DOCUMENTS Initial Application Date: LI kin!1% Application# $ 'J-�' '
CU#
COUNTY OF HARNETT RESIDENTIAL LAND USE APPLICATION
Central Permitting 108 E.Front Street,Lillirgton,NC 27546 Phone:(910)893-7525 exl:2 Fax:(910)893-2793 www.hamettorg/permits
"A RECORDED SURVEY MAP,RECORDED DEED(OR OFFER TO PURCHASE)&SITE PLAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
LANDOWNER: II C G1 ❑—AF UL4'ailing Address:QC)A beerewwon1(:A
•
City: ry'l C�� 4"i /le Stale:MCZID9Xiiii2Contact No: O mail:
APPLICANP_wn1e' As Own er Mailing�liAddressdrIlrl l)re.P Lt{U()CI Ave �4C • 400City: (agef-4evi Ile State: MC ZipQYO..Contact NocllO' ) tat/ Email:\Ec.nrtNit;lc f��1f1 nmej� dI))
•Please fill out pplicant Information if different than landowner L� q /Y Q /�
CONTACT NAME APPLYING IN OFFICE:I/ Lean net�1I tl,Qli� v /I Phone# �'J'"(�`n'pT l: - efc"'Ici
PROPERTY LOCATION:Subdivision:CC r 1Gf3e 6-len C AMery 11 reeK P.i.1i b Lot It: Lot Size: 0.agOA—
State Road# State Road Name: Map Book&Page: 2c14/ .14t1
Parcel: ppbni.trtvOe 5 aioo /W�- PIN: oSOS —9L • I.CIS.000 i
Zoning:J.'m Flood Zone: X Watershed: j' /1 t Deed Book&Page:3Ct /011inPower Company' l i)tVl R ter
'New shuctures with Progress Energy as service provider need to supply premise number from Progress Energy.
PROPOSED USE: / Monolithic
'1 Meek: Crawl Space:_Slab:Slab:
B�SFD:(Slzel2 xrJO )#Bedrooms #Baths:Z�asement(wlwo bath): Garage: •_ —
(Is the bonus room finished?U yes 90 no w/a closet?( )yes 90 no(N 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?U yes ( )no My other site built additions?( )yes (i no
❑ Manufactured Home:_SW—DW_TW(Size__x 1#Bedrooms:_Garage: (site built? 1 Deck: (site built? )
❑ Duplex:(Size_x )No.Buildings: No.Bedrooms Per Unit:
❑ Home Occupation:#Rooms: Use: Hours of Operation: #Employees:
❑ AdditionlAccessorylOther:(Size_x )Use: Closets In addition?U yes ( )no
Water Supply: ✓ Gounty 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) 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 (lot;
*Does the properly contain any easements whether underground or overhead(X)yes (i no
Structures(existing oredikaSygle family dwellings: Manufactured Homes: Other(specify):
4.Required Residential Property Line Setbacks: Comments:
/� Y 1
Front Minimum 11 Aclual_V.�
Rear (!L1)c�J .�
Closest Side F_ Aim
ii
Sidestreet/corner L 15 . 1--k---�
Nearest Building i )
on same lot Page 1 of 2 03!11
Residential Land Use Application 9
APPLICATION CONTINUES ON BACK
SPECIFIC DIRECTIONS TO THE PROERTU FROM LILLING ;: - LTJ (' of i c' rpt ('/f se 1�j I\(YV
, 1,1 -kn 1\ CY O r ve
•
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 foregoing statements 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 Date
'"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
< MICHAEL P. GRIFFIN certify that under my&fwmmi and
vyer ntan this mop was draw' Fan on actual field suety, Mot the error of
closure of the y as calculated by coordinates Is I: taaXM: that the
area Mom hrern was calculated by coo dtot n
Wins my hand mid seal this day of MOWN 2008
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GLEN BEND COURT
SITE PLAN APPROVALS° R/W
DISTRICT 2 C USES
#BEDROOMS 4 •
SETBACKS
L\ II 51 FRONTEAR30'
Date I nl^\\PPVYT:N--m�IMClrator REAR 25'
519E IO'
CORNER SIDE 20'
C I R=20.00'L=43.27'502°1031"V/35.3 I'
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09!09111 Application#
Harnett County Central Permitting .,
PO Box 85 Lillington NC 27546
Each section below to be filled out 910 993 7525 Fax 910 893 2793 www harnett erg/permits
by whomever performing work
Must be owner or licensed
contractor Address company Application for Residential Building and Trades Permit
name 8 phone must match 11 `���
Owners Name �� spot-Ntu irs (4-FC t*vl lie, LLQ Date '4(te tie
Site Address TTLD +.�.. i A+.d Cst4.4'k. Phone girt-LjgIc
vections to Job site from Lillington ' ' 'JCS I 7r f +r
c c LLD Rae t'ZaM . ur-n kelt+ and How-Fa
Subdivisiont--c.l rings.Gar&fir rs3n(• reekL: '�J *LT ys9
Description of Proposed Work 1vl
' +�w fY3IC-,I�CIk'Ytr ylc; &L&lr q. #of Bedrooms 4
�+ ,}�
''1Heated SFeQOOotUnheated SF V3p1 Finished Bonus Room's At 'Crawl Space Slab
//��
General Contras or Information
00r6rucior: a} cki ekkv. Ile I 1 /. 4gt)- `ito��
Building Contractors Company Name Telephone
cfril9 Brzazeuxnl Ave Sie.ufb Fag *"cc. afc 3 IR-nntlttrPl
Address Email Address
'141`
License#
Electrical Contractor Information
Description of Wnrk Service Size�OU Amps T-Pole Yes No
-3-M cPC-• tier*r'iC, a r1C i. �11�I rj; ci
Electrical Contractors Cdinpany Name Telephone
14 Oct spec%ain Stfeet% rN rl: ' •
! . . _ a> t1,rxt.
