BUILDING / PERMIT/ RECEIPT inII 11 11 1, r tl tI 1911
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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 Electncal 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)v mining below I have obtained all subcontractors
permission to obtain these cermet%end if ppy 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-S Months to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee
is es per current fee schedule
Spnatu of Owner/Contractor/Ofticer(s)of Corporation Date 2-r 1417r,1 -7
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 suboontractors(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 winch Mrs permit is sought it is understood that the Central Permitting
Department issuing the permit may require certificates of coverage of worker a compensation insurance pnor
to issuance of the permit andmeat any time during the permitted work from any person firm or corporation
carrying out the
Company or Name 7'�/1'Ieic Y2 L, � (P5nc7y / /LL
Signw/fae P Date �2/7 (7
Appointment of Lien Agent:Details-LiensNC Lien Services://a ttp, pps.Iienenaeom/scrifiling/details.html7entryNnmber-765743
h
DO NOT REMOVE!
Details: Appointment of Lien Agent
Entry if: ]65]43 Flied on: 201]
Initially /sleledd by:by: mosahomabuilders
Designated Lien Agent Project Property
Print & Post
Investors Tale Insurance Company Lot7 aatl ❑
Vnlloe:wm:limaoccorn ,.,.,.,.,,,, 61JoelWayLillingtonC 27546
Address:19 W Nvyn:9L Suite 507 Raleigh.NC
enbp County
'.7601
nano 888-690-7384Contractors:
Far 9u-159-5231 Property Type Please post this notice on the Job Site.
Suppliers and Subcontractors
Scan this image with your Minn phone 10
1-2 Family Dwelling viewthis filing.You can then flea Notice
to Lien Agent for his project.
Owner Information
Date of First Furnishing
Triumph Capital LLC
510 F.Washington Sheet
Lillinglon, NC 27546 12:06.12017
United Stales
Email 2526moss(ygmep corn
Phone:910.890-2111
View Comments 101
Technical Support Hotline:(888)690-7384
oft
12/6/17,9:10 AM
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 17-50042628 Date 12/04/17
Property Address 61 JOEL WAY
PARCEL NUMBER 13-0610- - -0255- -10-
Application type description CP NEW RESIDENTIAL (SFD)
Subdivision Name CENTRELLA BLOTS
Property Zoning RES/AGRI DIST - RA-30
Owner Contractor
CENTRELLA MARK & LYNN MOSS KENNETH A
115 WILLIE CAMERON RD PO BOX 577
LILLINGTON NC 27546 LILLINGTON NC 27546
(910) 893-4875
Applicant
MOSS HOMEBUILDES #7
PO BOX 577
LILLINGTON NC 27546
(910) 890-2111
--- Structure Information 000 000 60X55 3BDR 2 . 5BA CRAWL W/ GARAGE & DECK
Flood Zone FLOOD ZONE X
Other struct info # BATHS 2 . 5
# BEDROOMS 3000000 . 00
PROPOSED USE SFD
SEPTIC - EXISTING? NEW TANK
WATER SUPPLY COUNTY
Permit BLDG,MECH, ELEC, PLB, INSU PERMIT
Additional desc .
Phone Access Code 1220599
Issue Date . . . 12/04/17 Valuation . . . . 0
Expiration Date . 12/04/18
Special Notes and Comments
T/S: 10/26/2017 10 : 07 AM JBROCK ----
CENTRELLA #7
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
PERMIT INCLUDES BLDG, ELEC,MECH, PLUMB
INSULATION AND LAND USE.
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
Work must conform and comply with the
STATE BUILDING CODE and all other State
and local laws, ordinances & regulations
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 17-50042628 Date 12/04/17
Property Address 61 JOEL WAY
PARCEL NUMBER 13-0610- - -0255- -10-
Application description . . CP NEW RESIDENTIAL (SFD)
Subdivision Name CENTRELLA SLOTS
Property Zoning RES/AGRI DIST - RA-30
Permit BLDG, MECH, ELEC, PLB, INSU PERMIT
Additional desc .
Phone Access Code 1220599
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
10-30 814 A814 ADDRESS CONFIRMATION / /
10 101 B101 R*BLDG FOOTING / TEMP SVC POLE / /
20 103 B103 R*BLDG FOUND & TEMP SVC POLE / /
30-999 105 8105 R*OPEN FLOOR / /
40-50 129 I129 R*INSULATION INSPECTION / /
40-60 425 R425 FOUR TRADE ROUGH IN / /
40-60 125 R125 ONE TRADE ROUGH IN / /
40-60 325 R325 THREE TRADE ROUGH IN / /
40-60 225 R225 TWO TRADE ROUGH IN / /
50-60 429 R429 FOUR TRADE FINAL / /
50-60 131 R131 ONE TRADE FINAL / /
50-60 329 R329 THREE TRADE FINAL / /
50-60 229 R229 TWO TRADE FINAL / /
50-60 209 E209 R*ELEC TEMP POWER CERT / /
999 H824 ENVIR. OPERATIONS PERMIT / /
HARNETT COUNTY CASE RECEIPTS
Ober: JBROCNCUSTOMER RECEIPT 0*
Te:Date: 12/84/17 52 Receiptpno:D169261
Year Number
2017 50042628 Amount
61 JOEL WAY
KILLINGTON� NC 27546
B1 BP - PERMIT FEES
SFD $1009.80
MOSS HUNEBUILDERS
Tender detail
CK CHECK PAYMEN 7275 11080.00
Total tendered
Total payment $1000.00
$1800.08
Trans date: 12/04/17 Time: 10:12:46
ee THANK YOU FOR YOUR PAYMENT as