DOCUMENTS Initial Application Date:I I 1 I- Application# I t—\__ .g c tt
CU#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillington,NC 27546 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 www.harnett.org/permits
"A RECORDED SURVEY/� MAP,RECORDED DEED(OR OFFER TO PURCHASE)/ &SITE PLAN ARE REQUIREDWHENSUBMITTING A LAND USE APPLICATION"
LANDOWNER:/iIt" Non[l.` acitir iv- ray Jae Mailing Address: dt779 /,/?(r�E etu L'[�A(,e. fie va)
city�tif(C I La [ V A � State:�� Zip: )r) ContactNo: 9/0•ia6)' gfeq Email: ulr)(',.h(tirehkkOnts.t'ao
APPLICANT*: SEUL{ EL AS (ITIV ObLOA)F-2 Mailing Address:
City: State: Zip: Contact No: Email:
'Please fill out applicant information if different than landowner�erea
� (�/1 /� / t
CONTACT NAME APPLYING IN OFFICE: I,r/I ec' l' n_ Oct. / LI�•)(0—(66-vi( V
G
PROPERTY LOCATION:Subdivision: The And A r3 (f�X//)(7/pq 15/& �krT/0, Lot#: u Y I Lot Size::. res
State Road# (f r� StatezaRoadRoadName:Na /`� /\ Map Book&PageU11I7/
Parcel: // 1 r-7L JS1 O&OA is PIN:"1 5-40 -51 «�
Zoning:/U1-7J Flood Zone: F Watershedt Deed Book&Page: yY Power Company*: (1PF1 7l/IA (
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE: H1
y�1 kn1N �.L Iy� ?Qin) Monolithic
13 SFD:(SizelV mala )#Bedrooms&#Baths$ asement(w/wo bath):AX) Garage: Deck:k Crawl Space._Slab:_Slab:_
(Is the bonus room finished?( )yes ( )no w/a closet?(_)yes ( )no(if yes add in with#bedrooms)
LI Mod:(Size x )#Bedrooms_#Baths_Basement(w/wo bath) Garage: Site Built Deck: On Frame Off Frame_
(Is the second floor finished?( )yes ( )no Any other site built additions?( )yes ( )no
❑ Manufactured Home:_SW_DW_ 1W(Size x )#Bedrooms: Garage: (site built? )Deck: (site built?_)
LI Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
LI Home Occupation:#Rooms: Use: Hours of Operation: #Employees:_
LI Addition/Accessory/Other:(Size x )Use: Closets in addition?( 1 yes ( )no
Water Supply: r/ 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 no
Does the property contain any easements whether underground or overhead yes ( )no
Structures(existing or proposed):Single family dwellings: V' Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks:�-1Comments:
Front Minimum 3S/ Actual3 11
Rear JS 104.1-1[
Closest Side D I IO I5
Sidestreet/corner lot CU
Nearest Building
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON:
c a/c otA-6-,- ' J C e0 —U'''I ✓f c..-,
lilie(110s fid. 7I)/-n /etc/ acs-/ nn Ott/'/2r//r
Ct:A 4/nue rt/Cc ,S Al tr?1() Aut Pty
7&(n rf oc ) di 7 [U/rn ; i On JawLie , (I et' cfc cU .
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 tatements are accurate
add rrreot to the best of my knowledge. Permit sub ect to revocation if false information is provided.
Signature of Ovine ner's Agent Da e
"'It 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
t MICHAEL P. GRIFFIN army that tinder my dk,at/on and
aup.wvo, this map was dram from s,actual deed au...% that the ..or of
draw.of Me Y a calculated by coo'Males Is e 1400O+: that the
area snow hereon was calculated by coo-dole.
Mltn.aa my hand and seal this day of MOWN 2077
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10'UNDERGROUND
UTILITYUTILITYEASEMEEMEN?
