BUILDING/OWNER EXMPT AFFID/LIEN Application# 17541278
oe make below reMed l by
wperkinessone wot Mull be Harnett County Central Permitting
airier a loaned =tractor. Address. PO BOM 65 LMnatcc NC 27548
company name a phone meet meth 910203.7525 Fax 910223-2797 wwelwntl.arpl]enNb
Wamubn on 3181.3 kens. COMMERCIAL,
Application for Building and Trades Permit
Owner's Name: PJM TRUCK BODIES&EQUIPMENT CO. Date: 7/92018
Sae Adtlresa: 1580 GEORGE PERRY LEE ROAD.DUNN,NC 28334 phone: 910492.5288
Directions to job site from LBington: TRAVEL DOWN HWY 421 THRU DUNN TO 1-95. 00 UNDER THE BRIDGE
AND TURN LEFT ONTO 1-96 N. TAKE.EXIT 77. ABOUT 12 WAYUP THE EXIT RAMP,GEORGE PERRY LEE RD.
(SERVICE ROAD)WILL BARE OFF THE RIGHT. N'S WILL BE ON YOUR LEFT.
Subdivision: Lot:
Deaviption of Proposed Work: CONSTRUCTION OF METAL BUILDING
Heated SF Unheated SF 8•e
General Contractor Information;Building Cost$ °•°°°
PJS TRUCK BODIES&EQUIPMENT CO. 910892.52813
Building Contractors Company Name Telephone
PO BOX 1207,DUNN,NC 28335 ABBIE®PJSTRUCKSODIES.COM
dresst^ASn 1 ij Email Address
't J .J
Signature of ractor/OMar(s)of Corporation License#
glsotr cal Contractor Information: Electrical Cost$ 45,000
Description of Work Santee Size: Amps ST-Poles
CHRIS SINCLAIR ELECTRIC 9198202229
Electrical Contractors Company Name Telephone
119 BRIGH1WOOD CIRCLE.DUNN.NC 28334
Email Address
27819
aWre of Iacbr/Oflker(s)of Corporation License#
Mechanical Contractor Infonnatlo0j Mechanical Cost$
Description of Work #Unile
Mechanical Contractors Company Name Telephone
Address Email Address
Signature of Owner/ContractorlOBfcer(s)of Corporation License#
Plumbing Contractor Information;Plumbing Cost$
Description of Work #Baths
Plumbing Contractors Company Name Telephone
Address Email Address
Signature of Owner/ConiractortOfhcer(s)of Corporation License#
Insulation Contractor Information
Insulation Contractor's Company Name&Address Telephone
'NOTE:General Contractor must RII out and sign the second page of this application
Cmnmernal Building Application I of Er, ,.
Sorinkbr Contractor Information
Sprinkler Contractors Company Name Telephone
Address Email Address
Signature of Officer(s)of Corporation License• 0
Firs Alarm Contractor Information
Fire Alan Contractor's Company Name Telephone
Address Email Address
Signature of Officer(s)of Corporation License s
Driveway Access- NC Depanmem of Trasponatton Driveway Access/Permit? _Yes_No
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 Ordnance. I state the information on the above
contractors is correct as known to me and if um changes occur including listed contractors, site plan,
number of bedrooms,building and trade plans, Environmental Health permit changes or proposed use
changes, I unify it is my responsibility to notify the Harnett County Central Permitting Department of
any and as changes.
Expired Permit Fess-6 months to 2 years permit re-issue fee is$150.00. After 2 years re-issue fee
is charged at full price per current fee sctsdu
Pr.� �..,� 72018
SignatureSignatureof 1/C/Carlrector/Oftiur(e)of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87-14
The undersigned applicant being the:
✓General Contractor _Owner _Officer/Agent of the Contractor or Owner
Do eel hereby
oMmy confirm under penalties of perjury that the;thrombi),firm(s)or corporation(s)pedomdng the work
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
covering themselves.
