BUILDING Sep 1317,03:12p R&L Builders&Sons LLC 252-443-1506 p.1
Application# /7 coo 416 20
"Each section below must be filled out by Harnett CountyCentral Permitting
whoever is pcensedng the work. Must be
owner or licensed contractor. Address, PO Box 65 93-Vtan,NC 27546
company name & phone must match 910-893-7525 Fax 910-693-2193 www.harnetl org;permits
Information on stale license. COMMERCIAL
Application for Building and Trades Permit r('��
Owner's Name: ‘14.-4,4 �arfbrraho:". Date: ✓`- 13' 11
Site Address: VTR'. Lk -kP� C.3., r✓nn JUG 772/n Phone:
Directions to job site from Lillington: Oa C.-JeF 00"1"901•- Md.i-N
Subdivision: Lot
Description of Proposed Work: 1 yrai jtr;(v
Healed SF Jgj(m Unheated SF
p ) {{ 'G'eneral Contractor Information: Building Cost $_ 331,, ere,
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Building Contractor's Company Name Telephone
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Address Email Address
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Sigorf ture of Owner/Conbactor/Officer(s)of Corporation License#
Electrical Contractor Information: Electrical Cost$ &&OO
Description of Work Service Size: Amps #T-Poles
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Electrical Contractor's Company Name Telephone
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Address Email Address
Signature of Owner/Contractor/Officer(s)of Corporation License#
Mechanical Contractor Information: Mechanical Cost S Z9 rX:�
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Description of Work HV ✓- hood t # Units
Mechanical Contractors Co pany Name Tele one
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Signature ofOwner/Contractor/Officer(s)of Corporation License#
Plumbing Contractor Information: Plumbing Cost $ /-..g men
Description of Work #Baths
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Plumbing ntractors CPa�zpan N e Telephone
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Address Email Addr6ks
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ignature
off Owner/Contractor/Officer(s)of Corporation License#
Insulation Contractor Information
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Insulation Contractor's Company Name &Address Telephone
'NOTE: General Contractor must fill out and sign the second page of this application
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Sep 1317,03:12p R 8 L Builders 8 Sons LLC 252-443-1506 p.2
Sprinkler Contractor Information
Sprinkler Contractor's Company Name Telephone
Address - Email Address
Signature of Officer(s)of Corporation License#
Fire Alarm Contractor Information
Fire Alarm Contractor's Company Name Telephone
Address Email Address
Signature of Officer(s)of Corporation License #
Driveway Access - NC Department of Transportation Driveway Access/Permit? _Yes_No
I hereby certify that I have the authorityto make necessaryapplication,
Blthat 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 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 - 6 months to 2 years permit re-Issue fee is$150.00. After 2 years re-issue fee
is charged at full price per current fee schedule.
Signatureof Owner/Contractor/Officer(s)of Corporation Dale
Affidavit for Worker's Compensation N.C.G.S. 87-14
The undersigned applicant being the: •
V 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.
✓ 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 parson, firm or corporation
carrying out the work.
Company or Name:R1 L. `a r i 1I A/ ' ni LLC
Sign w/Title: /c7.-/e/7 Date: q
Sep 13 17,03.12p R B L Builders&Sons LLC 252-443-1506 p.3
2739 NC-24,Cameron,NC 29326 to Lillington,NC 27546-Google Maps 9/13117,10.56 AM
- r. H 1-; Maps 2738 NC-24, Cameron, NC 28326 to Lillington, NC Drive 19.3 miles, 24 min
27546
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Sep 1317,03:12p R&L Builders&Sons LLC 252-443-1506 p.4
2796 NC-24,Cameron,NC 28326 to LIIIInglon,NC 27546-Google Maps 9/13117,10:56 AM
2738 NC-24
Cameron,NC 28326
f 1. Head east toward NC-24 E/NC-87 S
151 ft
r 2. Turn right onto NC-24 E/NC-87 S
1.0 mi
▪ 3. Turn left onto Nursery Rd
2.4 mi
• 4. Turn left to stay on Nursery Rd
6.4 nil
f' 5. Turn right onto NC-27 E
99 mi
alt 6. Turn left onto S Main St
05 mi
lillington
North Carolina 27546
These directions are for planning psposes only.You may fend that construction projects,
traffic,weather.or other events may cause conditions to differ from the map results,and
you should plan your route accord'!ngly.You must obey all signs cr notices regarding your
route.
Vrpc//www.google.com/mepsidlr/2738+NC-24,aCameron,+NG283261._62644533c1ed:Oxeracc29e3ae9d3fe!2m2!td-26.8158526!24135.399322 Page 2 of 2
Sep 13 17,03:12p R&L Builders&Sons LLC 252-443-1506 p.5
Appointment or Lien Agent:Details-LiensNC Lien Service 9/13/I7,1:01 PM
•
DO NOT REMOVE!
Details: Appointment of Lien Agent Piled on: 09113/1017
Entry y: 720634
Initially filed by: RLBS
Designated Lien Agent Project Property
Print 3 Post
Chicago Title Company,LLC Burger King Rnmomnt C.nnemn,NC
2738NC 2187 Erse. O
Onii.e-m.!atone atm. Cameron,NC 28326
Address:19W IWyd S,Suii sm: Moore Colmty `Wi
Ndeitllt Nf.
lWl Off" r
Nmnc 011-690-7114
0-7186
Property Type Contractors:
Fie:se-:as-SZ!I Please post his notice on the lab Site.
Email:aypoa+ROumec am Other Suppliers and Subcoonaetun:
Scan this image with Yam snarl 00110 10
view this filirg YoU can Nen file a Notice
Owner Information Date of First Furnishing Co Lien Agent for thisprolen.
Carmis Corp 09/25t1017
965 James St
Syracuse, NY 1320S
United Swes
Email gpaticn*cwlnls corn
Phone:919-267-6fS9
Mew Comments(D)
Rcbnical Support Hotline:0881690-7384
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