DOCUMENTS Application#
Harnett County Central Permitting
PO Box 65 Lillington,NC 27546 - Ph:910-893-7525 - Fx:910-893-2793 - www.hamettorg/permits
Certification of Work Performed By Owner/Contractor
��11 (Individual Trade Application)
Owner(s)of Structure: Eat( I/'��///'10MSrj nr4x� t3 Phone: fit -✓5-71 a
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Owner(s) Mailing Address: orf' G *j2 t" L 7yt•e'
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Land Owner Name(s): J gent — Pone:
Construction or Site Address: S�JS i L rtfrTh K� ,
PIN# Parcel# I
Job Cost: Description of Work to be done ``�/
Mechanical: New Unit With Ductwork_ New Unit Without Ductwork Gas Piping_Other_ Vim_\/���j
Electrical*: 200 Amp_<200 Amp_Service Change_ Service Reconnect_ Other
*For Progress Energ customers we need the premise number
Plumbing: Water/Sewer Tap Number of Baths Water Heater
Specific Directions to Job from Lillington:
Subdivision: Lot#:
I
144/143* fl 414lt' will provide the /N� labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is ,which entitles me to
perform such work on the above structure legally. All work shall comply with the State Building Code and all
other applicable State and local laws, ordinances and regulations. q
��'>' -Y1 t�' YN r(..A4 t—�,-./ /0- 741-0961
Contractor's Company Name Telephone
Address Email Address
License#
S
Structure Owner I Contractor Signature: / Date: �-1174-/S
By signing this application you affirm t - you have obtained permission from the above listed license holder to
purchase permits on their behalf. If doing the work as owner you understand that you cannot rent, lease or sell
the listed property for 12 months after completion of the listed work.
*Company name, address, & phone must match information on license
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Application Number 18-50044358 Date 6/26/18
Intersection
Property Address 535 VIC KEITH RD
PARCEL NUMBER 03-9586-12- -0120- - -
Application type description CP SEWER/WATER TAP
Subdivision Name BUFFALOE LAKES MAP NO 2
Property Zoning RES/AGRI DIST - RA-20R
Owner Contractor
MCQUILKIN JAMES R CUSTODIAN & OWNER
EQUITY TRUST CO CUSTODIAN
14 CADE LANE
SANFORD NC 27332
Applicant
MCQUILKIN JAMES R CUSTODIAN &
EQUITY TRUST CO CUSTODIAN
14 CADE LN SANFORD, NC 27332
SANFORD NC 27332
(910) 574-0968
--- Structure Information 000 000 WATER / SEWER TAP HOOK UP
Permit RESIDENTIAL PLUMBING PERMIT
Additional desc
Phone Access Code 1249101
Issue Date . . . 6/26/18 Valuation . . . . 0
Expiration Date . 6/26/19
Special Notes and Comments
T/S: 06/26/2018 01 : 56 PM JBROCK ----
535 VIC KIETH RD
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 18-50044358 Date 6/26/18
Property Address 535 VIC KEITH RD
PARCEL NUMBER 03-9586-12- -0120- - -
Application description . . CP SEWER/WATER TAP
Subdivision Name BUFFALOE LAKES MAP NO 2
Property Zoning RES/AGRI DIST - RA-20R
Permit RESIDENTIAL PLUMBING PERMIT
Additional desc .
Phone Access Code 1249101
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
999 305 M305 R*PLUMB SEWER CONNECTION / /
999 307 P307 R*PLUMB WATER CONNECTION / /
999 309 P309 R*PLUMB UNDER SLAB / /
999 131 R131 ONE TRADE FINAL /
999 125 R125 ONE TRADE ROUGH IN
999 315 P315 R*PLUMB HW HEATER /_/_
HARNETT COUNTY SASH RE rC;=l4T.9
mac CUSTOMER RECEIPT tt+:
Uoer, :WKS Type: CP Drawer: i
Date: 6/86/i6 32 Receipt no: 401765
Year Number Amount
2016 50044356
535 VIC KEITH RD
SANFORD, NC 27332
E1 EP - PERMIT FEES
340.00
PLU PERMIT
EQUITY TRUST
Fender detail
CK CHECK PAWN. 702653 440.08
Total tenderee 440.00
Total payment $40.00
Trans date: 6/26/i8 Time: 14:05:53
44 THANK YOU RUR YOUR PAYMENT **
HARNETT L9UNTY CASH RECEIPTS
*** CUSTOMER RECEIPT awr:
Uper: JEROCK Type: CT. Drawer: 1
Date: 6/26/16 52 Receiot no: 401768
Customer Location hams Amount
227883 24062 MCOUILKIN JAMES R CU
U0 UT-''ATER TAP REES
$860.88
227663 24862 MCOUILKEN JAMES R CU
U9 U'-WATER CAPACITY FEES
41200.06
227063 24062 MCOUTLKIN JAMES R CU
UD WA UTILITY DEPOSIT
•
425.00
227063 24062 MCQUILKiN JAMES R CU
U7 UT-SEWER TAP FEET
4950.00
227083 24062 MCAPALKIN JAMES F CU
Un UT-SEWER CAPACITY FEES
41608.80
227063 24062 MCOUILTI:1 JAMES R CU
UD SW UTILITY DEPOSIT
425.00
fender detail
CK CHECK PAYMEN 702053 44600.00
Fotal tendered 44600.00
Total payment 44600.00
Trans date: 6/26/16 Time: t4:07:32
tt THANK YOU FOR YOUR PAYMENT t=