BUILDING, PERMIT & RECEIPT i I`Pdr dS 11011111.1 Piri1 -r
I-Lgihen, ,,, ',Io. 111. 01 Ai'0
sr L iinn 6 1) '6i=tq nn J Lade J'erndl
fiu r1 s 14mn" - - I;Nn
illlr lionr In i it, clic o.
C(11((-1(✓anon: ,r t ot
r';pr I onslnlrtinn (Pica t Chu 'kJ Bullrhn Tice_ (Please check)
Pi(.v / rl o✓riinn r Addihnn. ' E ''rrt a' 4Y l tr-h.lar O
(vloved Fiousc ,) ' n( o (j f omrnerrH O 11uhi-FnrniiV 1)
lir .iV I7i)Ci l '.1)- 1r
T1cl11Irnc Fe, Ir Inforn-ir lion
llnarcd Cray I p;-,( a( 'elinr lc i. i
ILlhcat d,,., 71-h (' ,r ,,,;(..„,1 / + u, c --__ --
ei dil ContraciIlrn s any Nark
IlAdd s
/./_ (C'A /8 C73 7 7c ft
.Signnt'rn of Offirrrrs) of rnrat,ca, 1 -r ... le C1-phone
(“_,:r. n n
(-1,1 of 'nk /i•Y/rfA 'a ral ' ncI g
TS PH,- 1c5 try No I Iv ,r. � I ---
+: an
,TyPqrminent Sfc�rvrcr_ i J r lnnd 0 1,--h r r nT, Amp,:
vd» 1 'rra/ o%! 1s .. Z
Ir1le 1 ontr to - tor1pany Name,- Ad Iress — A-2,-7,
�_ e `a sp GAO ./51-1 d'=/
-( gnann f Offic r (s) I I f Corporation _nsr b t'.l l hrnl _
ti' Insolr4inn Perm*. :nfrymzlinn
1 irl-n -(; — Cr 11..11 l O.
_17(-Sr Cin _ � A-5 =ta, . 'I 11 /..., u,-; �-r,
iiiridahrnCnnl a¢0C np.,1V Ho,, c
l-,iCphem
M l nmaj Per1111k Information
Llrscriplinn of Work if124 6 N h^r of Ih s Type_Fystem 1t{-rh-m-nl Cnpt t
p J mhrr of Inns
gedsteyi5 _/-/S1,4fr 7,_17t c 4 ✓.?L4--5 ,6y XN. /11:47-;- Air-" (195• '
I'rfann r nha.`l,rye otl �,i.
I I Orli , tic) i I barn'.
7 I l 9l lg J e r Ir'a:ahc
1.11 If f 'gr1 I L4$ t.r' TO 1,7)11r1 `PIMlornhiny r1l $
96 t C LJ j vennoi LLC _DIIL. tjr_-d . ci. "3 -vi t C -
rhIJ,Pio t(..Ir tnr rL lnrnR4 anF if l /1 a3
11, 5: I 1)(',77 ) f (17tiT\- .
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 tome and that yv*ammo below I have obtained all subcontractors
penndnon to obtain these oennes and if go 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-8 Months to 2 years permit re-issue fee is$150 00 After years re-issue fee
is as per c fee schedule
41/ 7 201$
Signature of Owner/Contractor/Olfscer(s)of Corporation Date
Affidavit for Worker's Compensation N C G 3 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
covenng themselves
Has no more than two(2)employees and no subcontractors
While working on the project for Much this permit is sought it is understood that the Central Permitting
Department issuing the permit may require certificates of coverage of workers compensation insurance poor
to issuance of the permit and at any time during the permitted work from any person firm or corporation
carrying out the work �A1
Company or Name 9 "i053 744ft.off1141CS P /.?hcTy // L/p
Sign w/Tdde Date /7(20/3
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Application Number 18-50043899 Date 6/01/18
Property Address 96 JOEL WAY
PARCEL NUMBER 13-0610- - -0255- -07-
Application type description CP NEW RESIDENTIAL (SFD)
Subdivision Name CENTRELLA BLOTS
Property Zoning RES/AGRI DIST - RA-30
Owner Contractor
TRIUMPH CAPITAL GROUP LLC & MOSS KENNETH A
CENTRELLA LYNN A PO BOX 577
510 E WASHINGTON STREET LILLINGTON NC 27546
LILLINGTON NC 27546 (910) 893-4875
Applicant
MOSS HOMEBUILDERS
PO BOX 577
LILLINGTON NC 27546
(910) 890-2111
--- Structure Information 000 000 50X50 3BDR 2 . 5BA CRAWL W/GARAGE
Flood Zone FLOOD ZONE X
Other struct info # BATHS 2 . 5
# BEDROOMS 3000000 . 00
PROPOSED USE SFD
SEPTIC - EXISTING? NEW TANK
WATER SUPPLY COUNTY
Permit BLDG,MECH, ELEC, PLB, INSU PERMIT
Additional desc .
Phone Access Code 1245240
Issue Date . . . 6/01/18 Valuation . . . . 0
Expiration Date . 6/01/19
Special Notes and Comments
T/S: 04/30/2018 04 : 21 PM JBROCK ----
96 JOEL
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
PERMIT INCLUDES BLDG, ELEC,MECH, PLUMB
INSULATION AND LAND USE.
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
Work must conform and comply with the
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 2
Application Number 18-50043899 Date 6/01/18
Property Address 96 JOEL WAY
PARCEL NUMBER 13-0610- - -0255- -07-
Application description . . CP NEW RESIDENTIAL (SFD)
Subdivision Name CENTRELLA BLOTS
Property Zoning RES/AGRI DIST - RA-30
Permit BLDG,MECH, ELEC, PLB, INSU PERMIT
Additional desc .
Phone Access Code 1245240
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 I129 R*INSULATION INSPECTION —/ /
40-60 425 R425 FOUR TRADE ROUGH IN —/—/-
40-60 125 R125 ONE TRADE ROUGH IN —/ /
50-60 429 R429 FOUR TRADE FINAL —/ /
50-60 209 E209 R*ELEC TEMP POWER CERT —/ /
999 H824 ENVIR. OPERATIONS PERMIT _/ /
HARNETT COUNTY CASs RECEIPTS
*** CUSTOMER RECEIPT ***
Open: JBROCK Type: CP Drawer:
Date: 6/01/18 52 Recent no: 372913
Year Number Amount
2018 50043899
96 JOEL WAY
LILLINGTON, NC 27546
Et BP - PERiMIT FEES
$1000.00
SED
MOSS BUILDERS
fender detail
CK CHECK PATEN 7514 !1000.00
Total tendered 61000.00
Total payment $1000.00
Trans date: 6/1t/i8 Time: :4:57:22
** THANK YOU FOR YOUR PAYMENT am