BUILDING `Each section below to be filled out by
. whomever performing work. Must be owner Application # 10 q SOD - 2`i7 �L
or licensed contractor. Address, company Harnett County Central Permitting
name 8 phone must match Information on
license. PO Box 65 Lillington, NC 27546
910 -893 -7525 Fax 910-893-2793 www.harnett.org /permits
Aooiicatlon for Residential Building and Trades Permit
Owner's Name: So tin lnyert Date: 77/0
Site Address: 72 1.14 ;41 Oak Cl( Phone: ` TI Q- q4q- 5/41
Directions to job site from Lilliington: 2 7 'a r se- 7/L FA., Wei. to L o, / P c (
T/e e`nt'o S/D rti 0 -fts ire. ,1c C :' %c /9
gOu fe eel t& 2. I
Subdivision: 2e cc ti Tet t ( ro s S ; Lot: 9;
Description of Proposed Work: 5 Ken i�o rc 6 /Deco #Bedrooms: 1
Heated SF V Unheated SF 1 1/0 Finished Rec Room? Crawl Space () Slab ( )
General Contractor Information
iltrpeld NOIK folu+mn) 91q- 9 17 - !R7
Building Contractor's Company Name Telephone
fr AS re: ah oba (J7 1aI01.1 ,VC 9,046 p rlu, AV,
Address / J License#
Must sign & fill out second page
Signature tractor / Officer(s) of Corporation
Electrical Permit Information
Description of Work Service Size: - Amps TPole: yes/no
Electrical Contractor's Company Name Telephone
Address License #
Signature of Officer(s) of Corporation
Mechanical /HVAC Permit Information
Description of Work
Mechanical Contractor's Company Name Telephone
Address License #
Signature of Officer(s) of Corporation
Plumbing Permit Information
Description of Work # Baths
Plumbing Contractor's Company Name Telephone
Address License #
Signature of Officer(s) of Corporation
insulation Permit Information
Insulation Contractor's Company Name & Address Telephone
8/21/08
carrying out the work.
Company or Name: - r 4c f NOwe So I ustr o n S
•
Sign w/Title: ! Date: 7 /1 /,(0
8/21108
Ho eowners Applying to Build Their Own Home
Please answer the following qua:. ons then see a Permit Technician to determine if you qualify for permit under Owners Exemption.
Questionnaire per G.S. 87- . Regulations as to Issue of Build ' g Permits (Memo available upon request)
1. Do you own the land on which is building will be con ucted? _ _ yes _ no
2. Have you hired or intend to hire an i • ividual t. uperintend and manage construction of the
project? _ yes _ no
/
3. Do you intend to directly control & supervis= construction activities? _ yes _ no
i
4. Do you intend to schedule, co tract, or directly •ay for all phases of construction work to be
done? yes _ no
5. Do you intend to personally occupy the building for a I@ast 12 consecutive months following
completion of construction and do you understand that if you do not do so, it creates the
presumption under law that you fraudulently secured the 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 Ordinance. I state the information on the above
contractors is correct as known to me and if Lai 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
a s per current fee sc -
Signature of Owner/ on rector • - cer(s) of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87 -14
The undersigned applicant being the:
A ` 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:
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
the .
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 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: r M> act Nowe So ju r'R.1 /
Sign w/Title: Z Date: 7 7 �eV
8/21/08
Plan Box Number -6 (2 . Job NamePCadirr¢ box i q t `t;
Date: -7 - /v
Required Inspections for SPA'S FD
ApPl. # !D. - $ a 47&
Valuation 4 /a, say
Sq Feet 4 fV
Sequence
10 B i d
=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 l'hree Trade Final
60 three Trade Final > 2500
60 Two Trade Final
60 Two Trade Final > 2500
60 ems" One Trade Final
60 One Trade Final > 2500
999 I:nvir. Operations Permit