BUILDING -Each section below must be (fled out by Application#
whoever is performing the work. Must be Harnett County Central Permitting
owner or licensed contractor. Address, PO Box 65 Lillington,NC 27546
company name 8 phone must match 910-893-7525 Fax 910-893-2793 www.harnen.org/permits
information on state license. COMMERCIAL
Application for Building and Trades Permit
Owner's Name: Campbell University 12/20/17
Date:
Site Address: 56 Main Street Phone: 910-893-1200
Directions to job site from Lillington: Take 421 to Campbell University, turn left onto Judge Taylor Rd go through
2nd round about and job is on the back side of convocation center.
Subdivision: Lot:
Description of Proposed Work: Wreskk. A $ ;S CC,3oocq*l..,1- CSC.
Heated SF 4770 Unheated SF
General Contractor Information: Building Cost$ 700,000
Southeastern Construction of Buies Creek, LLC 910-814-0990
Building Contractor's Company Name Telephone
PO Box 157 Buies Creek, NC 27506 michael@si-nc.com
Address Email Address
/ice_ 62649
Signature of Owner/Con rector/0 Icer(s) • orporation License#
Electrical Contra or Information: Electrical Cost$ 60,000
Description of Work New Electrical Service Size: Amps #T-Poles
Young's Electric Inc. 919-639-2297
Electrical Contractor's Company Name Telephone
PO Box 398/Angier, NC 27501 lemuel@youngselectric.com
Adess 7(J Email Address
.�w-...(/-- $4-. " 04504-U
Signature of Owner/Contractor/Officer(s) of Corporation License#
Mechanical Contractor Information: Mechanical Cost$ 60,000
Description of Work Add 2 new 7.5 ton HVAC Heat Pumps #Units 2
Young's Electric Inc. 919-639-2297
Mechanical Contractor's Company Name Telephone
PO Box 398/Angier, NC 27501 lemuel@youngselectric.com
Ad ss Email Address
1.J #4469
Signature of Owner/CK for/Officer(s) of Corporation License#
Plumbing Contractor Information: Plumbing Cost$ 30,000
Description of Work Plumbing per Plans #Baths 1
Youngs Heating and Electric 919-639-2297
Plumbing Contractor's Company Name Telephone
PO Box 398 / Angier, NC 27501
Ad, ess Email Address
4469
Signature of Owner/Con or/Officer(s)of Corporation License#
Insulation Contractor Information
Insulation Inc.
Insulation Contractor's Company Name&Address Telephone
*NOTE: General Contractor must fill out and sign the second page of this application
Sprinkler Contractor Information
Crossroads Fire Protection 919-207-3855
Sprinkler Contractor's Company Name Telephone
PO Box 926 / Benson, NC p -G her 6 eccsSecoSs te ,ne{—
Addr ss Eall Address
y✓ 16330
nature of Corp License#
Fire Alarm Contractor Information
Tyco Simplex Grinnell 919-279-6400
Fire Alarm Contractor's Company Name Telephone
540 Civic Blvd Ste 105/Raleigh, NC ggibb@simplexgrinnell.com
Address�� / Email Address
6 l/�'r 6<j 27575U
Signature of O Icer(s) of Corporation License#
Driveway Access - NC Department of Transportation Driveway Access/Permit? _ Yes ✓ No
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 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 charged at full pd cur/ // schedule.
l'a
`Signature of OwnE, C�ctor/�er(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 perjury 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.
✓ 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: Southeastern Construction of Buies Creek, LLC.
Signw/Title y,/ Date: 4-202&-(7