BUILDING/PERMIT Namur Cannty Central Pcrrniuing
PO Box 65 Lillington,NC 27616
Telephone Number 910-893-9759
pplication for)3ui_lding and Trade Permit ( G
Owner's Name' • A/44) (1M _e witty (rt Date: ( I
Address:_, � �{ S'lT i-J versa?"'r1 Phone: (?fn '{2-grog
Directions In inh siteT,_...,e,.. „...-.,.-_,,.,,u a ..o....—,
Subdivision: A,) - ___ ___ Lot
Type Conn I action: (Please Check) Building Use: (Please Check>
New {)-tenovation O Addition () Residential V Modular 0
Moved House () Other 0 Commercial 0 Multi-Family 0
Specify Type of Work; •
'/ Buildinr Permit Information
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Heated • Crawl Space 3 Building Construction Cost y
I eet�Slab 0 , nev, Acres Disturbed J Stories
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Bui ding Co ire is Company Nan/ Address
) /8637 91# - a-ss- ffls
Signature of Of@cer(s) of Corporation License# Telephone
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// ctnca�Permit Information
Description of Work /a-eAR& ( Electrical Cost S
Is Pole yes(V' N. • nderground f verheard O
• L. anent Service Unde and 0 _Overhea. ' "re: Amps
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Flee e r ✓ Address
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..ignanQe of Officer of Corporation License# Telephone
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' tial .O •tiler 0 Not Required Q
Inst ation Co ir. or'. Company Name Address
Teleph. e
eehanlo. Permit Information
Description of Work ' 6 Number of I its_ _Type System_ Mechanical Cost S
Number of Tons
_ 1 ea,. . .: A -Y to e [fess,/ _oar;- ..c NC: cora/
Mesita i Contrac .r'. C. 'an Name Address
Signature 'f Officer : of Corpor Bron License# Telephone
�j Plumb.I • Permit Information
Description of WorkT LILA_ - umber o 'alhs _ _ Numbing Cost S
PI mbin .outctor's um.a, ame - ads ,s —'
jl . I�r a )W' 7 '1-o/
.Igoe ke of Offce>rsio fro oration Icerme # Telephone
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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 Hamed County Zoning Ordinance I state the information on the above
contractors is correct as known to me and that yv mama below I have obtained all subcontractor;
permission to obtain these permits and d pay changes occur including listed contractors site plan
number of bedrooms budding and trade plans Environmental Health permit changes or proposed use
changes I certify d is my responsibility to notify the Harnett County Central Permitting Department of
any and all changes
EXPIRED PERMIT FEES-B Months to 2 years permit re-issue fee is 3150 00 After 2 years re-issue fee
is asr CUA fee schedule
Signature of Owner/Contractor/Officer(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 penury 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
1!/Has one(1)or more subcontractors(s)who has their own policy of workers compensation insurance
covenng 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 dunng the permitted work from any person firm or corporation
carrying out the work
Company or Name
AI bs5 / 11 /3t u-dt-cs ? 244v/� /lam .(
Sign wrtide
--_—re_________
Date //71"1(7°.7
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Bldg Insp scheduled before 2pm available next business day.
Application Number 17-50042606 Date 11/28/17
Property Address 1840 OLD US 421
PARCEL NUMBER 10-0640- - -0109- -34-
Application type description CP GARAGE/CARPORT RESIDENTIAL DETACHED
Subdivision Name TIRZAH VILLAGE SUB PHASE 4
Property Zoning PENDING
Owner Contractor
NAGEL DOUGLAS MOSS KENNETH A
1840 OLD US 421 PO BOX 577
LILLINGTON NC 27546 LILLINGTON NC 27546
(910) 893-4875
Applicant
MOSS HOMEBUILDERS
PO BOX 577
LILLINGTON NC 27546
(910) 890-2103
--- Structure Information 000 000 32X30 DET GARAGE
Flood Zone FLOOD ZONE X
Other struct info PROPOSED USE DET GARAGE
SEPTIC - EXISTING? EXT TANK
WATER SUPPLY COUNTY
Permit RESIDENTIAL BUILDING PERMIT
Additional desc .
Phone Access Code 1220003
Issue Date . . . 11/28/17 Valuation . . . 0
Expiration Date . 11/28/18
Permit LAND USE PERMIT
Additional desc .
Phone Access Code 1220011
Issue Date . . . 11/28/17 Valuation . . . . 0
Expiration Date . 5/27/18
Special Notes and Comments
T/S: 10/23/2017 03 : 33 PM JBROCK ----
1840 OLD US 421
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax : (910) 893-2793
Bldg Insp scheduled before 2pm available next business day.
Page 2
Application Number 17-50042606 Date 11/28/17
Property Address 1840 OLD US 421
PARCEL NUMBER . 10-0640- - -0109- -34-
Application description . . CP GARAGE/CARPORT RESIDENTIAL DETACHED
Subdivision Name TIRZAH VILLAGE SUB PHASE 4
Property Zoning PENDING
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
Permit type . . . . RESIDENTIAL BUILDING PERMIT
999 103 B103 R*BLDG FOUND & TEMP SVC POLE / /
999 111 B111 R*BLDG SLAB INSP/TEMP SVC POLE / /_
999 101 B101 R*BLDG FOOTING / TEMP SVC POLE / /
999 131 R131 ONE TRADE FINAL / /_
999 125 R125 ONE TRADE ROUGH IN / /
Permit type . . . . LAND USE PERMIT
999 818 Z818 PZ*ZONING INSPECTION / /
999 820 Z820 PZ*ZONING/FINAL INSPECTION / /_