BUILDING Application # 0850019397
Each section below must be filled out by Harnett County Central Permitting
whoever is performing the work. Must be
owner or licensed contractor. Address, PO Box 65 Lillington, NC 27546
company name 8 phone must match 910- 893 -7525 Fax 910- 893 -2793 www.harnett.org /permits
information on state license. COMMERCIAL
Application for Building and Trades Permit
Owner's Name: Solid Foundations, Inc Date: 8 Oct. 2010
Site Address: 2297 Highway 24 Cameron NC 28326 Phone: 919- 499 -1668
Directions to job site from Lillington: Hwy 27 West, left on to Buffalo Lake Rd, left onto Hwy 87 South, exit Hwy 87
"Cameron" exit, right onto Hwy 24, proceed @112 west on Hwy 24 to 2297 blue metal building on right side of Hwy 24.
Subdivision: Lot:
Description of Proposed Work: Installation of modular classroom for daycare.
Heated SF 864 Unheated SF
General Contractor Information: Building Cost $ 2900.00
Solid Foundations, Inc. 919
Building Contractor's Company Name Telephone
2297 Hwy 24 Cameron, NC 28326
Address Email Address
Signature of Owner /Contractor / Officer(s) of Corporation License #
Electrical Contractor Information: Electrical Cost $ 8500.00
Description of Work Installation of electrical to building Service Size: 200 Amps #T -Poles
CJS Electrical Co. 919 - 774 - 3050
Electrical Contractor's Company Name Telephone
1011 South rd St. Sanford, Nc cjselectricalcompany.com
Addr /' N 237955- Ldress
Signature of Owner /Co ractor /O lcer(s) of Corporation License #
Mechanical • ntractor Information; Mechanical Cost $
Description of Work # Units
Mechanical Contractor's Company Name Telephone
Address Email Address
Signature of Owner /Contractor / Officer(s) of Corporation License #
plumbing Contractor Information: Plumbing Cost $ 6200.00
Description of Work Run w er and hook up ptic # Baths 1
Reliable Plumbing Inc. eyyH02 919 775 - 5782, 919 - 708 - 5588 fax
Plumbing Contractor's Company N me Telephone
1480 Zion urch Rd. Sanford, N Reliableplumbing.com
Address „ Email Address
'c,1119,sf'/m_ 7151
ignature of O n r /Contractor /Officer(s) of Corporation License #
Insulation Contractor Information
Insulation Contractor's Company Name & Address Telephone
*NOTE: General Contractor must fill out and sign the second page of this application
, Commercial Building Application 1 of 2 3/10
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Sprinkler Contractor Information
Sprinkler Contractor's Company Name Telephone
Address Email Address
Signature of Officer(s) of Corporation License #
Fire Alarm Contractor Information
Fire Alarm Contractor's Company Name Telephone
Address Email Address
Signature of Officer(s) of Corporation License #
Driveway Access - NC Department of Transportation 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 Ordinance. I state the information on the above
contractors is correct as known to me and if any 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 $150.00. After 2 years re -issue fee
is charged at full pri - per current fee schedule.
•
IF
1 ALt .o$!ibi•y /L! h 1 11 /ao/o
Signature of Owner /Contractor /O icer(s) of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87 -14
The undersigned applicant being the:
General Contractor Owner r' 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
them.
�/ 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. y
Company or N. e: .�17) )ul\,tj n ., ' S
Sign w /Title: Its ashes" fr s t ' r SA! tar *1l 'JUL I L1 Date:
Commercial Building Application 2 of 2 3/10
1 /3 77
Application # 0980042887'
'Each section below must be Aged out by H County Central Permitting
whoever Is pedorming the work. Must be Y g
owner or licensed contractor. Address, PO Box 66 utegton, NC 27548
company name & phone mum march 910.003 -7525 Fax 910-893-2793 wvnv.hernell.orglpenNls
information on able license. COMMERCIAL
Aoolicatlon for Rulldino and Trades Permit
Owner's Name' Solid Foundations, Inc. Dale: 13 Oct, 2010
Site Address: 2297 Highway 24 Weet Cameron, Nc Phone: 919 489 - 1660
Directions to job site from Ljllinglon: Highway 27 West left an Buffalo Lake Road, left on to Highway 87 South,
exit Highway 24 - Cameron% right on lo Highway 24, proceed 0112 mile on Highway 24 to 2297 blue metal building
on the right side of Highway 24.
Subdivision: _ Lot:
Description of Proposed Work: Installation of Three modular buildings
Heated SF 884 Unhealed SF
General Contractorij fonnatIon: Building Cost $ 2800
Modular Technologies, Inc 262 -522 -5770
Building Contractors Company Name Telephone
PO Box 6026 Kinston, NC 20501
Addr ` Email Address
31101
na ure o wner on ractoriOfftcer(si'or'C3rporalion License #
Eleclrlcal Contractor Information: Electrical Cost $
Description of Work Service Size: _ Amps #T -Poles
Electrical Contractor's Company Name Telephone
Address Email Address
Signature of Owner /Contractor /Officer(s) of Corporation License #
Mechanical Contractor Information; Mechanical Cost $
Description of Work # Units
Mechanical Contractor's Company Name Telephone
Address Email Address
Signature of Owner/Contractor/Officer(s) of Corporation License #
Plumbing' Contractor Information: Plumbing Cost $
Description of Work # Baths
Plumbing Contractor's Company Name Telephone
Address Email Address
Signature of Owner /Contractor /Officer(s) of Corporation License #
insulation Contractor Information
Insulation Contractor's Company Name & Address Telephone
'NOTE: General Contractor must fill out and sign the second page of this application
Commercial Builoiny Applicalion I of 2 3110
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