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DOCUMENTS Initial Application Date:05/25/18 Application* CU# COUNTY OF HARNETT RESIDENTIAL LAND USE APPUCATION Central Pemdtng 108 E.Front Sheet,LNIfgtan,NC 27648 Phone:(910)893-7525 ext2 Fax(910)893-2793 www.hemetoypermlts "A RECORDED SURVEY MAP,RECORD)D DEED(OR OFFSETS PURCHASE)&SITE RAN ARE REQUIRED WHEN BUBIIn-DNG A LAND USEAPPLICATIOM' LANDOWNER:Tracey Petersen A u.}{„L '-YCYnraMa(lirp Addis=85 Bridle Creek Drive City. Edlington 910-705-2425.27546 Contact No: 910.705-2625 Email: APPLICANT':Peter Denicola Marina Address:919 N Main Street Ckc MoaesvlAe State.NC ZP 28115 Contact No: 704200-8883 Emal: mjervis®paxerhane.00m *Pease M out applaud NMMlen N WNW than Widower CONTACT NAME APPLYING IN OFFICE:Megan Jarvis Phone# 07042099893 PROPERTY LOCATION:SubdMaian: Tj p4'cr..5I`tt/�y�� Lot#: J I Lot Slm ' Slab Road#65 State Road Name: Bridle Creek Drive D Map Book&Page:94i 3/ 3o3 Ferrol`: 0330150s7 00200 76 PIN: 9597-83-2484.000 2oninP'Ac O/`pleod Zone' K Watershed: Deed Book&Pa03. 4O / 415 power company.: Duke Energy `New structures with Progress Energy as service provider need to supply premise number from Progress Energy. PROPOSED USE: Monolithic ❑ SFD:(Size x )#Bedrooms:_#Bath`Basemenl(wAvo baBtk_GMage:_Deck_Creed Space:_Slab:_Stab:_ (Is the bonus room finihed?U yes LJ no w/a Goset?Oyes ( )no(S yon add inwHh#bedrooms) ❑ Mod:(Size_z )#Bedrooms_#Baths_Basement(wAw bath)_Garage:_Site Suit Deck:_ On Frame_Off Frame_ (Is the second floor finished?U yes (_)no My other site built additions?U yea Uro ❑ Manufactured Home:_SW_DW_TW(Size x )#Bedrooms:_Garage: (site built? )Deck_(ste bunt? I ❑ Dupter.(Size, x I No.Buildings: No.Bedrooms Per Unt ❑ Home Occupation:*Rooms: Use: Hours of Operation: #EmPoyees:_ AMSNoNAcceaeory/Other.(Size x )Use:solar array Closets in addition?Oyes (*)no Water Supply: County _Existing Well _New Well(#of dwcAings usbg well )Must hew operable water before final Sewage Suppy: New Septic Tank(Complete Checkdds° Existing Septic Tank(Complete Checklist _County Sewer Does owner of this tract of land,own lend that contains a manufactured home within five hundred feet(5001 of bad listed above?( )yes no Does the property contain any easements whether underground or overhead( )yes U no Sbctues(existing or proposed):Single family dwellogr Manu)tared Homes: Other(specify): Required Residential Property List Setbacks: Comments: Front Minimum papal 28 roof mounted modules,grid lied,8.26 KW solar Installation on misting Rear residence Closest Side Sidrsbeet/coner lot_ Nearest Building on sane lot Residential Land Use Application Page 1 of 2 03/11 APPLICATION CONTINUES ON BACK SPECIFIC DIRECTIONS TO THE PROPERTY FROM UWNGTON: see attached If permits are granted I agree to conform to all ordinances end It. of the State of North Carolina hegulatlng such work and the spadflmtions el plans submitted. I hereby state thattwegdng statements are accurate coronad to the beet of my knowledge. Permit subject to revoranon If false Information Is provided. Jrek� a 0.518 Signature of Own or Car Date """Nb w the onedapplkants responsibility to provide the county it with any applicable Mfomiatlon about the subject property.Including but not limited to:boundary Infomston,house location,underground or ovmhead casements,etc.The county orbs employees an not responsible for any incorrect or missing information that Is contained within these applications "This application expires S months from the Initial date if permits have not been issued" Residential Land Use Application Page 2 of 2 03/11 lSS i I/ 4 ' S O LNOME f3.;Wta' J:,-P h Ti To Whom It May Concern: When this package is received can you kindly either call 704-209-9893 or email mjarvis@powerhome.com to relay the permit fees or the process to obtain our permits. Thank you, Permitting Team at Power Home Solar Megan Jarvis NC OFFICE:919 N Main Street,Mooresville, NC 28115 704-209-9893 MI OFFICE: 38905 Mound Road, Sterling Heights,MI 48310 ACCOREP® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDONTYY)032//2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTNAMEACT AN Carosella Insurance Agency (A/CNoExo- (72_41)335-9928 FAX No). (412)774-2316 3281 Leechburg Road T`. ADDRlESS: info@Carosellainsurance.com INSURER(S)AFFORDING COVERAGE l NAICI Lower Burrell _ PA 15068 INSURER A'. Endurance American Specialy Insurance Co. _ INSURED INSURER B' American International Group.INC(AIG). Power Home Solar Llc INSURER c Erie Insurance Exchange .. l 919 N Main St Ste 300 INSURER o: Travelers Insurance INSURER E'. Mooresville NC 28115-2355 INSURER F' COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSRTYPE OFINBURANCE ADDL SUER POLICY EFF POLICY EXP I TRIN 0 VWD POLICY NUMBER (MMNDNYYY) IMMNNYI9 LIMITSYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED CLAIMS-MADE 'IX OCCUR PREMISES(Ea occurrenCel 100,000 MED EXP(Any one persgnV- , 5,000 A X CBC20001146001 02/25/2018 02/25/2019 PERSONAL&ACV