DOCUMENTS Harnett County Central Permitting `+` CDS I
Each eeonon below b be Med out PO Box 85 Langton NC 27546
by whomever sector pe low to eMe 910 893 7525 Fax 910 893 2793 www homed oryperma
ork
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name&phone must match
Owners Name &reit Anclenvn ,I ,,I Dunn
Site Address NPnr a81-1c14Fair3rvund Ru Dunn NC,phone 910-a31- 8Sp°
Directions to job site from Lillington
Subdivision N p Lot
Descnption of Proposed Work #of Bedrooms
Heated SF al I Unheated SF Finished Bonus Room'i Ain Crawl Space _Slab _
General Contractor Information
Building Contractors Company Name Telephone
Address Email Address
Owy lf
License#
gleams!Contractor Information
Description of Work Service Size _Amps T-Pole _Yes No
Electncal Contractors Company Name Telephone
Address Email Address
DW nom'
License#
Mechanical/HVAC Contractor Information
Descnption of Work
Mechanical Contractors Company Name Telephone
Address Email Address
owner
License#
Plumbing Contractor Information
Description of Work #Baths
Plumbing Contractors Company Name Telephone
Address Email Address
oWner-
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 Budding 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 Dv sianma below I have obtained all subcontractors
permission to obtain these permits and if au changes occur including listed contractors site plan
number of bedrooms budding 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-S Months to 2 years permit re-issue fee is 5150 00 After 2 years re-issue fee
is as current feeschedule
p'
..,,e407`7& I9' fa -/4
Signature of OwnerlContractorlOfficer(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 subcontrectors(s)who has their own policy of workers compensation insurance
covenng 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 1
Company or Name L!d[�Cii/! St AnJnhh —
(
Sign wlTide 43 2/n mll er Date `-7 /P-A0
STATE OF NORTH CAROLINA OWNER EXEMPTION AFFIDAVIT
COUNTY OF PURSUANT TO G.S.87-14(a)(1)
Inspection Department
Parcel Identificationfi Number and address where the building Is to be constructed:PIN
Pali alirgvounA Qorid , Dunn NC a93g4
Type of const action: Residential ❑Commercial DIndustrial ❑Other
Intended use after completion(e.g.Personal residence): .
Building permit number associated with this a lication:
I. 116111 HoAlair Mit)) SOLI - qnu
BrCW AlVtiSmeh (Phare Number)
hereby claim exemption from licensure under G.S.87-1(b)(2)by initialing the relevant provision in paragraph I
and nitialin paragraphs 2-5 below attesting to the following:
I certify I am the owner of the property set forth above on which a building is to be constructed or
altered and for which application for a building permit is hereby made;
OR
I am legally authorized to act on behalf of the firm or corporation that is constructing or altering this
building on the property owned by the firm or corporation as set forth above:
I I (Name of Firm or Corporation)
•Lfu will personally superintend and manage all aspects of the construction or alteration of the building
and that duty will not be delegated to any person not duly licensed under the terms of Article 1,Chapter 87
al
/1ooff-thje�General Statues of North Carolina.
':1✓ (A44 will be on site regularly during construction and I will be personally present for all inspections required
by the North Carolina State Building Code,unless the plans for the construction or alteration of the building were
drawn and sealed by an architect licensed pursuant to Chapter 83A of the General Statutes of North Carolina.
di12 P I understand that by executing this licensing exemption AFFIDAVIT pursuant to G.S.87-1(b)(2),I am
required by law to occupy the building for which the licensing exemption is granted for twelve months after
completion,during which time it may not be offered for rent,lease or sale.
coriaoi
I understand a copy of this AFFIDAVIT will be transmitted to the North Carolina Licensing Board for
General Contractors for verification 1 am validly entitled to claim an exemption under G.S.87-1(b)(2)for the
budding construction or alteration specified herein.I further understand if the North Carolina Licensing Board
for General Contractors determines I am not entitled to claim this exemption the building permit issued for the
construction or alteration specified herein shall be revoked pursuant to G.S 153A-362 or G.S. 160A-422.