nocress Email Address
a13alc_
--' Mechanical/HVAC Contractor Information
Resonation of Work
`( IM;ne- (1Nn-fnr4 Air ,jot- , I f- ,3 - 131%13Mechanical Contractors Company Name Telephone
a - 6 roe e ' - AL a C.- Onrofi 'V"Y i-Or t+r€) LICth33,(&ry)
Address Email Address
0)1017 3-1
License#
Plumbing Contractor Information
Description of Work #Baths 2 ,S' 4.
VnrcL Xknvn PlumhtngCo.=Inc, . go-Log- (s-t ta
Plumbing Contractors Company Name Telephone
ii;ga ?glad P+ne Rad ragj€tfpv; Ile, IOC_ -1R33(i) \.r+nc•,i rtnn vjpic':nld+r , nn
Address Email Address
m7Sl- P-- i
License#
Insulation Contractor Information
Trrci+L TrisulcrhanlnG 4I%Pc,rsinSt. Q ,Ax_ g -Lt - 5�S5J
Insulation Contractors Company Name&Address D$301 Telephone
'NOTE General Contractor must fill out and sign the second page of this application
I hereby certify that I have the authonty 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 Hamett 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
(-2 .t31. (2 - iksa• -- 4113- 1146
Signature of Owner/Contractor/Officer(s)of Corporation Date
Affidavit for Worker's Compensation N C G S 87-14
The and Igned applicant being the
V 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 fo 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/
1 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 d is understood that the Central Permitting
Department issuing the permit may require certificates of coverage of workers compensation insurance pnor
to issuance of the permit and at any time dunng the permitted work from any person firm or corporation
carrying out the work � 1 1
Company or Nat-.
41 4 ,( 0'T^ r0..d �L w
r L
I7
Sign w/Title a-.Raft&r—le--.• / p(Jrrrill4;n�P'. nnlinrd 411'1.`1S
Appointment of Lien Agent: Details -LiensNC Lien Service Page 1 of 1
DO NOT REMOVE!
Details: Appointment of Lien Agent Flied on: 04/10/2018
Entry #: 831760 Initially flied by: meaganbradshaw
Designated Lien Agent Project Property Print & Post
Fun American Title Insurance Company CGA000989 Lot 989 Carnage Glen @ Anderson El".L�O
Creek Club Corner Lot Carriage Glen Dr&Glen
Unline:3nnvhwma wm.e..�..w.� Bend C:.
AJJw.19W.Hagen SL Suite 507/Ruldpf,NC GLEN BEND COURT I -�' p
Spring Lake,NC 29390
31601 Remelt County Contractors:
Mime:t53b70773a4 Please post this nonce on the lob Site
F¢913-4845231
Suppliers nm Subcontractors:
fmril:ssp®p'dlkosrcmm..-„�.���..
Soon image with your smut phone to
Property Type view this Fling You can men file a Notice
to Lien Agent for project.
Owner Information 1-2 Family Dwelling
H&HConswnors of Fayetteville,LLC. Date of First Furnishing
2919Breeeewood Avenue De 400
Fayetteville, NC 28303
Email.leannahair@bhhomes.wm 03/21/2018
Phone:910-486-4864
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Technical Support hotline:(888)690.7384
https://apps.liensnc.com/scr/appointment/details.html?entryNumber=831760&printable= 4/10/2018