DOCUMENTS Initial Application Dater Application# 1 1`��`� a� C I
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillington,NC 27546 Phone:(910)893-7525 exl:2 Fax:(910)893-2793 www.harnettorg/Permits
_A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITRNG A LAND USE APPLICATION**
Mailing Address:2919 Breezewood Ave.,Ste.400
LANDOWNER H&H Constructors of Fayetteville,LLC. Leannahair�hhhomes.com
NC 28303 910-486-4864 Email:
City: Fayetteville State:_Zipr__Contact No:
Same As Owner Mailing Address:Same
APPLICANT': Same Same
Same Cooled No: Email:
City: Stete:_.Zlp:__
'Please fill out applicant Information idifferent than landowner
CONTACT NAME APPLYING IN OFFICE:
Leanne Hair Phone#910A86 864
Anderson Creek ClubLot#: Lot Size' jlaCreS
PROPERTY LOCATION:Subdivision: 1
1117 State Road Name: Nursery Road ff�/�� R Map Book&Pag
258
State Ronl/NFa 7.�.�• ` PIN:y /L V•T 1 ` a l
Parcel: � O'L�`❑— � (y�� (y ^��(y��•��� South River
��''JJ//������������ Watershed:.jy�__Deed Book&PageW-13/CPti grower Company':
Zaningl]t'JB{b�lootl Zone:_.__
from Progress Energy.
'New structures with Progress Energy as service provider need to supply p remise number
PROPOSED USE:II1kV[� G lt616
pr SED:(Sizel'r x "/ 4#B rooms:11 41 #Baths?-Basement(wlwo bath): Garage:. Deck:_Crawl Space: Slab: Mow
51ab:i
(Is the bonus room finished?( )yes Lino w/a closet?U yes ( )no(if yes add in with#bedrooms)
❑ Mod:(Sizex )sBedrooms_#Baths_
Basement(w/wo bath)_Garage:_Site Built Deck:_ On Frame_Off Frame_
(Is the second floor finished?( lyes (.ono Any other site built additions?Li yes (ono
❑ Manufactured Home: SW DW -NV(Size a 1#Bedrooms:, Garage: (site built? )Deck: (site built? )
❑ Duplex:(Size____x___)No.Buildings: No.Bedrooms Per Unit:
�
❑ Home Occupation:#Rooms:
Use: Hours of Operation: #Employees:
Closets In addition?U yes ( )no
❑ Addition/Accessory/Other:(Size x____)Use:
Water Supply: j_County Existing Well _.New Well(#01 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 ofland,own land that contains a manufactured home within five hundred feet(500)of tract listed above?1 )yes (✓no
Does the property contain any easements whether underground1r overhead yes ( )no
Structures(existing o •mpose• 'Single family dwellings:
Manufactured Homes' Other(specify):
Required Residential Property Line Setbacks: Comments:
j /I#
Front Minimum 30 Actuals)I
25 q Rear 10
Closest Slde _—
SidestreeVcamer lot 20 __
Nearest Building 0 03111
on same lot Page 1 of 2
Residential Land Use Application
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
Hwy.27 to Nursery Road,turn left and follow Ray Road.Turn left and
follow to Anderson Creek Drive.
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 foregoin atements are accurate and correct to the best of my knowledge. Permit subject to if false information Is provided.
Ignature ofOwner or rs Agent :t
"It is the owner/applicants responsibility to provide the county with arty applicable etc.Inead easements, Theon aboutnty thelhemploct yees cpsperty,Including re Irespongibut not
tamyhed
to:boundary information,house correct or mining infoation,underground rmatior n that is contained within these applications."'
"This application expires 8 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 mot under my direction and
euprSVm this map was boon /ion an actual field survey that the error of
aowra of the survey as calculated by coo"M"otes is r: I0, 0*; that Me
area*holm hereon was Calm mtw by coo'dn°x.. MAP 20
iur
wthess my hand and seal this day of MONTH 1017 HARNETf'5 pc
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T Com. REcis—2 9.258
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FU JRE DEVLLOPMfNT
5 14°27'03"E--60.00
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PROPOSED
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CAN 9I- 1 - _ - H ! X44.3a- - N.
