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BUILDING RR 09109/11 Application# Harnett County Central Permitting LH b/5 PO cox 85 LAYngton NC 27548 Each section below to be Med out 910 893 7528 Fax 910 893 2793 www homed org/pennss by whomever performing work Must be owner or licensed =tractor Address company Application for Residential Building end Trades Permit name 8 phone must match n �1_r+ �) Owners Name WYNN CONSTRUCTION INC Date d-I-O' ( b Site Address I I S ad Y2 St v Phone ��iq-a Sts it/t13,31 to job site from Llllington _ Ko✓✓1 14 no r/- �--+e.tato T�-1 3 M i less 10-f+ oa yah Nwy Pot- Ls- mile S, l'J+ on &skjbntte, Rd Pot. ks /1rnat., J v.u4 rb rid arJ (€24V- Subdivision /-i ILO(L1 4-D Olt Lot g‘.2) Descnption of Proposed Work NEW CONSTRUCTION, SFD #of Bedrooms _3 Healed SF/936/ Unheated SF 1aa Finished Bonus Room') 4 Ls Crawl Space Slab General Contractor InformatloYi WYNN CONSTRUCTION, INC. 919-258-2430 Building Contractors Company Name Telephone 2550 CAPITOL DR., STE. 105. CREEDMOOR,NC 27522 ttrefftzs@wynnhomes.com Address Email Address 46295 License# Electncal Contractor Information Description of Work NEW CONSTRUCTION Service Size 200 Amps T-Pole ILYes_No BUFORD ELECTRIC 910-723-1937 Electncal Contractors Company Name Telephone 948 PAN DRIVE, HOPE MILLS, NC 28348 bufordelectricaomaiLcom Address Email Address 31424-U License# AtechanicalHVAC Contractor Information Description of Work NEW CONSTRUCTION CERTIFIED HEAT AND AIR 910-858-0000 Mechanical Contractors Company Name Telephone 779 SUNSET LAKE RD., LUMBER BRIDGE, NC 28357 Address Email Address NC 200212 H3 CLASS 1 License# Plunt ina Contractor Information Descnption of Work NEW CONSTRUCTION #Baths THORNTON'S PLUMBING 919-550-4833 Plumbing Contractors Company Name Telephone 3160A Vinson Road, Clayton, NC 27527 brendaactpi©gmail.com Address Email Address 22152 License# Insulation Contractor Information TATUM INSULATION 919-661-0999 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 pv wawa below I have obtained all subcontractors permission to obtain these permits and If my 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 Hamett County Central Permitting Department of an and all changes EX' 'E' PER , 0 ES-S .nths to 2 years permit re-issue fee is$150 00 After 2 years re-issue fee 18864 1 In . / i/aJ/IIS,. oD - (- c9-0 / 7( Signature •T • :r/Contract',nit)of Corporation Date Affidavit for Worker's Compensation N C G $ 87-14 The undersigned applicant being the General Contractor _Owner J 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 J 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 J 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 ny person firm or corporation carrying out the work Company or Name WYNN CONSTRUCT 'N, INC. rA/! Sign w/Title CONSTRUCTION, COORD. Date a- / -ad ll LIEN AGENT INFORMATION Effective April 1,2013 In accordance with North Carolina General Assembly Session Law 2012-158, Inspection Departments are not allowed to issue any permit where the project cost is $30,000 or more unless the application is for improvements to an existing dwelling that the applicant uses as a residence OR the property owner has designated a lien agent and provided the inspections office with the information below: • Name of Lien Agent TITLE INSURANCE COMPANY 19 W. HARGETT STREET, SUITE 507 Mailing address of Agent RALEIGH, NC 27601 Physical address of Agent 19 W. HARGETT STREET, SUITE 507 RALEIGH, NC 27601 Telephone 888-690-7384 Fax _ 913-4859-5231 Email support @liensnc.com The information will be attached to the permit record and a copy provided to the applicant. The applicant is required to post a copy on the construction site. Excerpt from North Carolina G.S. 160A-417: "(Effective April 1,2013)No permit shall be issued pursuant to subdivision(1)of subsection(a)of this section where the cost of the work is thirty thousand dollars($30,000)or more,other than for improvements to an existing single-family residential dwelling unit as defined in G.S. 87-15.5(7)that the applicant uses as a residence,unless the name,physical and mailing address,telephone number, facsimile number,and electronic mail address of the lien agent designated by the owner pursuant to G.S.44A-11.1(a)is conspicuously set forth in the permit or in an attachment thereto.The building permit may contain the lien agents electronic mail address. The lien agent information for each permit issued pursuant to this subsection shall be maintained by the inspection department in the same manner and in the same location in which it maintains its record of building permits issued." www.liensnc.com DO NOT REMOVE! Details: Appointment of Lien Agent Filed on: 03/15/2017 Entry k: 819958 Initially flied by:wynnhomee Designated Lien Agent Project Property Print 8 Post I j !I Inrmmt fiat Insurance Company every Pb subdivision lot 023 Ers-O 115illuiren. cS•R , ! 0.41ac five).wine.NC 31516 fll of • MWm:19W.anal h.St sS:N/PaicM1A.NC I Imen Cowry M 'n PhuvN n.J4 -131N 4 enlnebm Plttuyclontatthisintim on the Job Silt. u.9RY93151 Property Type fuppllen sn:i Suheonlr.Hnn: ¢sell:IwWItke." :vw-.....w.. I sea:Mekir wthyoozsmartplwne10 view this ft.,You em iben Me a Naia L1Pm:ly DwellingtoLinAsal(m lhi,P:Vecr Owner information I E tordiomn 2550 cipiWh axdnoor,NC PSR United Sala Emil;nu:ry@wnfa°e.tvn I Phone:919-528-1347 View Cmmam(0) Teehnia'Support Hain,(Egg)690-7384 Cf Fl d e•