DOCUMENTS Initial Application DatedI Il 'I f I Application# 1 n5l o 3 •O
CU#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E. Front Street,Lillingtora,NC 27546 Phone. (910)893-7525 ext:2 Fax:(910)893-2793 www.harnett orglpermits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
LANOOWNEft'.
H&H Constructors of Fayetteville,LLC. Mailing Address:2919 Breezewood Avenue, Ste.400
City:
Fayetteville State:NC Zip'.28303 Contact No: 910-486-4864 Email: leannahair@hhhomes.com
APPLICANT':HLH Constructors of Fayetteville, LLC, Mailing Address:2919 Breezewood Avenue, Ste.400
City:
Fayetteville State:NC Zip'28303 Contact No: 910-486-4864 Email: leannahair@hhhomes.com
'Please till out applicant information if different than landowner
CONTACT NAME APPLYING IN OFFICELeanna Hair Phone#910486-4864
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PROPERTY LOCATION:Subdivision: Oakmont Lot#151 Lot
xSsi1ze:_ 54 ��V
State Road##�111166 Sin '
State RoadrName. Docs Road �n 2 ^ p Map Book 8 Page/ 0/10 / LI
ei
Parcel:0515 Dill I O a i PIN i v •� aa I/9%0
RA-20R -Ze�dS/O�dr`[ Power Com an : Central Elec.
Zoning'. Flood Zone: [. Watershed M) Deed Book 8 Page P Y
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE: l� /T // Monolithic14SFD:(Size 7O x )#Bedrooms5#Baths:A flasemenl(w/wo bath): Garage:!Deck:_Crawl Space./Slab:_Slab:_
(Is the bonus room finished?( )yes ( )no wl a closet?( 1 yes ( )no Of yes add in with#bedrooms)
❑ Mod:(Size_x_)#Bedrooms_#Baths_Basement(w/wo bath)_Garage:_Site Built Deck:_ On Frame_Off Frame_
(Is the second floor finished?( 1 yes ( 1 no Any other site built additions?( )yes ( )no
❑ Manufactured Home:_SW_OW_TW(Size x )#Bedrooms: Garage' (site built? 1 Deck: (site built?_)
❑ 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?( 1 yes ( 1 no
Water Supply: / County Existing Well New Well(#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 (f)no
Does the properly contain any easements whether underground or overhead( 1 yes iCrto
Structures(existing or proposed):Single family dwellings:ProposedManufactured Homes: Other(specify)
Required Residential Property Line Setbacks: Comments:
101
Front Minimum 35 Actual.
aaRear 25 ay
Closest Side
5/10
Sidestreeucorner lot 20
Nearest Building
on same lot 03/11
Residential Land Use Application Page 1 of 2
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: Take Hwy, 27 to Docs Road,turn left,go about 1.5,turn let into
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 foregoinatements are accurate and correct to the best of my knowledge. Permits bjeci to revocation if false information is provided.
yVY Signature of Own wners Agent D e
••9t is the owner/applicants 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•
Residential Land Use Application Page 2 of 2 03/11
1 MICHAEL P. GRIFFIN certify roof undue my dseatmn and
•upe dNan this mho was bash ham an actual/Mid suJc that the error of i CO
Bosun of me fumy as calculated by coordinates Is r: 10.0.00+ ; mal the p v
area sham hereon was calculated by cowdmates. T O
Mines,my hand and seal m's day of MOUTH 2017 (Th-‘h
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EXECUTIVE DRIVE
GO' RAV(PUBLIC tt UTILITY ACCESS) 5 E T 5 A C K 5
FRONT 35'
REAR
SIDE 10'
REVISION: BACK,5IDELOAD, MOVE RIGHT. COV.POROh ONLY 52Yi I7 '2`2
I LEGEND
NAME:j4511 c Sirue,I')1'.S Ill- FLS-+ • CL.`i , APPLICATION th
*This application to be filled out when applying for a septic system inspection.*
County Health Department Application for Improvement Permit and/or Authorization to Construct
IF THE INFORMATION IN THIS APPLICATION IS FALSIFIED,CHANGED,OR THE SITE IS ALTERED,THEN THE IMPROVEMENT
PERMIT OR AUTHORIZATION TO CONSTRUCT SHALL BECOME INVALID. The permit is valid for either 60 months or without expiration
depending upon documentation submitted. (Complete site plan=60 months;Complete plat=without expiration)
/ 910-893-7525 option 1 CONFIRMATION#
{X Environmental Health New Septic SvstemCode 800
• All property Irons must be made visible. Place "pink property flags" on each corner iron of lot. All property
lines must be clearly flagged approximately every 50 feet between corners.