INJURY 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 X POLICY PRO LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: AUTOMOBILE LIABILITY ((Ea accidentSINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per person) C A ( SCHEDULED UTO001-0133753 01/01/2018011012019 BooNY INJ)RY(Peraxidenp H1— AUTOS HIRED S ONLY ' NON—OWNED PROPERTY idem)DAMAGE AUTOS ONLY i AUTOS ONLY (Per accident) I UMBRELLA DAB X OCCUR EACH OCCURRENCE 5,000,000 B X EXCESS LIAB CLAIMS-MADE X EBU 015888144 02/25/2018 02/25/2019 AGGREGATE 5,000,000 DED RETENTIONS WORKERS COMPENSATION X STATUTE ETH AND EMPLOYERS'LIABILITY D OFFICERMEMBEER EEXXCCL DEEDDI cmlvE Y/N N/A 25439330 03/08/2018 03/082019 E.L.EACH ACCIDENT 1,000,000 (Mandatory in NH) EL DISEASE-EA EMPLOYEE 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached I1 mote space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE a . Fax: Email: ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 09/09/11 Application# Harnett County Central Permitting PO Box 65 Winton NC 27546 Each section below to be filled out 910 893 7525 Fax 910 893 2793 www hamett orglpernits by whomever performing work Must be owner or licensed contractor Address company Application for Residential Building and Trades Permit name&phone must match Owners Name Tracey Petersen Date 05/25/18 Site Address 65 Bridle Creek Drive, Lillington,NC 27546 Phone 910-705-2425 Directions to job site from Lillington Subdivision Lot 28 roof mounted modules,grid lied,8.26 KW solar installation on Description of Proposed Work existing residence #of Bedrooms Heated SF Unheated SF Finished Bonus Room? Crawl Space _Slab General Contractor Information Power Home Solar 704-209-9893 Building Contractors Company Name Telephone 919 N Main Street,Mooresville,NC 28115 mjarvis@powerhome.com Address Email Address 60946 License# Electrical Contractor Information Description of Work same as above Service Size _Amps T-Pole _Yes No Power Home Solar 704-209-9893 Electrical Contractor s Company Name Telephone 919 N Main Street,Mooresville,NC 28115 mjarvis@powerhome.com Address Email Address 26074-U License# MechanicallHVAC Contractor Information Description of Work Mechanical Contractors Company Name Telephone Address Email Address License# Plumbing Contractor Information Description of Work #Baths Plumbing Contractors Company Name Telephone Address Email Address 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 Building 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 by stoning below I have obtained all subcontractors permission to obtain these permits and if a y 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$150 00 After 2 years re-issue fee is as per current fee schedule CD 1/4. 05/25/18 Signature of Owner/Contractor/Officer(s)of Corporation Date Affidavit for Worker's Compensation N C G S 87-14 The undersigned applicant being the x General Contractor _Owner % _ Officer/Agent of the Contractor or Owner Do hereby confirm under penalties of perjury that the person(s) firm(s)or corporation(s)performing the work set forth in the permit x Has three(3)or more employees and has obtained workers compensation insurance to cover them Has one(1)or more subcontractors(s)and has obtained workers compensation insurance to cover them Has one(1)or more subcontractors(s)who has their own policy of workers compensation insurance covering themselves Has no more than two(2)employees and no subcontractors While working on the project for which this permit is sought it is understood that the Central Permitting Department issuing the permit may require certificates of coverage of workers compensation insurance prior to issuance of the permit and at any time during the permitted work from any person firm or corporation carrying out the work Company or Name Power Home Solar/Peter Denicola Sign w/Title °" General Contractor Date 05/25/18 5125/2018 Harnett GoutyCentral Permit to 65 Bridle Creek Dr,Lillirgt i,NC 27546-Google Maps Google Maps Harnett County Central Permit to 65 Bridle Creek Dr, Drive 13.7 miles, 19 min Lillington, NC 27546 Fe. Broadway Stilt Ps& s, ra! iHn��ne.9 ‘"` o ilim um =Fg 4- p o 0 o ...� ,. . s nen o 'er = o _ r-� t, ® o..o '�, r..,, ?=,.. :ai.w 'o A w,.a Tal -r, L C 7.1tIm.i^11= m+t R .. o .�.o w abca „. O f G IJ 'M I ii ® rmmnt® MJ G 4.6e mon on ® e. 0 o w=.�wlw$ o a .Ci o ii Google a. ^' °`m 74, Le o _ a ® lit Map data©2018 Google 2 mi Harnett County Central Permit 108 E Front St Lillington,NC 27546 1 1. Head west on E Front St toward Slst St 0.1 mi h 2. Turn left onto S Main St 14 mi r 3. Turn right onto W Old Rd o o mi 11 4. Turn left onto NC-27 W 119 mi 1 5. Turn left onto Docs Rd 19 mi r 6. Turn right onto Kentucky Derby Ln o 7 mi 41 7. Turn left 0 Destination will be on the left 358 ft 65 Bridle Creek Dr Lillington,NC 27546 MtosJMwwgoogle coMrn pl5/dirMarnett+Cou ly+Cerdral+Pernit+Fast+Front+StreetAillirgton,+NC165+Bride+Creek+Dr,+Lillington,+NC+27546/@35.3431233,-78.9