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TIMBER SKIP DRIVE
50' PRIVA FE R/W SE7- 6AG K5
FRONT 3O'
REAR
ONE 5105 IO'
CORNER 510E 20'
LEGEND I t
Application#
Harnett County Central Permitting
PO Box 65 Lillington,NC 27546
Each section below to be filled out 910-893-7525 Fax 910-893-2793 www.harnett.org/permits
by whomever performing work.
Must be owner or licensed
contractor. Address,company Application for Residential Building and Trades Permit
name&phone must match ml
Owner's Nam(ee��H&H ConstructorsofCFai(eettteville, LLC. Date: .
Site Address"L3 T\mL-Pr Sic-4p On Ivt Phone: 910-486 864
Directions to job site from Lillington: Hwy 27 to Nursery Road, Turn left,follow to Ray Road,turn left and
follow to Anderson Creek Drive.
^I
Subdivision: Anderson Creek Club Lot: O{
Description of Proposed� Work: SFC) ` L #of Bedrooms:
14
Heated SF:pr.y3/�M0 Unheated SF:(034 Finished
Bonus Room? CrawlCrawl Space: Slab:
General ✓—
H&H Constructors of Fayetteville. LLC. 910-486-4864
Building Contractor's Company Name Telephone
2919 Breezewood Avenue Ste.400,Fay, NC 28303 LeannahairGDhhhomes.com
Address
Email Address
74158
License#
Electrical Contractor Information
Description of Work
Service Size: 200 Amps T-Pole: X Yes_No
JM Pope Electric LLC. 919-776-5144
Electrical Contractor's Company Name Telephone
409 Chatham Street Sanford, NC 27330 electricpopeCalwindstream.net.com
Address Email Address
21326
License#
Mechanical/HVAC Contractor Information
Description of Work
Carolina Comfort Alrinc. 919-934-1060
Mechanical Contractor's Company Name Telephone
5212 US Hwy 70 Business, Clavton,NC 27520 carolinacomfortairrgv)yahoo.com
Address
Email Address
29077 H-3-I
License#
Plumbing Contractor Information
Description of Work #Baths rQ • YJ
Vance Johnson Plumbing Co.. Inc. 910-424-6712
Plumbing Contractor's Company Name Telephone
3242 Mid Pine Dr. Fayetteville. NC 28306 etoepferviplumbine.com
Address Email Address
07756-P-I
License#
Insulation Contractor Information
Tri-City Insulation 418 Person St. Fay. NC 28301 910-486-8855
Insulation Contractor's Company Name&Address Telephone
*NOTE: General Contractor I owner 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 by signing below I have obtained all subcontractors
permission to obtain these permits and if my 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 as per current fee schedule.
.ern IO ( 11
Signature of OwnerlContr fficer(s)of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87-14
The undersigned applicant being the:
X General Contractor Owner X 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:
X 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.
X 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: H&H Constructors of Fayetteville, LLC. 1 `-t
Sign w/Titlel,��� / Permitting Coordinator Date: IO\ `Y` ` 1
Appointment of Lien Agent: Details-LiensNC Lien Service Page 1 of I
DO NOT REMOVE!
Details: Appointment of Lien Agent Filed 10/04/2017
Entry St: 732864 Initially filed by: mesganbradshaw
Designated Lien Agent Project Property Print & Post
First Noel-wan Nle Insurance Co n pay AC X000022 Lm 22 Anderson Creek CDS El.
El
Crossing 1 +
Online. wx llnme corn _ 90 Timber Skip Dave 1-
Addre 19W Rego St Sm¢NT Raleigh.NC Spring Lake,NC 28390 :
Damen County
216ul Contractors:
Plane.Xxii-640.7o4 Please pool this nese an the lob Site
Fn:c13-15C.5211Suppliers and Suhmntrvtloes:
Foca iop reprep ar rpm . . - Property Type Scan this image witli your soma phone
w this filing You can Den file a Notice
to Lim Agent for this project
1.2 Family Dwelling
Owner Information
Date of First Furnishing
xEu Cansmtanrs of Fayette rile LLC.
2919 meezewood Avenue Ste 400
Fayetteville NC 28102
06/01/20
Fmmp Ieaneahancg`hhhomes mm
Phone.910A86-4R64
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Technical Supper'11otline:leSe)690-1394
https://apps.liensnc.corn/Scr/appointment/details.html?entryNumber~732864&printable= 10/4/2017