DOCUMENTS 50°
Site Name: 5RA0212A Application# 4
Harnett County Central Permitting
PO Box 65 Llllington,NC 27546 - Ph:910-893-7525 - Fx:910-893-2793 - www.hame8.org/pennitS
Certification of Work Performed By Owner/Contractor
(Individual Trade Application)
Owner(s)of Structure:
American Tower,LLC Phone:919-4663544
Owner(s)Mailing Address:3500 Regency Pkwy,Ste 100
Cary,NC 27518
Land Owner Name(s): Brinkley Sam Heirs Phone:
Construction or Site Address:174 Brinkley Hill,Cameron NC 28326
PIN# Parcel# 019594 0004
Job Cost: 59,000 Description of Work to be done
T-Mobile to install diesel generator and 4k8'concrete pad to existing tower.
Mechanical: New Unit With Ductwork_ New Unit Without Ductwork Gas Piping_Other_
Electrical*: 200 Amp_<200 Amp_Service Change_ Service Reconnect_. Other_
•For Progress Energy customers we need the premise number
Plumbing: Water/Sewer Tap_ Number of Baths_ Water Heater
^pacific Directions to Job from LillinatQl
See attached drawings
Subdivision: Lot#:
Infinity will provide the electrical 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.
Infinity
Contractor's Company Name Telephone
110 Litho Way,Durham NC 27703
Address Email Address
74619/U231.21
License#
Structure Owner/Contractor Signature:
tF/, rte_ Date:712/18
By signing this application you affirm that you have twined 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 18-50044407 Date 7/03/18
Property Address 174 BRINKLEY HILL LN
PARCEL NUMBER . 01-9594- - -0004- - -
PIN 9594-34-8634 . 000
Application type description CP STANDALONE TRADE - COMMERCIAL
Subdivision Name B B BRINKLEY HEIRS
Property Zoning PENDING
Owner Contractor
BRINKLEY SAM INFINITY COMMUNICATIONS
110 LILTHO QY
85 BRINKLEY HILL LANE DURHAM NC 27703
CAMERON NC 28326 (919) 797-2334
(910) 497-3377
Applicant
AMERICAN TOWER LLC
3500 REGENCY PKWY STE 100
CARY NC 27518
(919) 466-5544
--- Structure Information 000 000 DIESEL GENERATOR ON PAD
Other struct info PROPOSED USE GENERATOR
Permit COMMERCIAL ELECTRICAL PERMIT
Additional desc .
Phone Access Code 1249879
Issue Date . . 7/03/18 Valuation . 9000
Expiration Date . 7/03/19
Special Notes and Comments
T/S: 07/03/2018 10 : 16 AM JBROCK ----
174 BRINKLEY HILL
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 18-50044407 Date 7/03/18
Property Address 174 BRINKLEY HILL LN
PARCEL NUMBER . 01-9594- - -0004- - -
PIN 9594-34-8634 . 000
Application description . . CP STANDALONE TRADE - COMMERCIAL
Subdivision Name B B BRINKLEY HEIRS
Property Zoning PENDING
Permit COMMERCIAL ELECTRICAL PERMIT
Additional desc .
Phone Access Code 1249879
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
999 265 E265 C*ELEC FINAL / I_
999 257 E257 C*ELEC OVERHEAD _/_/_
999 263 E263 C*ELEC RECONNECT / /_
999 253 E253 C*ELEC TEMP POWER CERT /_/_
999 261 E261 C*ELEC UND POOL II_
999 259 E259 C*ELEC UNDER SLAB / /_
999 255 E255 C*ELECTRICAL UNDERGROUND / /_
999 251 E251 C*ELEC ROUGH IN / /_
999 267 E267 C*ELEC TEMP SERVICE POLE / /_
HARNETT COLAI Y CASH RECEIPTS
o* CUSTOMER RECEIPT *tm
T7/03/I8 52 Receipt noDrawe2
: 1
Date: 622
•
Year Number Amount
2818 58644487
174 BRINKLEY 'TILL LH
CAMERON, NC 283E6
Bl Nu - PEMII EEE.,
4362.66
ELE PERMIT
TOWER ENG
Tender detail $360.60
CP CREDIT CARD 366.66
Total tendered $$366.66
Total payment
Trans date: ?/63/18 Tlre: 1.4:56:31
** THANK YOd FER YOUR PAYiIEnT **