DOCUMENTS Initial Application Date: s\ \1 ern Application# 1 SCXaid3Saa
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COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Edlington,NC 27546 Phone:(910)893-7525 ext:2 Fax:(910)893-2793 www.harnett.org/permits
"A RECORDED SURVEY MAP,ARECORDED DEED(OR(OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER:IA.
JJroc MsZ. l"�r� il-i Mailing Address: d9/kl (,J/eL'd cu're AII��QP) f{ky,�Jcc A
City:c('(ime(1CUI I Q state:tiY Zlp: D )D3 Contact No: 9/C)'y�(0'VIW Emaib'�ulTl(lr,CUr Ehh •e�n
APPLICANT': SAAA E AS (4&)cluck Ef Mailing Address:
City: State: Zip: Contact No: Email:
*Please till out applicant information if different than landownerea-in
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CONTACT NAME APPLYING IN OFFICE:f ' ri4�ea-i 11 1C4 kco rr9 / 9/('�, 1Y�16-w&V
PROPERTY LOCATION:Subdivision- ///�' ''lahoA61 (PX//C/Oq (1712/2/4/64 Lot#: (o(e'T Lot Size: 0 , 10- AC.
State Road# -4I) State Road Name: Map Book&Page: 101-1 / ck rn
Parcel: � t)gS5GSiri o2% L 3{e PIN: c&S\S-'-11 -14S9C T300 /p alai Zoning:/u�-7CIZ Flood Zone: A Watershed: 00 Deed Book&Page:Ineto /0144 Power CompanyCompany*: l PFal /IA'(
"New structures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE: CRT/0/ MMonais
9 SFD:(Size i-dn' xS01
)#Bedrooms:A#Baths:a�SBasement(w/wo battik/00 Garage: Deck: Crawl Space:_Slab:_Slab:
(Is the bonus room finished?( )yes (/)no w/a closet?(_)yes (_)no(if yes add in with#bedrooms)
❑ Mod:(Size x )#Bedrooms #Baths_Basement(w/wo bath)_Garage:_Site Built Deck: On Frame Off Frame_
(Is the second floor finished?( 1 yes (_)no Any other site built additions?( )yes ( )no
❑ Manufactured Home: SW_DWTTN(Size x )#Bedrooms: Garage: (site built? )Deck: (site built? )
❑ Duplex:(Size x )No.Buildings: No. Bedrooms Per Unit:
❑ Home Occupation:#Rooms: Use: Hours of Operation: #Employees:
❑ Addition/Accessory/Other:(Size_x )Use: Closets in addition?( )yes ( )no
Water Supply: Z 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) x"..."-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 (I%no
3 Does the property contain any easements whether underground or overhead( )yes ( )no
Structures(existing ,i.ingle family dwellings: (/' Manufactured Homes: Other(specify):
Required Residential Property Line Setbacks: Comments:
Front Minimum 355 Actual .2)1'
Rear r)l p.A"
Closest Side h I I O is'L"
SidestreeVcorner lot DU 35
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:
R> C 2-/O Owc,I f ' C • e /e4 d o
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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 forego' stytq atements are accurate and correct to the best of my knowledge. Permit subject to revocation if false information is provided.
Signature of Owner or Owner's Agent `Dat
'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
I. MICHAEL P. GRIFFIN , coif Mot,mar my*meta,aro j
aper abt this mm we tom from an actual fled swingy Mot Me n of
closure of the uwy as chvbted by coatkotes(a I: 140001: that the
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50'PUBLIC/UTILITY W
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SITE PLAN APPROVAL
DISTRICTCT ��\3 ` USE :-.1-4-.
SETBACKS
'BEDROOMS 4 FRONT 35
REAR 20'
�e 'al
lQl. SIDE(ONE SIDE) 5'
O SIDE(ONE SIDE) 10'
KEVISION. LEFT RAND 3gp5 CORNER SIDE 20'
CI R-25.00'L-39.27 N69°4908"E 35.36' LEGEND
PRELIMINIAR Y I DP EXISTING IRON PIFs EE5 FLARED END SECTION
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.harnetl.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: H&H Constructors// -\of Fayetteville, LLC. Date:41453
Site Address: ��
TaD IMAct�l.90 u., Phone:
Directions to job site from Lillington: NC Hwy 210 to Spring Lake. Turn Rt. On Overhills turn left to stay on
Overhills. Continue straight onto Nursery. Turn Rt. On 24/87. Turn Rt on Sawyer. Keep Straight.
Subdivision: The Manor Ca) Lexington Plantation Lot: (p la�
Description of Proposed4 Work: New Single Family Dwelling #of Bedrooms:
Heated SF: aLls4- Unheated SF: Finished Bonus Room? no Crawl Space: Slab:
General Contractor Information
H&H Constructors of Fayetteville, LLC. 910-486-4864
Building Contractor's Company Name Telephone
2919 Breezewood Ave. Ste,400 Fay., NC 28303 Leannahairhhhomes.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 electricpopeawindstream.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(o)yahoo.com
Address Email Address
29077 H-3-I
License#
Plumbing Contractor Information
Description of Work #Baths
Dell Haire Plumbing 910-429-9939
Plumbing Contractor's Company Name Telephone
PO Box 65048,620 Gillespie St. Fay. NC 28306 dellhaireplumbinq(dihotmail.com
Address Email Address
32886P-1
License#
Insulation Contractor Information
Tricity Insulation, Inc.418 Person St. Fay., NC 28301 910-486-8855
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 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.
Signature of Owner/Contractor/Officer(s)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 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:() 'v � /Permitting Coordinator Date: 3
Appointment of Lien Agent: Details- LiensNC Lien Service Page 1 of 1
DO NOT REMOVE!
Details: Appointment of Lien Agent
Filed on: 03207f201e
Entry p: 519967 Initially flied by: meaganbradshaw
Designated Llan Agent Project Property Print 8 Post
PIM American Title Insurance Company MLPO00663 Lot 663 Manor @ Lexington El SID
Plantation eV
"1.111"11131"‘11"`"'""h r. "...,r.,.. 369tRFIELB HM 4
Address.19 Hargen Sr.Suite 507 IR2Jeit]L NC Cameron,NC 20326 ❑e --Ws
21601 Harnett County
Con
Phone AOA-S-73as Please post this notice on the lob Site
Fm.01340O-5131
Email:yupgp'-, nmr rvn r.... Property Type Supplier and Subcontractors:
Sc' this image with your smart phone
view Iiiis filing You can then Me a Notice
to Lien Agent for this project
1-2 Family Dwelling
Owner Information
tl&H Constructors of Fayetteville,LLC. Date of First Furnishing
2919 Breezewood Avenue Ste 400
Fayetteville. NC 20303
United States 02202018
Emaiilleannnahair@hhhomes corn
Phone 9104864064
View Comments(OJ
Technical Support Hotline:(88E 6904384
https://apps.liensnc.com/scr/appointmentldetails.html?entryNumber=812967&printable= 3/7/2018