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Ote tan, AO Contracting Inc. - Dew 11-8-10
See Adld reas•,fj0 Sandy TinaenCourt Phone 919- 656 -6900
Vireo ons 10 10h idle stem t.WeIQn_ fit 27 West to Left on Tingen Rd. to Left on Tower Drive (Tingen Mace)
right on Sandy Tingen Ct. Lot 70 on the right.
SUhdalsiox Tingen Place et 70
Dasctlption of Proposed vent: New Single Family Residential
Heated SF 1741 Utthesbed EF 659 Fintehed Roe Roca? yes Came &pose pi Stab t i
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AQ Contracting inc. 919- 542 -9893
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PO Box 1508, Pittsboro, NC 27312 47496
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CeaC isIan '('Wong Electrical Wiring S @r111R6 WZe ao Urt ir tat Amps wow ¥E5
Maida Electric, LLC 910- 897 -6216
EtesIrical Codtedafs Otanpanw Name Telephone
34 Eagle Road, Coats, NC 27521 23491 L
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SIgneAtus of pat Cegpnrodon
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O@BCttplion of Work New Single Family Residential
ARS / Rescue Rooter 919 -828 -5147
Meehw Contiactars Company Name Tstsphene
517 Pylor Drive, Raleigh, NC 27606 16245
Stratum of sy W Corp
attaliaiLiategyeelign
Olaclltllonot Worn PIumbing Per Code F e arns 2.0
Hare's Plumbing Inc. 919 - 774 -2482
Prvfibilg Canfractots Company Menlo Telephone
412 Swaringen Lane, Sanford, NC 27330 19443
Licensed
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Tri City Building Insulation &Building Products 910 -486 -8855
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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 Regulations as to Issue of Building Permits (Memo available upon request)
1. Do you own the land on which this building will be constructed? X yes _ no
2. Have you hired or intend to hire an individual to superintend and manage construction of the
project? yes X no
3. Do you intend to directly control & supervise construction activities? X yes _ no
4. Do you intend to schedule, contract, or directly pay for all phases of construction work to be
done? X yes _ no
5. Do you intend to personally occupy the building for at least 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? X
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 ch. •.es.
EXPIRE 0 • ' IT FEES - 6 Months to 2 years permit re -issue fee is $150.00. After 2 years re -issue fee
is as' en -. e.
r i `i` ��� Ill 11 -8 -2010
S :nature of Owner /Con actor /•'of Corporatio Date
Affidavit for Worker's Compensation N.C.G.S. 87 - 14
The undersigned applicant being the:
X X
General Contractor Owner Officer /Agent of the Contractor or Owner
Do hereby confirm under penalties of perjury that the person(s), f rm(s) or corporation(s) performing the work
set forth in the permit:
X Has three (3) or more employees and has obtained workers' compensation insurance to cover them.
X
Has one (1) or more subcontractors(s) and has obtained workers' compensation insurance to cover
them.
X
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.
• - . tracting Inc
Company or Nam. •
' �
Sign w/Title �r �i /,r Date: 11 -8 -2010
8/21/08