FM DOCUMENTS Application# ' 135 1
Harnett County Central Permitting
PO Box 65 Lillington,NC 27546 - Ph:910-893-7525 - Fx:910-893-2793 - www.hamed.org/pennls
Certification of Work Performed By Owner/Contractor
(Individual Trade Application)
•
Owner(s)of Structure: Phone:
Owner(s)Mailing Address:
Land Owner Name(s): Phone:
Construction or Site Address:
PIN# Parcel#
Job Celt: 70 Description of Work to be done
Mechanical: New Unit With Ductwork_ New Unit Without Ductwork_ Gas Piping_Other
Electrical': 200 Amp_<200 Amp_Service Change_ Service Reconnect Other*
For Progress Energy customers we need the premise number
Plumbing: Water/Sewer Tap Number of Baths Water Heater
Specific Directions to Job from Lillington:
Subdivision: Lot#:
17.2,'//e',,,u.(did-iry will provide the �w �e/o l labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is /8-a' I-"cc ,which entitles me to
perform such work on the above structure legally. All work shall comply with the State Building Code and all
other applicable State and local laws,ordinances and regulations.
G✓eS��� to7rre�eeG�til�c� Cr/ve 9/7/99-"716
G
Contractor's Company Na � N Telephone/�/.�.,�//eA.pq/ .�ev� C� 71°2
Address Email Address
./....21727
License# �/
Structure Owner/Contractor Signature: _. Ji /li'Date `✓. 10�f"o�t'eP
By signing this application you affirm that you have obtained permissio ,0 . a above listed license holder to
purchase permits on their behalf. If doing the work as owner you and‘, :tend that you cannot rent, lease or sell
the listed property for 12 months after completion of the listed work.
*Company name, address, 8 phone must match Information on license
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call: (910) 893-7525 Fax: (910) 893-2793
Application Number 18-50043587 Date 4/04/18
Property Address 2627 BUFFALO LAKE RD
PARCEL NUMBER 03-9585-01- -0118- - -
Tenant nbr, name **EMAIL TO FM ON 3/27/18*
Application type description CP MISCELLANEOUS INSPECTION APPLICATION
Subdivision Name
Property Zoning RES/AGRI DIST - RA-20R
Owner Contractor
FOREVER GOLF INC WESTER & PACE ELECTRIC INC
CAROLINA LAKES GOLF COURSE 546 LESLIE ROAD
53 CAROLINA LAKES RD SANFORD NC 27330
SANFORD NC 27332 (919) 499-5389
Applicant
DIVOTS, INC TANK REMOVAL
42 INDIAN TRL
SANFORD NC 27332
(919) 775-8634
--- Structure Information 000 000 TANK REMOVAL FROM ONE LOT TO ANOTHER LOT
Other struct info PROPOSED USE ABOVE GROUND TK
Permit COMMERCIAL ELECTRICAL PERMIT
Additional desc .
Phone Access Code 1236850
Issue Date . . . 4/04/18 Valuation . . . . 0
Expiration Date . 4/04/19
Special Notes and Comments
T/S: 03/27/2018 12 :29 PM DJOHNSON --
27 W TO BUFFALO LAKES RD TO JUST BEFORE
3039 BUFFALO LAKES RD AND THE PROPERTY
IS ON THE LEFT.JUST PAST MALLARD RD.
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 18-50043587 Date 4/04/18
Property Address 2627 BUFFALO LAKE RD
PARCEL NUMBER 03-9585-01- -0118- - -
Tenant nbr, name **EMAIL TO FM ON 3/27/18*
Application description . . CP MISCELLANEOUS INSPECTION APPLICATION
Subdivision Name
Property Zoning RES/AGRI DIST - RA-20R
Permit COMMERCIAL ELECTRICAL PERMIT
Additional desc .
Phone Access Code 1236850
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
999 265 E265 C*ELEC FINAL / /
999 257 E257 C*ELEC OVERHEAD / /_
999 263 E263 C*ELEC RECONNECT / /
999 253 E253 C*ELEC TEMP POWER CERT
999 261 E261 C*ELEC UND POOL / /
999 259 E259 C*ELEC UNDER SLAB / /
999 255 E255 C*ELECTRICAL UNDERGROUND / /
999 251 E251 C*ELEC ROUGH IN / /
999 267 E267 C*ELEC TEMP SERVICE POLE / /
HARNETT COUNTY CASE RECEIPTS
*0 CUSTOMER RECEIPT ***
Oper: JBROCK Type: CP Drawer: 1
Date: 4/04/18 52 Receipt no: 307875
Year Number Amount
2818 50043587
2627 BUFFALO LAKE RD
SANFORD, NC 27330
B5 BP - FIRE MARSHAL FEES BB
FM FEES
2018 50043587
2627 BUFFALO LAKE RD
SANFORD, NC 27330
B1 BP - PERMIT FEES f160.00
COMM ELE
CAROL HALL
Tender detail
CA CASH PAYMENT $260.80
Total tendered 4260.00
4260.00
Total payment
Trans date: 4/04/18 Time: 13:41:17
** THANK YOU FOR YOUR PAYMENT **