MECH PERMIT 09/00/11 Application#
Harnett County Central Permitting 4a 31 a
PO Box 65 L1119191191 NC 27546
ESCh section below to be haled out 910 893 7525 Fax 910 893 2793 www harnett org/permits
by whomever performing work
Must be owner or ttcensed
contractor Address company Application for Residential Building and Trades Permit
name&phone must match
Owners Name 9tint't � Date '1inA1 \$
Site Address %2J )s10: T[1n^ad t 21104•1 Phone tar'Ivy DW].
Directions to lob site from Lillington \Olrft tln F %rev f -taut 1%•71 to
no Coin+t)& to fl On W1 21y3U]4. CCY1y\tlt en
t3 it L thss Oct -ony ClUtiina %Mk -t l n .
Subdivision 1 Lot
Description of Proposed Work titin Y19.\SZOJ #of Bedrooms
Heated SF Unheated SF Finished Bonus Room? Crawl Space _Slab _
General Contractor Information
Building Contractors Company Name Telephone
Address Email Address
License #
Electrical Contractor Information
Description of Work Service Size _Amps T-Pole _Yes_No
Electrical Contractors Company Name Telephone
Address Email Address
License #
��,a�..� Mechanical/HVAC Contractor Information
Description of Work �'e3'LOSt V
9•a%1\ Utz Yu tiro cp4 tr..s '..ny gVm" 'y'tilr
Mechanical Contractors Company Name v Telephone
')X Qjirla_z .Na. Fay z�� .ba1aa t tt ttko
Address Email Address
11.155‘.%
License #
Plumbing Contractor Information
Description of Work #Baths
Plumbing Contractors Company Name Telephone
Address Email Address
License #
Insulation 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 stale 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 f e schh le ��
6/4
ce
-ure of Owner/Contract icer(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 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
Company or Name
Sign w/Tltle Date
L__
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call: (910) 893-7525 Fax: (910) 893-2793
Application Number 17-50042372 Date 3/21/18
Property Address 83 LONG DR
PARCEL NUMBER 03-9585-02- -0008- - -
Application type description CP STANDALONE TRADE - RESIDENTIAL
Subdivision Name CAROLINA LAKES
Property Zoning RES/AGRI DIST - RA-20R
Owner Contractor
KRUEGER ROBERT H & ADAMS ELENA ONE CALL ELECTRIC NC LLC
83 LONG DRIVE 108 WOODWINDS INDUSTRIAL COURT
SANFORD NC 27332 CARY NC
CARY NC 27511
(919) 930-5969
Applicant
ONE CALL ELECTRIC
108 WOODWINDS INDUSTRIAL COURT
CARY NC 27511
(919) 930-5969
--- Structure Information 000 000 GENERATOR INSTALL
Flood Zone FLOOD ZONE X
Other struct info PROPOSED USE ELECTRICAL/MECH
WATER SUPPLY UNKNOWN
Permit RESIDENTIAL MECHANICAL PERMIT
Additional desc .
Phone Access Code 1234707
Issue Date . . . 3/21/18 Valuation . . . . 0
Expiration Date . 3/21/19
Special Notes and Comments
T/S: 09/25/2017 04 : 20 PM BPETRICH --
83 LONG DRIVE SANFORD 27332
CAROLINA LAKES #8 ELK B
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 17-50042372 Date 3/21/18
Property Address 83 LONG DR
PARCEL NUMBER 03-9585-02- -0008- - -
Application description . . CP STANDALONE TRADE - RESIDENTIAL
Subdivision Name CAROLINA LAKES
Property Zoning RES/AGRI DIST - RA-20R
Permit RESIDENTIAL MECHANICAL PERMIT
Additional desc .
Phone Access Code . 1234707
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
999 409 M409 R*GAS PIPING / /
999 407 M407 R*MECH ABOVE CEILING / /
999 405 M405 R*MECHANICAL UNDERGROUND / /
999 131 R131 ONE TRADE FINAL / /
999 125 R125 ONE TRADE ROUGH IN / /
HARNETT COUNTY CASH RECEIPTS
**m CUSTOMER RECEIPT ***
Date: 33/OCK Te:/21/18 52 Recpe tno:Drawer:5988
Year Humber Amount
2017 50042372
83 LONG DR
SANFORD, NC 22733BPERMIT FEES
61 460.00
MEN PERMIT
BELL COY
Tender detail 460.08
CP CREDIT CARD 460.00
Total tendered 460.80
Total payment
Trans date: 3/21/18 Time: 70:14:45
** THANK YOU FOR YOUR PAYMENT **