LAND USE 09109/11 Application#
Hamett County Central Permitting
M tecbon below to M filled out PO Box 85 Liangton NC 27546
E
M
Each
s whomever ow ng work
910 893 7525 Fax 910 893 2793 www Monett or9/pemats
Must be owner or Incensed
contractor Address company AooltcMlon for Residential Building and Trades Perini!
coma 8 phone must match
Owners Name Date
Site Address Phone
Drecbons to lob site from Lillington
Subdivision Lot
Description of Proposed Work #of Bedrooms
Heated SF Unheated SF Finished Bonus Room, Crawl Space _Slab _
General Contractor Information
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Building Contractbr s Company Name Telephone
02 5-63 CaA 6relCJ1 i24 AisleflC 27J / jrfro mbcrlq 45„l tfl . ecr
Address Email Address
76 20 7
License
glectrical Contractor Information
Description of Work Service Size _Amps T-Pole _Yes_No
Electrical Contractors Company Name Telephone
Address Email Address
License#
Mechanical!HVAC Contractor Information
Description of Work
Mechanical Contractors Company Name Telephone
Address Email Address
License#
Plumbing Contractor Information
Description of Work St Baths
Plumbing Contractor s Company Name Telephone
Address Email Address
License#
Jnsulehon Contractor Information
Insulation Contractors Company Name&Address Telephone
'NOTE General Contractor 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 IN mama below I have obtained all subcontractors
permission to obtain these permits and if gpy 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 nobly 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
�Sg a
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r(tur6 of� / actor/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 perjury that the person(s) firm(s)or corporaton(s)performing the work
set forth in the permit
_____/7/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 a 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 n
Company or Name ' 0 W - SRo;ICICC5
Sign w/Tide �/ AJflt '
C Date � J)- 7<
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Application Number 18-50043186 Date 1/31/18
Property Address 150 SANDRA CT
PARCEL NUMBER 04-0663- - -0072- - -
Application type description CP ADD & ALTER RESIDENTIAL
Subdivision Name NEILLS CREEK FARMS PHASE 1
Property Zoning RES/AGRI DIST - RA-40
Owner Contractor
JOHNSON DAVID M & PERRINE WIMBERLY TONY RAY
150 SANDRA COURT 2563 OAK GROVE CH RD
ANGIER NC 27501 ANGIER NC 27501
(919) 669-7066
Applicant
WIMBERLY TONY #35
2563 OAK GROVE CH RD
ANGIER NC 27501
(919) 669-7066
--- Structure Information 000 000 REPLACE FLAT ROOF/EXTENDING OVER DECK
Flood Zone FLOOD ZONE X
Other struct info # BATHS 99
SEPTIC - EXISTING? EXISTING
WATER SUPPLY COUNTY
Permit RESIDENTIAL BUILDING PERMIT
Additional desc .
Phone Access Code 1226786
Issue Date . . . 1/31/18 Valuation . . . 0
Expiration Date . 1/31/19
Permit LAND USE PERMIT
Additional desc .
Phone Access Code 1226794
Issue Date . . . 1/31/18 Valuation . . . . 0
Expiration Date . 7/30/18
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call: (910) 893-7525 Fax: (910) 893-2793
Page 2
Application Number 18-50043186 Date 1/31/18
Property Address 150 SANDRA CT
PARCEL NUMBER . 04-0663- - -0072- - -
Application description . . CP ADD & ALTER RESIDENTIAL
Subdivision Name NEILLS CREEK FARMS PHASE 1
Property Zoning RES/AGRI DIST - RA-40
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
Permit type . . RESIDENTIAL BUILDING PERMIT
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 /_/_
HARNETT COUNTY CASH RECEIPTS
wow CUSTOMER RECEIPT ♦ma
Open SBROCK Type: CP Drawer: 1
Date: 1/31/18 52 Receipt no: 232844
Year Number Amount
2018 58043186
150 SANDRA CT
81 BP - PERMIT FEES
4125.88
BLDG
Tender detail
CP CREDIT CARD $125.00
Total tendered 4125.08
Total payment $125.00
Trans date: 1/31/18 Time: 13:27:02
** THANK YOU FOR YOUR PAYMENT as