Has no more then 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 worker's compensation insurance pier
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,7rblpme:PJ'S TRUCK BODIES&EQUIPMENT C
sign wffitle: f bx..44L(�js r�w+y4 ?rode^
T/„/18
Commercial Budding Application(/ 2 ol 2 0810
STATE OF NORTH CAROUNA OWNER EXEMPTION AFFIDAVIT
County of Harnett PURSUANT TOGS.87.14(01)
Inspections Department
Address and Parcel Identification of Real Property When Building is to be Constructed or Altered:
1560 GEORGE PERRY LEE ROAD. DUNN NC 28334 PID 1537-17-7973
I, PAUL JUNIOR FAIRCLOTH
(Prim fug Name)
hereby claimys� .• from'censure under G.S.8740)(2)by boat the relevant provision In paragraph l and
initleppa 1 ng , V 5 bebw and attesting to the following:
1. I certify that I am the owner of the property set forth above on which this building b to be
nstructed or aMred;
OR
I am leply authorized to act on behalf of the firm which b constructing or altering
thio uNding onthepropeny owned by the firm or corporation as set forth above(name offrmor
Won: );
2. I will personally supertmend and manage all aspects of the construction or alteration of the building
irc
that duty will not be delegated to any person not duly'tensed under the terms of Article 1 of Chapter
the General Statutes of North Carolina;
3. I will be personally present for all inspections required by the North Carogne State Building Code,
gkfs the plansconstructionfor the or alteration of the buading were drawn and sealed by an architect
I pursuant to Chimer 83A d the Genesi Statutes of North Carolina;
4. 1 understand that a copy of this AFFIDAVIT con betransmitted to the North Carolina Licensing Board
rGeneral Contractors for verification that lam validly entitled to claim an exemption under 5.5.87-1(b)(2)
or the building construction or alteration specified herein. I further understand that,If the North Caroline
Licensing Board for General Contractors determines that I was not entitled to claim this exemption,the
but ng permit issued for the building construction or alteration specified herein shall be revoked pursuant
253A-362 orG.5.160A-422.
S. ThebulNky witlhisolelycoupled bythe owner(s),firm or corporation as set forth above brat
act twelve(12)momM fo'oving conpbtbn.
Tits AFFIDAVIT applies to the following trades:
6'VBuilding ❑Electrical ❑Mechanical I:Plumbing
`�7. The t� �
total cost of this project is 5125000 /
`w1A —�L4e4J 7/11/2018
JJJ (Signature ofAfWMI Date
(Vac beton me this than_day of JULY toil,
Signature of re Public
ABIGAIL B.ARNOLD *er�rn,
Printed Name of NOON Public CTAR�
My Commission Expires: 5/30/2020 ( tory`�p oases
fNOR:abeybfs iydany to wiefuarnnnrmtperAW Nanrogidana Men 7R. IghwlG�a
Jennifer Brock
From: Abbie Arnold <abbie@pjstruckbodies.com>
Sent: Wednesday,July 11, 2018 4:39 PM
To: Jennifer Brock
Subject: FW: LiensNC Notice of Appointment of Lien Agent -Address: 1560 George Perry Lee
Road, Dunn, 28334
Attachments: DOCS FOR COUNTY.pdf
Below is the info for the Lien Agent and attached are the other two forms that you said are
required. Please review and let me know if anything else is required. If not, Id like to send someone over
tomorrow to bring this and pick up the permit. No more money is due, correct?
From: LiensNC Support<donotreply@liensnc.com>
Sent:Wednesday,July 11, 2018 4:35 PM •
Subject: LiensNC Notice of Appointment of Lien Agent-Address: 1560 George Perry Lee Road, Dunn,28334
A(n) Appointment of Lien Agent was filed on July 11,2018, 04:34:33 PM using the North Carolina Online
Lien Agent System (LiensNC). Details of this filing include:
Project Property
1560 George Perry Lee Road
Dunn,NC 28334
NC County
Entry Number: 883782 (entry search, view related filings)
Date of Filing: July 11, 2018, 04:34:33 PM
Lien Agent
Fidelity National Title Company, LLC
• Online:wtow.liensnc.com
• Address:19 W.Hargett St.,Suite 507/Raleigh,NC 27601
• Phone:888690-7384
• Fax:913-489-5231
• Email:support@Ilensnc.com
Owner Information
PJ's Truck Bodies & Equipment Co.
1560 George Perry Lee Road
Dunn, NC 28334
United States Email: abbie@pjstruckbodies.com
Phone: 910-892-5286
1