de C961 4 LI 1 a I I e
(signature man*) ^ Date)
Sworn or affirmed and a bsaibed beforeome
this the IQ day of LA 2g1�
•
( nature of Notary Public)
�+ "S (Notary Stamp or Seal)
v Jt
'rimed Name of Notary Public) •
(NOTE It Ls a doss F felony to willfully commit per/ury in any affidavit taken pursuant to NC G.S. 14-200)
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Application Number 18-50043657 Date 4/12/18
Property Address 67734 *UNASSIGNED
PARCEL NUMBER 02-1519- - -0053- -03-
Application type description CP NEW RESIDENTIAL (SFD)
Subdivision Name
Property Zoning RES/AGRI DIST - RA-30
Owner Contractor
ANDERSON BRETT B & HOLLY L OWNER
4978 HWY 41 S
WALLACE NC 28466
Applicant
ANDERSON BRETT
3494 FAIRGROUND RD
DUNN NC 28334
(910) 231-4858
--- Structure Information 000 000 69X65 3BDR 2 . 5 BTH W/GAR W/DECK CRWL
Flood Zone FLOOD ZONE X
Other struct info # BATHS 2 . 5
# BEDROOMS 3 . 00
PROPOSED USE SFD
SEPTIC - EXISTING? NEW
WATER SUPPLY COUNTY
Permit BLDG,MECH,ELEC, PLB, INSU PERMIT
Additional desc .
Phone Access Code 1236181
Issue Date . . . 4/12/18 Valuation . . . . 0
Expiration Date . 4/12/19
Special Notes and Comments
T/S : 03/27/2018 02 : 15 PM LLUCAS ----
FAIRGROUND RD
TAKE HWY 421 TOWARDS DUNN - LEFT ONTO
HWY 27 TOWARDS COATS - TAKE HWY 27
THROUGH COATS TOWARD BENSON - TURN LEFT
ONTO FAIRGROUND RD - DESTINATION IS
APPROX 2 MILES ON THE RIGHT
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
PERMIT INCLUDES BLDG, ELEC,MECH, PLUMB
INSULATION AND LAND USE.
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
Work must conform and comply with the
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 18-50043657 Date 4/12/18
Special Notes and Comments
STATE BUILDING CODE and all other State
and local laws, ordinances & regulations
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Page 3
Application Number 18-50043657 Date 4/12/18
Property Address 67734 *UNASSIGNED
PARCEL NUMBER 02-1519- - -0053- -03-
Application description . . CP NEW RESIDENTIAL (SFD)
Subdivision Name
Property Zoning RES/AGRI DIST - RA-30
Permit BLDG,MECH, ELEC, PLB, INSU PERMIT
Additional desc
Phone Access Code 1236181
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
10-30 814 A814 ADDRESS CONFIRMATION
10 101 B101 R*BLDG FOOTING / TEMP SVC POLE _/_/_
20 103 B103 R*BLDG FOUND & TEMP SVC POLE / /
30-999 105 B105 R*OPEN FLOOR / /
40-50 129 1129 R*INSULATION INSPECTION
40-60 425 R425 FOUR TRADE ROUGH IN / /
40-60 125 R125 ONE TRADE ROUGH IN / /--
40-60 325 R325 THREE TRADE ROUGH IN / /--
40-60 225 R225 TWO TRADE ROUGH IN /
50-60 429 R429 FOUR TRADE FINAL / /
50-60 131 R131 ONE TRADE FINAL /
50-60 329 R329 THREE TRADE FINAL /_/_
50-60 229 R229 TWO TRADE FINAL
50-60 209 E209 R*ELEC TEMP POWER CERT / /
999 H824 ENVIR. OPERATIONS PERMIT / /
HARNETT COUNTY CASH RECEIPTS
*** CUSTOMER RECEIPT ***
Oper: TRUCK Type: CP Drawer: 1
Date: 4/12/18 52 Receipt no: 319594
Year Number Amount
2018 50043657
67734 *UNASSIGNED
DUNN, NC 28334
GI BP - PERMIT FEES
1990.08
SEP
BRETT ANDERSON
' Tender detail
CN CHECK PAYMEF 5108 $990.00
Total tendered $990.00
Total payment 5990.00
Trans date: 4/12/19 Time: 14:04:51
** THANK YOU FOR YOUR PAYMENT **