DOCUMENTS Initial Application Date:I al S I I 1 Application# 1115(334.: t_
CUR
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.harnett.org/permits
^A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)A SITE PLANARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION'•
LANDOWNER:H&H Constructors of Fayetteville,LW. Mailing Address:2919 Breezewood Ave., Ste.400
City: Fayetteville State:NC 21p:20303 Contact Na 910-4864864 Email: Leannahalr@hhhomes.com
APPLICANT*:Same As Owner Mailing Address:Same
City: Same State: Zip: Contact No: Same Email: Same
'Please fill out applicant Information[(different Nen landowner
CONTACT NAME APPLYING IN OFFICE: Leanne Hair Phone#910486-48/I64 ('� /��,�n
PROPERTY LOCATION:Subdivision: Anderson Creek Club Lot#: ILI tO LotrSize:e1 ICC C&PUGS
State Road#1117 ^Sttat'e Road Name:amrNurseryrslRoad CMOS
^ Map(B000k&PagexilJJyl aai
Parcel: O los a a L1 O 100 11 I PIN: CMOS � .rya�)- I W-S1
ZonlnO{�d[_t-blood Zone:Y- Watershel�'^ ` Deed Book&Page:AR/AdoSia Power Company': South River
'New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE: N) I 0
" II 5 Ded ,1 C� / �Sonalithic
p( SFD:(Sleext�t- #Betlrooms:�i #Beths:gr.gasement(wAvo bath): Garage: Deck: Crawl Bpace:_Slab:✓_Slab:_
(Is the bonus room finished?(J yes ( no w/a closet?(_)yes ( )no Qf yes add In with*bedrooms) .
❑ Mod:(Size x )#Bedrooms_#Baths_Basement(wAvo bath)_Garage: Site Built Deck:_ On Frame_Off Frame_
(Is the second floor finished?( )yes (i no My other site built additions?( )yes ( . )no
❑ Manufactured Home: SW_DW_TW(Size x 1#Bedrooms: Garage: (site built? )Deck: (site builttJ
❑ Duplex:(Size x )No.Buildings: No.Bedrooms Per Unit:
L I Home Occupation:*Rooms: Use: Hours of Operation' #Employees:
❑ Addition/Accessory/Other(Size x )Use: Closets in addition?( )yes (__)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?f 1 yes (✓)no
Does the property contain any easements whether underground or overhead yes (___)no
Structures(Sating• ngle family dwellings: Manufactured Homes: Other(speciry):
Required Residential Property Line Setbacks: Comments:
611
Front Minimum 30
Actual
25 rcr6N
Rear Cita!
�O
Closest Side
Sldesireet' mer lot20
Nearest Building 10
on same lot
Residential Land Use Application Page 1 of 2 03/11
APPLICATION CONTINUES ON BACK
Date \ a113 ) / r?
Plan Box# �A 1 Job Name \-i 4 1-4
1 IPlan Name
App # I a0J k Valuation' g g0. SQ Feet I77
Garage yb.S
Inspections for SFD/SFA
Crawl_ Slab V 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
SPECIFIC DIRECTIONS TO THE PROPERTY FROM LILLINGTON: Hwy.27 to Nursery Road,turn left and follow Ray Road.Turn left and
fallow 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 foregoing ements are accurate and c rrect to the best of my knowledge. Permit subject to revocation if false information Is provided.