• Place "orange house corner Bags" at each corner of the proposed structure. Also flag driveways, garages, decks,
out buildings, swimming pools, etc. Place flags per site plan developed at/for Central Permitting.
• Place orange Environmental Health card in location that is easily viewed from road to assist in locating property.
• It property is thickly wooded, Environmental Health requires that you clean out the undergrowth to allow the soil
evaluation to be performed. Inspectors should be able to walk freely around site. Do not grade property.
• All lots to be addressed within 10 business days after confirmation. $25.00 return trip fee may be Incurred
for failure to uncover outlet ltd,mark house corners and property lines. etc. once lot confirmed ready.
• After preparing proposed site call the voice permitting system at 910-893-7525 option 1 to schedule and use code
800 (after selecting notification permit if multiple permits exist) for Environmental Health inspection. Please note
confirmation number given at end of recording for proof of request.
• Use Click2Gov or IVR to verify results. Once approved, proceed to Central Permitting for permits.
❑ Environmental Health Existing Tank Inspections Code 800
• Follow above instructions for placing flags and card on property.
• Prepare for inspection by removing soil over outlet end of tank as diagram indicates, and lift lid straight up (if
possible) and then put lid back in place. (Unless inspection is for a septic tank in a mobile home park)
• DO NOT LEAVE LIDS OFF OF SEPTIC TANK
• Atter uncovering outlet end call the voice permitting system at 910-893-7525 option 1 & select notification permit
if multiple permits, then use code 800 for Environmental Health inspection. Please note confirmation number
given at end of recording for proof of request.
• Use Click2Gov or IVR to hear results. Once approved, proceed to Central Permitting for remaining permits.
SEPTIC
If applying for authorization to construct please indicate desired system type(s): can be ranked in order of preference,must choose one.
1_1 Accepted {_} Innovative LL1 Conventional lam} Any
{_1 Alternative 1-1 Other
The applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in
question. If the answer is"yes",applicant MUST ATTACH SUPPORTING DOCUMENTATION:
{_}YES (X} NO Does the site contain any Jurisdictional Wetlands?
{_)YES {›) NO Do you plan to have an imeation aystem now or in the future?
{_}YES (K) NO Does or will the building contain any drains?Please explain.
{_)YES {,L}NO Are there any existing wells,springs, waterlines or Wastewater Systems on this property?
{_}YES {y41 NO Is any wastewater going to be generated on the site other than domestic sewage?
(_}YES (4) NO Is the site subject to approval by any other Public Agency?
{_}YES ig) NO Are there any Easements or Right of Ways on this property?
{_)YES {4 NO Does the site contain any existing water,cable,phone or underground electric lines?
If yes please call No Cuts at 800-632-4949 to locate the lines. This is a free service.
I Have Read This Application And Certify That The Information Provided Herein Is True,Complete And Correct. Authorized County And
State Officials Are Granted Right Of Entry To Conduct Necessary Inspections To Determine Compliance With Applicable Laws And Rules.
I Understand That I Am Solely Responsible For The Proper Identification And Labeling Of All Property Lines And Corners And Making
The Site Ac /�Ibblle So That A Complete Si e valuation Can Be Performed.
PROPER OWNERS OR R AL REPRESENTATIVE SIGNATURE(REQUIRED) DAT
10/10
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00109111 Application#
Harnett County Central Permitting
PO Box 85 Edlington NC 27546
Each section below to be filled out 910 893 7525 Fax 910 B93 2793 www harnett erg/permits
by whomever performing work
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name 8 phone must match , + /� �f� tate
Owners Name 1'� 4l-oi'Ts}c l.LC\tf.i (SC �-tU.I E'�QVl Ilc lLL�.- • Date-I 113111
-*Site Address 464 Execuft Ye. br'IvePhoneril0- y53N " CI7�`Lt
r
Directions to job site from Lillington 1 c tL NL0.1L a I --i-o, ��C)C 12c'r c&C\ *i_w 1
1 -c-t m UL\D * 1�h ct \ems , " cuic(-) 1e-4* \Ili*c
Subdivision np.-C11v:1n+ Lost 16 1
Description of Proposed Work NIe ce Si(rile FLUI\tIti L)LtA'U If1c1 #Bf Bedrooms
*Heated SFe Unheated SF Finished Bonus Room's Crawl Space ✓ Slab
General Contractor Information
NE:* t4 (inn tr0o-ory cif- VeLveiity IIELit . CI IJ- LISib- c810cl
Building Contractors Company Name Telephone
Lectnctl-al -Kir 60'1
cil9 preeze.�w,ri Ave �te,'i ) RL"•uc- y 'cEmail Address
Address
r7 L-I 13
License#
Electrical Contractor Information
Description of Work Service Size '� �4mps T-Pole Yes_No
IThcinc\y R %C1�..:-Cr:1€L.trir ,�-r1C . Q - ' ?3 `133?
