BUILDING 1 • Each section below to be filled out Application #
by whomever performing work Harnett County Central Permitting
Must be owner or licensed PO Box 65 LIIIIngton, NC 27548
contractor. Address, company 910-893-7525 Fax 910- 893 -2793 www.hamett.orglpennits
name & phone must match
Application for Residential Building and Trades Permit ��
Owner's Name: Sez� e On Da �, ,� O
Site Address: /l.S ?? h21 Phone:
• ' ;di stojob '1afr•' Lillin on: ,�L v f %Z ,COOir
4 77 L . viixitec l / advS DA' ce�i.
ubdivision: Lot:
/ 1 ��
Description of Proposed Work: :,:. Us. 1 44.4 ' # of Bedrooms:
Heated SF: Unheated SF: Finished Bonus Room? Crawl Space: _ Slab:
General Contractor Information
�0 ,r3U16 � -`PS �� wsrRr 910 - 868 .Sgg9
B Tiding Contracto o oom. =ny Name Telephone
7 -61 4 -0 4
Address // / e Email Address
Sign :rof Owner /Contractor /•fficer(s) of Corporation License #
Electrical Contractor Information
• ription of Work p Service Size: - .. - e: Yes No Arrzes- g.
ectrical Contracto s Company Name Telephone
- C�/COi$ a �'
A•LW a Email Address
_.a1� t....r...-6,..■ I3 U
Signs ure■fOw = bract•r /OHicer s) of Corporation License # •
jMechanlcal/HVAC Contractor Information
Description of Work
Mechanical Contractor's Company Name Telephone
Address Email Address
Signature • e ner /Contractor /Officer(s) of Corporation License #
Plumbing Contractor Information
Description of Work # Bath;
Plumbing Contractor's Company Name Telephone
Address Email Address
Signature • • erlContractor /Ofcer(s) of Corporation - ;
ulatlo • I form:. •
Insulation Contractor's •mpany Name & Address Telephone
*NOTE: General Contractor must fill out and sign the second page of thls application.
SFD, Addition, Modular Application 7 of 8 08/10
•
i
Homeowners Applying to Build Their Own Home
Please answer the following questions then see a Permit TechnicJan 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 constru« :d? _ Yes _ No
2. Have you hired or i : • • to hire an individual t• : rperintend and
manage construction of the p •' : ? _ Yes _ No
3. Do you intend to directly contro : supe : construction activities? _ Yes _ No
4. Do you intend to sche• . e, contract, or directly pay fo - •hases of
construction work to • = done? Yes No
5. Do you in : d to personally occupy the building for at least 12 consecutive
months fo •wing 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 am 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 Hamett County Central Permitting Department of
any and a changes.
EXPIRE ERMIT FE - 6 Months to 2 years permit re -issue fee is $150.00. After 2 years re -issue fee
is as urrent fee edule.
4 /fit./ / -r //
;Sigrid re of Owner ontractor /Oflicer(s) of Corporation :Rate°„ &.
Affidavit for Worker's Compensation N.C.G.S. 87 -14
The undersigned applicant being the:
7- General Contractor 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
them.
H 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 a • at any time during the permitted work from any person, firm or corporation
carrying out the work. / /
Company or Name: 11 P (/ �G _4 " ge a� �' ! � J
• r'
Sign wrntle: , - - ..-� / al , /Oa Date: '. 10
Ir
SFD, Addition, Modular Application 8 of 8 08/10
J C.Ert e rt;
Plan Box Number Q� Job Name PrO 2 u.,XJ Cr.!
Date: 2 ' 1 - 1 (
Required Inspections for SFA/SFD
AppL # I 1 S A) 2 5 5?
Valuation 41 Z a `1 Z.
Sq. Feet 3 72-
Sequence
10 R* Bldg. Footing
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 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