BUILDING * Each section below to be filled out Application # /0 5 - 49 25
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.org /permits
name 8 phone must match
Application for Residential Building and Trades Permit
Owner's Name: ( i Arta 1.16249 Date: �Ld
Site Address: Phone:
Dire tions to job site from Lillington: - �($6 c?` / _ •G Oi c �� e
ECG /��v/hr \ r4 T!
i. J ( /� . a- / ( • l
vSiG 15 OA/ &Orr
Subdivision: Lot:
Description of Proposed Work /»'R/6 Itie2,et t,Zi.Q'OJ # of Bedrooms:
Heated SF: Unheated SF: Finished Bonus Room? Crawl Space: Slab:
1 � 6 Gene Contractor Information Se _ Q
B Ild ing Contractor's C3paNyne Telephone ��—
3�« Cr /CPt �L
Address Email Address
,A/ 4 _,07 / 4 A. - -
Signat�l� o Owner /Contractor /Off er(s) of Corporation Licen
Electrical Contractor Information
Description of Work $ rvice Size: Amps T -Pole: Yes No
6C�r -�, e.�c y�o -pest iQ/s
Electrical Contractor's Company Nam Telephone
A16‹ e.9s Jai.
Addr Email Address
"! (37,071 (1
Signatu f O r /Contractor /Officer(s) of Corporation License #
Mechanlcal/HVAC Contractor Information
Description of Work
Mechanical Contractor's Company Name Telephone
Address Email Address
Signature of Owner /Contractor /Officer(s) of Corporation License #
Plumbing Contractor Information
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.
Residential Building Application 1 of 2 08110
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? _ Yes _ No
2. 'Have you hired or intend to hire an individualto•superintend and - `
manage construction of the project? _ Yes _ No
3. 'Do you intend to directly control '& supervise construction °activities? _ Yes _ No
4. Do you intend to schedule, contract, or directly pay for all phases of
construction work to be done? _ 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? ' • , . - 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 iriformation on the above
contractors is correct as known to me and if ay changes occui including listed contractors, site plan,
number of bedrooms, building and trade plans, Environmental Health permit changes or proposed use
changes, 1 certify it is my responsibility to notify the Harnett County Central Permitting Department of
any an , changes. •
EXPI D PERMIT: FEES - 6 Months to 2 years permit re -issue fee'is'$1 After 2 years re =issue fee
is a r current to schedule.
Si ature of Ow er /ContractorlOfficer(s) of Corporation . Date
Affidavit for Worker's Compensation N.C.G.S. 87 -14 •
The un ersigned applicant being the:
General Contractor Owner Officer /Agent of the Contractor or Owner
Do hereby confirm under penalties of perjury that the person(s), firms) or corporation(s) performing the work
set forth in the permit:
Has three (3) or more employees and has obtained workers' compensation insurance to cover them.
Has one (1) or more subcontractors(s) and has obtained workers' compensation insurance to cover
them.
H s one (1) or more subcontractors(s) who has their own policy of workers' compensation insurance
coven themselves.
Has no more than two (2) employees and no subcontractors.
While working on the project for which this permit is sought it is understood that the Central Permitting
Department issuing the permit may require certificates of coverage of worker's compensation insurance prior
to issuance of the permit and at any time during the permitted work from any person, firm or corporation
carrying out the work
Company or Nam frf / (4t flt11$ 62 'cc; v
' 2 / D G�
Sign w/Title: / �jl
4y�— - ->7�1/ Date: 7✓
Residential Building Application 2 of 2 08 /10
NI
Plan Box Number 0 r Job Name Pro 73, r it
Date: j(07 ( 7"/D
Required Inspections for SFA/SFD
Appl. # 6 ` � .„ ?
Valuation r. y 7_
Sequence
Sq. Feet / 15
10 ti' R* Bldg. Footing
10 -30 �- -' R* Elec. Temp Service Pole
20 Ci R• Building Foundation
20 Address Confirmation
30 -999 Open Floor
30 -999 tom R* Bldg. Slab Insp.
30 -999 c, R* Elec. tinder Slab
30 -999 cam R*Plumb. Under Slab
40 v'"_ Four Trade Rough In
40 . Four Trade Rough In> 2500
Three Trade Rough In
tU 't i 40 ` Three Trade Rough In> 2500
40' Two Trade Rough In
r *!.` ; . 40 Two Trade Rough In> 2500
One Trade Rough In
40 One Trade Rough In > 2500
50 L R' Insulation
60 4 Four Trade Final
60 Four Trade Final > 2500
60 Three Trade Final
60 Three Trade Final > 2500
60 Two Trade Final
60 Two Trade Final > 2500
60 One Trade Final
60 One Trade Final > 2500
999 Envir. Operations Permit
e