er or Owner's Agent Date
"'It is the ownerlapplicants 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 6 months from the Initial date If permits have not been issued"
:lea! .-ppneaccnRaja 2
.2 a_2. I
NOTE : CONTRACTOR TO CURVE TABLE
, x VERIFY ALL BUILDING CURVE LENGTH RADIUS BEARING CHORD
o '• AR II SETBACKS PRIOR TO Cl 16.05' 25.00' _ N05-27'40'W 16.63'
30N oA L CONSTRUCTION. C2 105.00' 235.00' N30'48'451E 105.27'
s la
I Q63
1/ 1 7-
H5 ‘1 FOREST OAKS
PHASE 4
/ld' FORESTS AKS 1 1 MA
2012.
V' PG. 44
MAP 2012, 1 _ --
VICINITY MAP PG. 544 1 ——
...ems"I 05,D
0.40
ACRES
`51 / 17,448 SQ. FT.
FOREST OAKS /i 351
PHASE 4 /19 `J
MAP 2012, n /
PC. 544 $ / FOREST
OAKS
Iv / PHASE 4
eMAP 2012,
/ PG. 544
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BURR OAK
CIRCLE
50 FT. PUBLIC R/W
PLOT PLAN
PLOT PLAN FOR: CAVINESS LAND DEVELOPMENT TOWNSHIP OF: ANDERSON CREEK
" ADDRESS: BURR OAK CIRCLE DATE: AUGUST 23RD, 2017
`:y1.11— REV DATE: AUGUST 25TH, 2017
CITY OF: NEAR SPRING LAKE, NC ;?.Ye: '. `.SCALE: 1" = 40'
COUNTY OF: HARNETT .. REFERENCE: LOT 354
i4 FOREST OAKS
lq '1` PHASE 4
I ,.� MAP 2012, PG. 544
WG PIS L-1339
h. MIS MAP CAN ROI RR US=FOR RECORDATION
T, OR amens TO•DEllo TO BE RECORDED.
Larry King&Associates,R.L.S.THAT TIM W M , P.A. HH H,_�_ NET HHAM IN.H[HBFMI"WITH
5 r�T PUNY=ET erwmTa CE BAY BE P.O.Box 53787
pu°m°n m ACOURAnmdTiaOTRUCTURE 1333 Morganton Road.Suite 201 TICE BOUNDARY ASO WiT 114rtmaalloti Mon ON
1101I BAP 03 2 sMO/0 TITE INSTRUCTOR!GIVEN ET THE - Fayelleville,NC 28305 TM vsmu ream n ims gown °f
RI VERIFIED pox rwuuru rrtx wxm° Phone:(910)483-4300 IR TEL BOST=non POR ME PROPERTY
x"° .ITITI Fax:191014834052 me or CONEMUCTON.NO TIRE MACH 10.13
www.LKandA.com ?WORMED ON TRW PROPERTY ETT®SURVEYOR
NC Arm License C-0887
'Each section below to be filled out Application#
by whomever performing work. Harnett County Central Permitting
Must be owner or licensed PO Box 65 Lillington,NC 27546
contractor. Address,company 910-893-7525 Fax 910-893-2793 www.harnett.org/permits
name&phone must match
Application for Residential Building and Trades Permit
Owner's Name: Caviness Land Development 8128/17
Date:
Site Address:67 Burr Oak Circle
Phone: 9103398332
Directions to job site from Lillington: From 87S make a left onto Nursery Rd and then continue to the left
on Nursery Rd. Make a right into Forest Oaks subdivision.
Subdivision: Forest Oaks Lot: 354
Description of Proposed Work: Building House #of Bedrooms: 3
Healed SF:1629 Unheated SF:754 Finished Bonus Room? No Crawl Space:_ Slab: ✓
General Contractor Information
Caviness Land Development 910-339-6330
Building Contractor's Company Name Telephone
639 Executive Place Suite 202 janine@cavinessland.corn
Address Email Address
37485
License#
Electrical Contractor Information
Description of Work electrical Service Size:_Amps T-Pole: ✓ Yes_No
Southern Pride Electric 919-750-9436
Electrical Contractor's Company Name Telephone
370 Slap Out Road, Mount Olive NC 28365 southernpride.mp@gmail.corn
Address Email Address
24728
License#
Mechanical/HVAC Contractor Information
Description of Work heating&air
Carolina Comfort Air 919-550-7711
Mechanical Contractor's Company Name Telephone
703 N. Clinton Ave., Dunn, NC 28334 phillip@carolinacomfortair.com
Address Email Address
29077
License#
Plumbing Contractor Information
Description of Work Plumbing #Baths2
Chris Holloway Plumbing 910-824-2670
Plumbing Contractor's Company Name Telephone
737 Old NC 20 St Pauls NC 28384 chrisholloway@ncrccom
Address Email Address
28541
License#
Insulation Contractor Information
Cumberland Insulation 4205 Clinton Road Fayetteville, NC 28312 910-424-7118
Insulation Contractor's Company Name&Address Telephone
*NOTE:General Contractor must fill out and sign the second page of this application.
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 I No
2. Have you hired or intend to hire an individual to superintend and Yes No
manage construction of the project? —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 that I affirm that I have obtained all listed contractors
permission to obtain these permits and if pr(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 per current f-= : -••• e. \
• 8/28/17
Signature of Owner/0•• .ctor/Oflicer(s) of Corporation Date
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:
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.
1 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:Cameos Land Development
/ x7r� Date:8/28/17
Sign wRitle: —/�rCS/GYl
DO NOT REMOVE!
Details: Appointment of Lien Agent Flied 0e/25i2017
Entry if: 710278 Initially flied by: caviand
Designated Lien Agent Protect Property
Print & Post
Investors Title Insurance Company Forest Oaks lot 354
67 Bun Oak Circle
Bunnlevel,NC 28323 0
Address:19W Harare St..Suite 5117/Raleigh,NC Harnett County
27601 El
Pb...:989-690-7389
Property
D y TypeContractor':
Pat 91N3952 I Please post this notice on the lob Site.
I-2 Family Dwelling Suppliers nd Subtend-actors:
Scan this image with your smart phone to
view this filing.You can then file a Notice
Owner Information Date of First Furnishing to Lien Agent for this project.
Coolness Land Development 08/28/2017
639 Executive Place,Ste 202
Fayetteville, NC 28305
United States
Email:j urine@cavmessland.com
Phone:910-339-6330
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Technical Support Hotline:(888)690-7384