DOCUMENTS Initial Application Date: 1 I La I Irl Application# l I S C'e 1 3 13
DR8# CU#
COMMERCIAL
COUNTY OF HARNETT LAND USE APPLICATION
Central Permitting IPhyaoal)108 E.Front Street LAGnolon,NC 27596 (Malmo)PO Box.65 IJilin91on NC 27506 Phone'(910)693-7525 opi N 2 Fax(910)893-2793 v.wwdameto191pettls
LANDOWNER. Harnett County School Mailing Address: P.O.Box 1029
City' Lillington State: NC Zip: 27546 Contact# 910-985-1003 Email: roregow1(EDharnett.k12.nc.us
APPLICANT':
Harnett County School Mailing Address: P.0 Box 1029
repo
910-985-1003 r 1@harnett.k12.ncus
City Lillinaton State: NC Zip: 27546 Contact Email: 9 ry
•Please fill our applicant information if different than landowner
Rodney Gregory Phone# 910-985-1003
CONTACT NAME APPLYING IN OFFICE: ,�..��JI '�(( p
2495 Ray Road, Spring Lake NC 28390 Lot#: Lot Size IL. /
PROPERTY LOCATION:Subdivision'. �AT-- �., �1 nn�������� -I ��LOS State Road# l t-a..c` State Road
Name'. c� \l k c� '`�',\' I , 1 Map` Bolok&Page&C aJ\/ 4 LOS
Parcel: C) t DS/ 0 an) ` PIN: bSOLl -14 Lt - I Ll`t S •n0O
Zoning aZIS'1 food Zone: y. Watershed: A. ms Deed Book&Page:I act t / tic VJ Power Company':
"New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINCTON: Take Hwy 210 out of Lillington turn right on to Ray Road school
Left
PROPOSED USE:
U Multi-Family Dwelling No.Units: No.Bedrooms/Unit:
❑ Business Sq.Ft. Retail Space: Type: #Employees: Hours of Operation:
U Daycare #Preschoolers: #Afterschoolers: #Employees: Hours of Operation:
❑ Industry Sq.Ft: Type: #Employees: Hours of Operation:
�❑p Church Seating Capacity #Bathrooms: Kitchen':
r Accessory/Addition/Other(Size 24 x 36 )Use: Mobile Classroom with no plumbing
'Water Supply: County _Existing Well _New Well(N of dwellings using well ) 'MUST have operable water before final
Sewage Supply: New Septic Tank(Complete Checklist) Existing Septic Tank(Complete Checklist) _County Sewer
Comments:
.eT,10/ n 1\ PNves,-E— \-1 — 1.$ -ttL.-os& \ C0-C
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 accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
/'
Signator IOwner Owner' Agent Date
-This application expires 6 months from the Initial dale It penults have not been issued"
A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
Application# '1 'a 3 3 1
'Each section below must be filled out by Harnett County Central Permitting
whoever is performing the work. Must be PO Box 65 Lillington,NC 27546
owner or licensed contractor. Address, 910-893-7525 Fax 910-B93-2793 www.harnea org/permits
company name & phone must match COMMERCIAL
Information on state license.
Application for Building and Trades Permit
Harnett County School Date: 9-6-2017
Owner's Name. 910-893-4806
Site Address'. 2495 Ray Road, Spring Lake NC 28390 Phone:
Directions to lob site from Lillington: Take 210 turn to right onto Ray Road go to you see school on left turn in by
football Held go to back of the school
Subdivision: Lot:
Description of Proposed Work: Building a mobile classroom 24'x 36'
Heated SF 864 Unheated SF 10000.00
General Contractor Information: Building Cost$
Harnett County school 910-893-4808
Building Contractor's Company Name Telephone
1500 South main St.Lillington, NC 27546 rgregory1@harnett.k12.nc.us
Address Email Address
Signature of ner/Con42ctq�Officer(s)of Corporation License#
Electrical Contractor Information: Electrical Cost$ 500.00
Description of Work install a 100 amp panel Service Size: 100 Amps #T-Poles
Harnett County School
Electrical Contractor's Company Name Telephone
1500 South main St.Lillington, NC 27546
Address 67
Email Address
Signature%ner/Contraactor/ Icer(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&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 Depanment ofransponation 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 311y 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.
— L — /7
Signature of Oyer/Contra r/Off er(s)of Corporation Date
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:/ /1/4/1--4-7-..-re xi '71 7fcL m /
on/ . (7 4 Date: /C�
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Sign wlTitle: J" - /
Harnett CFM) Ern.••Mr Da waist
COUNTY ve n thatnmm.•
Fire Marshal Division
P.O. Box 370
Lillington,NC 27546
910-893-7580
Application for Plan Review
�
^ Application # I - 5vrati I
Date Received: j 1 \ p�al Received By:
Name of Project: H \
arnett County School Q C
Physical Address of Project:
2495 Ray Rd.
Spring Lake NC 28390
Plans Submitted By: Harnett County School
Project Phone: (910 )"893 4808
Contact Person/Address: Rodney Gregory
1500 South Main St.
910 985 1003
Contact Phone: ( )" -
Contractor's Name/Info: Harnett County School
Contractor's Phone: (910 985 1003
• Plans that are submitted will be reviewed as quickly as possible with an
average time of review between 7-10 working days.
• Status checks may be conducted on plan reviews by visiting the website
httn://hteweb.harnett.ore/Click 2GovBPQndex.iso or by calling the Harnett
County Central Permitting Office (910-893-4759),or the Harnett County
Fire Marshal's Office(910-893-7580).
• Approved plans must be picked up from the Central Permitting Office and
all fees paid before any required inspections can be conducted.