-Y- N39°59'I I"E-5- 50.00' ----_-- --
PITTFIELD RUN
50'PUBLIC/UTILITY WW
SITE PLAN APPROVAL
DISTRICT SF 5E TBACIAS
UBEti�'� FRONT 35'
#BEDROOMS REAR 25'
SIDE(ONE SIDE) 5'
SIDE(ONE SIDE) 10'
• • 1 ��� CORNER SIDE 20'
Date �� Va1Jr
LEGEND
Application#
Harnett County Central Permitting
•Each section below to be filled out PO Box 65 Lillington,NC 27546
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 —I
Olwener's Name:^H&H' Constructors f FavetJttgville LLC. (�Date: I I ti I Lab
Address:d3W P11 1�U Run Phone:`71� ` OIl1 ' q
Directions to job site from Lillington: NC Hwy 210 to Spring Lake. Turn Rt. On Overhills turn left to stay on
Overbills. Continue straight onto Nursery. Turn Rt. On 24/87. Turn Rt on Sawyer. Keep Straight. II 1'
Subdivision: The Manor(G Lexington Plantation Lot: L1 I
Description
rro��f,, 1Proposed Work: New
_Sin le Family Dwelling #of Bedrooms:S3
Heated SF:pIM-3' Unheated SF: LD�� Finished Bonus Room? - Crawl Space: Vilab:
General Contractor Information
1-18H Constructors of Fayetteville, LLC. 910-486-4864
Building Contractor's Company Name Telephone
2919 Breezewood Ave. Ste. 400 Fay., NC 28303 Leannahair@hhhomes.com
Address Email Address
74158
License #
Electrical Contractor Information
Description of Work Service Size: 200 Amps T-Pole: X Yes No
JM Pope Electric, Inc. 919-776-5144
Electrical Contractor's Company Name Telephone
409 Chatham Street Sanford, NC 27330 electricpope(pujwindstream.net
Address Email Address
21326
License#
Mechanical/HVAC Contractor Information
Description of Work
Carolina Comfort Air, Inc. 919-934-1060
Mechanical Contractor's Company Name Telephone
5212 US Hwy 70 Business, Clayton, NC 27520 carolinacomfortair(a)yahoo.com
Address Email Address
29077 H-3-I
License#
Plumbing Contractor Information !�
Description of Work #Baths (X •5
Dell Haire Plumbing 910-429-9939
Plumbing Contractor's Company Name Telephone
PO Box 65048,620 Gillespie St. Fay, NC 28306 dellhaireplumbing@hotmail.com
Address Email Address
32886P-1
License#
Insulation Contractor Information
Tricity Insulation, Inc. 418 Person St. Fay., NC 28301 910-486-8855
Insulation Contractors Company Name&Address Telephone
`NOTE: General Contractor/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 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-6 Months to 2 years permit re-issue fee is $150.00. After 2 years re-issue fee
is as per current fee schedule.
&-QO„Jaa I 1a1 1 n
Signature of Owner/Contractor of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87-14
The undersigned applicant being the:
X 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:
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.
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.
Company or Name: H&H Constructors of Fayetteville, LLC.
Sign w/TitleA.00J&.. .A /Permitting Coordinator Date:a `n� ` Y
Appointment of Lien Agent: Details - I.icnsNC Lien Service Page 1 of 1
DO NOT REMOVE!
Details: Appointment of Lien Agent Flied on: 11120f2011
Entry #: 758570
Initially flied by: meeganbredsbew
Designated Lien Agent Project Property Print & Post
Intl A toucan l the[Firman¢Company Ml7000641 Lot PO Manor in Lonngton 0 .-
Plantation
O " r o loin Patricia Run As"
//.1
Addre„,to ticNoon shi so;eoogL Ng Cameron.NC 28326
_jail HarnettCounty
Contractors:
Phone:XXX-mr-11114 Please post his not on the lob Site.
F n:9]1-e9-2.1
msilaopoonti lunme em Property Type Suppliers end Subcontractors:
Scan do image with your smut phone to
hiew this filing You can Nen file a Nopa
to Lien Agent for this prolecl
1-2 Family Dwelling
Owner Information
11th Colo ors of Fm edme LLCData of First Furnishing
2919 Neer-wood Avenue SR 400
Fayetteville, NC 281103
United States 11(07e017
Fmai lcannahm:@INM1nmes roFi.
Phone.910864864
?ter Comments 101
Technical Support Hotline:Mg)690-7384
https://apps.liensnc.com/scr/appointment/details.html?entryNumber=758570&printable= 11/20/2017