Electrical Contractor s Cbfnpany Name Telepho e
4`�1l 1,/,\;ckek1ead &c acl Fay• MC ,D.'33 I -Acme-mail ELI-At ItIl2'idtg±Eley+rnc .CYNI
Address
O% 16D" L
License#
Mechanical/HVAC Contractor Information
Description of Work
CUf IincA. Corvsfnr+ Air.,ti1c , Telephone1ici- IOLe3
Mechanical Contractors Company Name
,51 2 )N %n H1;'\(I)ns Gcy-h)ni Ni , J-1,.))1L) amli x ',min +An 9(4-1-rn kori )
Address Email Address
r13T1 N -3- 1
License#
Plumbing Contractor Informational
Description of Work of baths
Dell -kCuct . \1\km- \S1r4 CII)-. CI - (1CKl
Plumbing Contractors Company Name C Taianhone
Pr)1cX Itregc 1c+&3Er'i 11€1):1(t.,Si,kw.3 DeIIthi e9h� iiI*COM
• Address LAA 'C.-.)(.4.)
ress
License#
Insulation Contractor(Information
jrI sulatorrCity iCo tra tors Comp yName le &Adde s Ply Mt
Telephone
*NOTE
'NOTE General Contractor must fill out and sign the second page of this application
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 pv signing below I have obtained all subcontractors
permission to obtain these permit*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-0 Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
is as per current fee schedule
4 . q lig ' 1"1
Signature of Owner/Con rector/Officer(s)of Corporation Date
Affidavit for Worker's Compensation N C G S 87-14
The undo igned 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 workers 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 •
1 L
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Company gqr}}r..[��[11ame }{ N Urctstct:c*c c: .AL 1-C 4pWa 1V r 1� • /� �I
kign w/Titld. a / � fflrir�cdTiC+` 17luYZIO/Date'i 113 I 1 1
Appointment of Lien Agent: Details - LiensNC Lien Service Page 1 of 1
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed on: 00/28/2017
Entry N: 711055 Initially filed by: meagenbradshaw
Designated Lien Agent Project Property Print 3 Post
Fun American 1 ale Insurance Company OKM000157 Lot 157 Oakmont !7. - i7
404 Executivclbne 'lyor .Y
amine: xx lune,corns _. Lillingioo,NC 27546 11111.7
etltlmnl9W.avgmS,ettt, /RWJgh,NC Harnett County
➢WI
Contractors:
Phone:gxxnw➢N Please poll this notice on the lob Si'e
F..:
HI-He-5231 Property lyp. 'SWUM and subcomnnors:
lmnl:Hs=a lunerDem ..- Scan this image with sour smart phone
w this filing VOL.coo then file a Nonce
19 Family Dwelling to I den Agent for pmjecl.
Owner Information
Date of First Furnishing
i IL Ii Constructor.Inc
2919 Htrsrt000d Avenue gm 00
Fayetteville, NC 28303 06/21/21117
Un1e4 States
Email Ieannahi r@lhh homes mm
Phone.910-454-0064
View Commons IO)
Technical Support Hotline:(5S]O 5907304
https://apps.Iiensnc.com/scr/appointment/details.html?entryNumber-711055&printable= 9/20/2017
Date `''\ 1310 1 I
Plan Box # Job Name tt )�� 1 14
Plan Name t1-i-rv'.Jr- __
App # -SCL Valuation II a3s 1a SQ Feet d4'32
Garage '!1/a
= ac-77
•
Inspections for SFD/SFA
Crawl ✓ Slab_ Mono_ Basement_
Footing Footing Plum Under Slab Footing
Foundation Foundation Ele. Under Slab Foundation
Address Address Address Waterproofing
Open Floor Slab Mono Slab Plum Under slab
Rough In Rough In Rough In Address
Insulation Insulation Insulation Slab
Final Final Final Open Floor
Rough In
Insulation
Final
Foundation Survey_ Envir. Health "' Other
Additions/ Other
Footing
Foundation_
Slab_
Mono_
Open Floor_
Rough In
Insulation_
Final