Signature of Owner or wneYS Agentate
"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 oft g3ry1
4 MICHAEL P. GRIFFIN • certify that une*.mydfctbt and
rnrdaan this map was✓eee Aeon an actual"Fele x that the error of
dowry al the survey as[doubted by coordinates is I: taMO#: that the Z
area Moen throat ms MMoted by coordinates
N
Mien my hand and seal mL day at utww 2008
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13.5' DECK71 10.5'
/ \ 24.44' 6.56' /
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I N, PROPOSED
r5 CARDINAL
5l 5.0' '1
w ` v
m �� PORCh 53m
o 21.017 p o
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°' 20.00'
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1
CI' PROP
2 CONC
1 OD DRIVE
a u 8 o
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N. 5'LIMY(
H 0 EASEMENT
� a " M /
N 65°40'26"E — 60.00' �l
FALLS CREEK DRI V E
SETBACKS
50' PRIVATE R/VV FRONT 30'
REAR 25'
ONE 51DE 10'
CORNER 51DE 20'
REVISION: NPW PLANS 10/20/17
.REVISION.ADD WRAP I 0/19/17
I LEGEND I ..----
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
Owner's Name: Ht Pal
Constructors ofo� Fayetteville, LLC. Date:
Site Address:14 O al Is Erect. fr-tve.. Phone: 910-486-4864
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. 1 1
Subdivision: Anderson Creek Crossing Lot: 14 �O
Description ofofProposed Work: SF1D_I 1 #of Bedrooms: q
Heated SFgrDMLInheated SF:W4 al Finished Bonus Room? Crawl Space:_Slab:
General Contractor information
H&H Constructors of Fayetteville. LLC. 910-486-4864
Building Contractor's Company Name Telephone
2919 Breezewood Avenue Ste.400,Fay. NC 28303 Leannahaithhhomes.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 electricpope(alwindstream.net.com
Address Email Address
21326
License#
Mechanical/HVAC Contractor Information
Description of Work
Carolina Comfort Airinc. 919-934-1060
Mechanical Contractor's Company Name Telephone
5212 US Hwy 70 Business, Clayton,NC 27520 carolinacomfortair yahoo.com
Address Email Address
29077 I-1-3-I
License#
Plumbing Contractor Information nn C
Description of Work #Baths Q. J
Vance Johnson Plumbing Co., Inc. 910-424-6712
Plumbing Contractor's Company Name Telephone
3242 Mid Pine Dr. Fayetteville, NC 28306 etoepferCa�viplumbinq.com
Address Email Address
07756-P-I
License#
Insulation Contractor Information
Tri-City Insulation 418 Person St. Fay. NC 28301 910A86-8855
Insulation Contractor's 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 conect as known to me and that by shining below I have obtained all subcontractors
permission to obtain these permits and if a�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.
ALO IaI5t fZ
Signature of Owner/Contracort /Offcer(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.
Sign w/Title:4 0 044,..1freOv tjQM.�� /Permitting Coordinator Date: IQ 15 111
Appointment of Lien Agent: Details - LiensNC Lien Service Page 1 of I
DO NOT REMOVE!
Details: Appointment of Lien Agent
Filed on: 12/06/2017
Entry #: 16 6003 Initially flied by: meegenbredshew
Dulgneted Lien Agent Protect Property Print 8 Post
hot American the Insurance Co:Wong ACX000146 Lot 146 Anderson Creek Club Ore! El
Crossing NO:e
Online:.uti liansrc.ora.. ._... .. IiB Falls Creek Drive
Address.lis N.Horace St Suuc SOD Raleigh.NC Sint ng Lake,NC Ee390 El '7199
Soul Remelt County
Contractors:
Phone:5ABd473114 Please post this nonce on We lob Silo.
Few 913459-5231
Email:yup®p uliumm rrvn u. Pro pe Sly Type Suppliers and Subcontractors:
Stan this image with youml phone 10
view this riding.You can then file a Noma
to Lien Agent for this project.
1.2 Family Dwelling
Owner Information
Mb Consonants of Fayetteville,LI C. Date of First Furnishing
29191Secrewood Avenue Sce 400
Fayetteville, NC 28303
10/03/2017
I'med b.nnahartdhhhomes tom
Phone:910486-4864
View Comments(03
Technical Support Hotline(855)0904154
https://apps.liensne.com/sedappointment/details.html?entryNumber=766003&printable= 12/6/2017