BUILDING Harnett County Central Permitting
PD Boa 6S Lillington,NC 27546
Telephone Number 910-893-4759
A.•lica Pion for pudding and Trade Permit
Owner's Name: • 1 . j-4tAf1/4F in 1\o ,rte Date:
Address:„ _ Phone
�
Directions tn inb site , ...e,,,. ---,, _.. - -
•
Subdivision: 4k (y fL—Fy1/4-Q. ,LQ,, Lot:____5_
Type Con truction: (Please Check) Building Use: (Please Check)
New kienovation O Addition. 3 Residential 0--- Modular O
Moved House 0 Other 0 Commercial 0 Multi-Family 0
Specify Type of Work: •
Building Permit Information
Heated i - Crawl Space V Building Construction Cost$
Un,ficatedlab F Acres Disturbed / Stories
•
Building Contractor's Company Nare Address Aft
.& -- • /8437 - (/'A ..ts3, tens
Signature of Officer(s) of Corporation License# _ Telephone
•
Electrical Permit Information •
Description of Wrk e/ey/'rey ( Electrical Cost$
TS Pole: Yes W No 0 Underground r).- Overheard 0
PP�ymanent Service: Underground Q Overhead Q Service Size: - Amps
/'b.ver£/e-'c% .s,C.re..e. ?o. ' -. ViXO/e/vss1ai £Y/' „ .7e s,
Electd 1 n,263ym ' C pony Name✓ n Address ." `1—P6
t anu> Officer(s)of Corporation "1/cel? 7/O Telephone
�-.�7d-/
grr rP License`# Telep
-41," Insulation Permit Information
Amid- tial .Q Other 0 Not Required 0 o
/l t -71,-. .. _ ' ...i 4t/ Oo. 1 ,Lyiiti
Insulation Contra or s Company Name Address
9/a - d$6 ASCs-
Telephone
M./14
'''J `` Mechanical Permit Information •
Description of Work AV146 Number or-Units Type System Mechanical Cost t
Number of Tons
Bei/�� S f!{ <A c d 6 ts/cy 4. ('aA-i e: 010,574/Mechanic. Contrac r' Compton Name Addres
. 917497 q/9- 21Y- 5`;,2 4/7
Signature of Officer(s) of CorporJo on License# Telephone
�j Plumbing Permit Information
Description ofWor4 7—LAJ' t%.eitt Number of Baths _Plumbing Cost S
_ l �-. ^�—,rJ--ti�r,i v�-LJ-�.' ..,�_..,,.��
Plum7if 'ontrac or'sLomna N e - 4ddress —'
,f, i - '�� i ( O1L0�1Ci S). c� Isle} %US
Signatire of Officeo(s) f C(odporation Licence # c Telephone
02/01 -
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 Hamett County Zoning Ordinance I state the information on the above
contractors is correct as known to me and that pv alumna below I have obtained all subcontractors
permission to obtain these Dermas and if may 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-c Months to 2 years permit re-issue fee is$150 00 After years re-issue fee
is asvper c/ugent fee schedule /A, (L
SgnatuCCre of OwnerlContractorlOffwer(s)of Corporation Date
Affidavit for Worker's Compensation N C G $ 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
the
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 pnor
• to issuance of the permit and at any time during the permitted work from anyperson firm or
corporation
carrying out the work AA-v-7 icb�
Company or Name /V1o55 lGAtt't utr[-4 4l K /M-
Sign wRitle_ 4(2e------14--- ( N a"-;-;7 1) Date c--17/1/21)/e3,
Appointment of Lien Agent:Details-LiensNC Lien Service https://apps.liensne.com/scr/filing/details.html?entryNumber=851837
DO NOT REMOVE!
Details: Appointment of Lien Agent Fila on: 05/14/2018
Entry #: 051037 Initially filed by: mosshomebuilders
Designated Lien Agent Project Property Print & Post
Investors Title Insurance Company Lot 5 Centrella Subdivision ❑ '❑
pa box 577 rr
Iillingtort NC 27546 !
Address:19 W.peryrn St Siam 507,Raleigh,NC Nmlh Carolina County ❑
37601
Contractors:
Phone:822-690.73t4 Please post this notice on the Job Site.
Fax:913489-5231 Property Type
Suppliers and Subcontractors:
Scan this image with your smart phone to
view this filing You can then file a Notice
1.2 Family Dwelling to Lim Agent for this project
Owner Information
Date of First Furnishing
Triumph Capital Group LLC
510 C.Washington Street
Lillington. NC 27546 0514:2018
United States
Email:vickie(rcailtincam.com
Phone:910890-2111
View Comments(U)
Technical Support Hotline:(888)690-7384
I of 1 5/15/18,8:47 AM