BUILDING •
'Each section below to be filled out Application # I 0 ^..5 470-d' y(,al
by whomever performing work. Harnett County Central Permitting
Must be owner or licensed PO Box 65 Lillington, NC 27546
contractor. Address, company 910 -893 -7525 Fax 910 -893 -2793 www.harnett.orgfpermits
name 8 phone must match
Application for Residential Building and Trades Permit
°I.)./0 Owner's Name: OtepElln son g1/ t Ide Ten( . Date:
Site Address: 43 ‘r r_( r.06.5 ck. .n1.,..,1 Nc ]35'3 Phone: 9 II- - )3() -l$f) )
Directions to job site from Lillingt :
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Subdivision: LJal 3 5- G. Lot: 30
Description of Proposed Work: S,, a €c W L7 # of Bedrooms: 9
Heated SF: x549 Unheated SF: c1 Finished onus Room? t/ Crawl Space: Slab:
General Contractor Information
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Building Contractor's Company Name Telephone
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Addres Email ddress
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Signa ure of 'iwner /Co it rot r Officer(s) of Corporation License #
Electrical Contractor Information
Description of Work t•n/ Service Size: OW Amps T -Pole: t /Yes No
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Electrical Contractor's Company me Telephone
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Addres Email Address
Signa re Owner /Contractor /Officer(s) of Corporation License
Mechanical /HVAC Contractor Information •
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Description of Work SC1./ -
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Mechanical Contractor4 Company Name ( Telephone .
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Address -?51j Q Email A dress
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Signat of O er /Contractor /Offcer(s) of Corporation License #
Plumbing Contractor Information
Description of Work rkc 01 # Baths
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Plumbing Contractor's ojpany Name Telephone
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Addres Email Address
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Signat a of O nerr o ntractor /Officer(s) of Corporation License #
Insulation Contractor Information
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Insulation Contract. Company Name & Address Telephone
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*NOTE: General Contractor must fill out and sign the second page of this application.
ResldenGal Di old Application 1 of 2 03,10
Homeowners Applying to Build Their Own Home
Please answer the following questions then see a Permit Technician to determine if you qualify for permit under Owners Exemption.
Questionnaire per G.S. 87 -14 Regulati.ns as to Issue of Building Permits (Memo available upon request)
1. Do you own the land on which thi building will be construc - .? _ Yes No
21IEPacetyou hired or intend to hire an i dividual to su•`- rintend and • , a •
manage construction of the project? " Yes _ No
3. Do you intend to directly control & supe is: construction activities? _ Yes No
4. Do you intend to schedule, contract, or .l -ctly,pay for ell phases of
construction work to be done? Yes No
5. Do you intend to personally occu• the buil. g for atleast.12 consecutive
months'following completion of c. struction and .o you understand that if
you do not do so, it creates t - • resumption und: law that you fraudulently
secured the permit? Yes _ No
I hereby certify that I have the authority to make necessary application, thatthe is correct
and that the construction will conform to the regulations in the ,Building, Electrical, Plumbing and
Mechanical codes, and the Hamett County Zoning Ordinance. I state the information on the above
contractors is correct as known to me and if 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.
EXPIREIaggh4I ,MES - 6'Months to 2 years permit re -issue fee is $150.00: After 2 years,re- issue'fee
is as per cur nt fe sch le.
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7 `11-ID
Signatur of Ow r Cori ctor /Officer(s) of Corporation Date
4
Affidavit for Work 's Compensation N.C.G.S. 87 -14 •
The unde�rsi ned applicant being the:
✓ Ggr ep1 Qoi$9ctor 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:
F s 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,bne. (1 or4o subcontractors(s) who has their own policy of workers' compensation insurance
covering th &mselves.
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 worker's 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: t - ,. _II. O. 111 ; •a. _ c
Sign w/Title: / ..J, I i Date:
—7' f
Residential Building Application 2 of 2 0'3710
C trefirio
Plan Box Number Job Name D'..o
Date: c7— 12 - ) 0
Required Inspections for SFA.'SFD
Appl.# . � t3-`2 -`/40
Valuation �`
Sq. Feet le ,26, S
Sequence
10 ✓ R* Bldg. Footing
10 -30 R* Elec. Temp Service Pole
20 ✓ R* Building Foundation
20 Address Confirmation
30 -999 Open Floor
30 -999 R* Bldg. Slab Insp.
30 -999 R* Elec. Under Slab
30 -999 R *Plumb. Under Slab
40 / Four Trade Rough In
40 Four Trade Rough In> 2500
40 Three Trade Rough In
40 Three Trade Rough In> 2500
40 Two Trade Rough In
40 Two Trade Rough In> 2500
40 One Trade Rough In
40 One Trade Rough In > 2500
50 ✓ R* Insulation
60 ✓ Four Trade Final
60 Four Trade Final > 2500
60 'Three Trade Final
60 Three Trade Final > 2500
60 Two Trade Final
60 l'wo Trade Final > 2500
60 One Trade Final
60 One Trade Final > 2500
999 Gnvir. Operations Permit