DOCUMENTS Initial Application Date: \\ 9 a 1 / Application# in t-t _ '-^3Z)
DRB# CU#
COMMERCIAL
COUNTY OF HARNETT LAND USE APPLICATION
Cenral Permitting (Physical 105 E.Roll StreeI,LAI'gton NC 275.46 (Mailing)PO an 65 L14nglon NC 27546 Phone.(910)093-7525 opt 42 Fax(n1 01 593-2793 w,w.harneilorg/pernls
LANDOWNER. Harnett County School Mailing Address: P.O.Box 1029
City: Ellington State: NC Zip: 27546 Contact# 910-985-1003 Email: rgregorv1(o3harnett.k12.nc.us
APPLICANT*: Harnett County School Mailing Address: P.0 Box 1029
City: Ellington State' NC Zip: 27546 Contact 910-985-1003 Email: rgregoryl@harnett.k12nc.us
'Please Int out applicant information it ditlerent than landowner
CONTACT NAME APPLYING IN OFFICE: Rodney Gregory Phone# 910-985-1003 C
PROPERTY LOCATION:Subdivision: 2911 Harnett' `_Central Road, Angier(`� NC 27501 Lot#: 1 Lotw �Siizzee:: 3S .�5 fl L
State Road#yI^�`ea,t``1S1 __ State Road N'amme•\ TA tY'^(:� CQJ1 ,.✓a..1 �A Map B000kk&Paget'Ya.t / <as
Parcel: 04 f o(� d�GUDI PIN: x�to a� ^-Css- a ` Is • (DvC)
Zoning` 7b Flood Zone: Watershed'i ^ Deed Book&Paget95. 95 (_A .S Power Company':
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: Take Hwy 210 out of Lillington turn right on to Harnett Central Rd
go to Neil Creek Rd,turn left school will be left
PROPOSED USE:
O Multi-Family Dwelling No.Units: No.Bedrooms/Unit:
❑ Business Sq.Ft.Retail Space: Type: #Employees: Hours of Operation:
O Daycare #Preschoolers. #Afterschoolers: #Employees: Hours of Operation:
❑ Industry Sq.Ft: Type: #Employees: Hours of Operation:
❑ CNurch Seating Capacity: it Bathrooms: Kitchen:
00/Accessory/Addition/Other(Size 24 x 36 )Use: Mobile Classroom with no plumbing
Water Supply: Count Existin. ell New Well(Col dwell r - r well ) 'MUST have operab e •. :r before final
Sewage Supply: 'ew Septic Tank(Comp); : ecklis' 'sting Septic Tank(Complete Checklist County Sewer
Comments:
C ilvil ()D\ CPriysA- 1[ 1 LY Sc 1-1-a-2 .1 Ni 4 na r-
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.
Si inure ofCh .er or i7wner's Agent Date />
"This application expires 6 months from the Initial date II permits have not been issued"
A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)AND PLAT ARE REQUIRED WHEN APPLYING FOR LAND USE APPLICATION
'Each section below must be filled out by App cation#
Harnett County Central Permitting
whoever is performing the work. Must be
owner or licensed contractor. Address, PO Box 65 Lillingmn,NC 27546
company name & phone must match 910-893-7525 Fax 910-893-2793 www.harnettorg/permits
information on state license. COMMERCIAL
Application for Building and Trades Permit
Owner's Name: Harnett County School Date: 9-6-2017
Site Address: 2911 Harnett Central Road,Angier NC 27501 Phone: 910-893-4808
Directions to job site from Lillington: Take 210 turn right on to harnett central rdand then turn Left on to Neill Crelj
school on left
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 —�7 Email Address
Signature of O er/Contfactor/6fficer(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 Email Address
Sign tura of 0r/Contrdtior/ Icer(s)of Corporation License#
Mec anica1 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#
Plumbina 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 Department of Transportation 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 sex 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.
`.4 — l7
Signature of net/Co tactor fficer(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. -.�.lq� L'f/ //! / /.
Company or Name: Z' / % 4, 4" ( . �u-W' `� ��K6� /
Sign w/Title: &12 47
Yh..y.
r hJa Date: R—�e ' I7
r
/' -s Harnett
COUNTY * A (FM) Eng
W'AJIYIYa.�
Fire Marshal Division
P.O. Box 370
Lillington,NC 27546
910-893-7580
Application for Plan Review
yA�pplication #In - [X7 a 3 3 Q
Date Received:q i tp Oc 1 '7 Received By:all •
Name of Project: Harnett County School C_ANS
Physical Address of Protect: 2911 Harnett Central Rd
Angier Nc 27501
Plans Submitted By: Harnett County School
Project Phone: (910 )_893 4808
Contact Person/Address: Rodney Gregory
1500 South Main St.
Contact Phone: (910 985 1003 ( )_
Contractors Name/Info: Harnett County School
Contractor's Phone: (91 0 ) 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/Click2GovBP/Index.isn 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.