DOCUMENTS Initial Application Date: Ct I Zo1 I7 Application a ' /Sno leg 3 I (
DRBa CUM
COMMERCIAL
COUNTY OF HARNETT LAND USE APPLICATION
Centre'Permlun0 (PMwcLO IM E.Front Street.LYlrylnn.NC 27566 rMverpl PO&e 85 Lilbrgton NC 27546 Phone(910)893-7525 opt#2 Fa.:1910)e93.2793 onto Mmsnarvpo'mis
LANDOWNER: Harnett County School Mailing Address: P.O.Box 1029
City. Lillington State. NC Zip: 27546 Contact 910-985-1003 Email: rgregoryleharnetl.k12.nc.us
APPLICANT': Harnett County School Mailing Address: P.O Box 1029
City: Lillington Stale: NC Zip: 27546 Contact ft 910-985-1003 Email: rgregoryi@hametl.kl 2.nc.us
'Please lila out applicant information it diflerenl than landowner
CONTACT NAME APPLYING IN OFFICE: Rodney Gregory Phone N 910-985-1003 --'yy � a
PROPERTY LOCATION:fiSubdivision: 1915 Buffalo Lake Road,Sanford
'277332,,1 p�{ Lot a: Lot
sizeafi• 3a
Stale Road is R 15 State Road Name: \A 1 Br�'`d. ( CIN- It (?Lt I ,� Map BooS.&PagervN+Oa ci I)/
Parcel':nnD���1�pe�t ST 7 yt I 034 LO S Br
PIN: q' 15122...0. lac — lit _ 5s3 a.Olt
ZoningRA011sfa"lood Zone: /` Watershed:ND Deed Book6Page:IW O / ISI Power Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM❑LLINOTON: Take Hwy 27 west out Lillington turn left onto Buffalo school will be on
Left
PROPOSED USE:
❑ Mufti-Family Dwelling No.Units: No.BedroomsrUniL
U Business Sq.Ft.Retail Space: Type: a Employees: Hours of Operation:
❑ Daycare E Preschoolers: a Afterschoolers: 4 Employees: Hours of Operation:
❑ Industry Sq.Ft: Type: #Employees: Hours of Operation:
U Church Sealing Capacity: a Bathrooms: Kitchen.
U Accessory/AddnimvOlher(Size 24 x 36 1 Use: Mobile Classroom with no plumbing
Water Supply: County Existing Well New Well(Sol dwellings using well ) 'MUST have operable water before final
Sewage Supply: New Septic Tank(Complete Checklist) Existing Septic Tank(Complete Checklist County Sewer
Comments:
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II 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 slate that foregoing statements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
/� c /� /7
Signatur of Own or or er'e Agent Date
•This applies Ion expires 6 months from the initial date If permits have not been Issued"
A RECORDED SURVEY MAP,RECORDED DEED(OR OFFERTO PURCHASE)AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
*Each section below must be filled out by Application#
whoever is performing the work. Must be Harnett County Central Permitting
owner or licensed contractor. Address, PC Box 65 Lillirgton,NC 27546
company name & phone must match 910-893-7525 Fax 910-893-2793 www.harnett.org/permits
information on state license. COMMERCIAL
Application for Buildine and Trades Permit
Owner's Name: Harnett County School Date: 9-6-2017
Site Address: 1915 Buffalo Lake Rd.Sanford 27332 Phone: 910-893-4808
Directions to job site from Lillington: Take 210 turn right onto harnett central rd. and then turn Left onto Neill Creta
school on left
Subdivision: Lot:
Description of Proposed Work: Building a mobile classroom 24'x 36'
Heated SF 864 Unheated SF
General Contractor Information: Building Cost$ 10000.00
Harnett County school 910-893-4808
Building Contractor's Company Name Telephone
1500 South main St.Lillington, NC 27546 rgregoryl@harnett.k12.nc.us
Address Email Address
Signature of Owner/Contractor/Officer(s)of Corporation License#
Electrical Contractor Information: Electrical Cost$ 500.00
Description of Work Wring service panel Service Size: 10o Amps #T-Poles
Harnett County School
Electrical Contractor's Company Name Telephone
1500 South main St.Lillington. NC 27546
Address Email Address
Signature of Owner/Contractor/Officer(s)of Corporation License#
Mechanical Contractor Information: Mechanical Cost$
Description of Work #Units
Mechanical Contractor's Company Name Telephone
Address Email Address
Signature of Owner/Contractor/Officer(s)of Corporation License#
Plumbing Contractor Information: Plumbing Cost$
Description of Work #Baths
Plumbing Contractor's Company Name Telephone
Address Email Address
Signature of Owner/Contractor/Officer(s)of Corporation License#
Insulation Contractor Information
Insulation Inc. 919-772-9000
Insulation Contractor's Company Name Si Address Telephone
*NOTE: General Contractor must fill out and sign the second page of this application
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 Transponation Driveway Access/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 ay 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 chargedrggeat full price per current fee schedule.
Signatu,Owner/ ontract r/Officer(s)of Corporation Date
!!ll������ Affidavit for Worker's Compensation N.C.G.S. 87-14
The undersigned applicant being the:
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 person, firm or corporation
carrying out the work. """ """ '''
Company or Name: Krv[�T" -q L /
Sign w/Title: Date: T /6 -77