BUILDING Application # 0850019399
.Each section below must be filled out by Harnett Count
'whoever is performing the work. Must be pp f 65 Lillington, Central l Permitting
owner or licensed contractor. Address,
company name & phone must match 910- 893 -7525 Fax 910- 893 -2793 www.harnett.org /permits
information on state license. COMMERCIAL
Aaalication 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 @1/2 west on Hwy 24 to 2297 blue metal building an 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 3rd St. Sanford, Nc cjselectricalcompany.com
Add s Email Address
237955 - L
Signature of Owner /C•7 rector/0 ider(s) of Corporation License #
jechanical • •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 #
Plumbina Contractor Information: Plumbing Cost $ 6200.00
Description of Work Run water and hook up to septic # Baths 1
Reliable Plumbing Inc. 919- 775 -5782, 919 - 708 -5588 fax
Plumbing Contractor's Company Name Telephone
1480 Zion Church Rd. Sanford, NC Reliableplumbing.com
Addre Email Address
� „/l -- 4 7151
Signature of Ow er /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
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 c geld at full price ter current fee schedule.
Ir_.A _ !i_ . l _bsci awl Lis all. 4' Whi/o
Signature of Owner /Contrac •r • Icer(s) of Corporation I Date
Affidavit for Worker's Compensation N.C.G.S. 87 -14
The undersigned applicant being the: /
General Contractor Owner J 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. \� I
Company or me: _e LAn�y 1 �S C
Sign w /Title: l_.44, _t , i r blisn a/ ILL! 1:4 Date: /, S ao 0
1
Commercial Building Application 2 of 2 3110
/732,
ton, NC 27540
PO Box 05 UIII Application it OB500.1309lP
'Lath section below must be rued out by H Count Central Permitting
whoever Is performing the work Must be n g
owner or Ilcerg p r. Address, 010- 903.7525 Fex910- 893- 2703www.harnell.or
company name s f: phone hme must match g/pemdle
infomuaiob on stale license. COMMERCIAL
Application for BuIldlno and Trades Permit
Owner's Name: Solid Foundations, Inc. _ Date: 13 Oct 2010
Site Address: 2207 Highway 24 West Cameron, NC Phone: 919 - 499 -1668
Directions to job site from Lillington: Highway 27 West, len on Buffalo Lake Road, left on to Highway 87 South.
exit Highway 24 'Cameron', right on to Highway 24, proceed @1/2 mile on Highway 24 to 2207 blue metal budding
on the right side of Highway 24.
Subdivision: _ Lot:
Description of Proposed Work: Installation of three modular buildings
' Heated SF 064 Unheated SF
General Contractor Information; Building Cost $ 2900
Modular technologies, Inc. 252. 5224770
Building Contractor's Company Name Telephone
PO Box 8028 Kinston, NC 28501
Address Email Address
31101
Signs ure o Owner/ ontractor /Oulcer(s) o :.oration license
Electrical Contractor Information_ Electrical Cost $
Description of Work _ Service Size: _ Amps #T -Poles
Electrical Contractors 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 Contractors Company Name Telephone
Address Email Address
Signature of Owner/Contractor/Officer(s) of Corporation License 0
plumbina 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 J License #
Insulation Contractor Information
Insulation Contractor's Company Name & Address Telephone
'NOTE: General Contractor must all out and sign the second page of this application
Commercial Beiilding Applicelion 1 of 2 nt1e
d SLEL'oN INVE1 :8 0102 'Ef'100