BUILDING Feb 04 2011 3:02PM HP LASERJET FAX 910- 893-6100 p.1
Application 11 ✓rp, 25-109 Zy+•J/
*Each eemon balm" to be 9lbd out Harnett Coun Central Permittin /
..py whomever performing work. PO aox a5 NC 2764a g - WA Se 6 •—
Mal ct owner or s, company 910.8917525 Fax 810.812793 www.hemen.orglpermib
cordredW. Address, company �--
name & phone must match
Application for Residential Bulldina and Tra • es Penn G
7 � jLa✓ Date: /' /1 / /
Owner's Name: � n r ��
She Address: y76 amid rkorcti In G, // Ny
id Phone: q/0 cry d /57y
Directions to Job site from Lillington: n a 7 W 'To doe ' s f ve..- `4
-toll DOC} led T wo rcd CL ',ere! C fwN t y ate, ->A //o w red o f o wr.l
A ; /( T-o I a i -. 1 a7L 7 s o, Ay lir
Subdivision: L, ,Marti a.ev. .. Lot:
Description of Proposed Work: 0 of Bedrooms: . "4
Heated SF: Unheated SF: Finished Bonus Room? Crawl Space: ✓ Slab:
A General Contractor information
As acne. 9/0 n-a -ff' y
Building Contractor's Company Name Telephone
63/5e tun d L% OV( I n CiGy) 4,✓� 1.414.4 r #0 ® rn / (tw
Address, 277~, f. Emaj,Addt
Signatuure.'of Owner/Contractor/Offloads) of Corporation License # #
Electrical Contractor Information
Description of Work Service Size: Amps T -Pole: Yes No
9/9 4yf 290 0
Electrical Contractor's Company Name � Telephone ydt / /����r c
/'7 /1.3 N C / /t 27 Id/ $v IIA1A 1 '' C 2201 Email Address � C ° °`
Addrea (7 ��r lib S W 253 j�j ) (0
Signature of Owner /Contractor/dfuc ( err(e) o f o ratlon License # (J
/�, C
Description of Work j // a i i} 4- �
A// 4u"c4vt r,tea.7 4,. rv;r TJO QV 766
Mechanical Contractor's Company Neme - Telephone
2/.S n'e4a! •f7` siA4 28T81/
Ad• ==s Em Address
q Addres � s / n �
', , / ft V 7 IkC3 �� gob erricarLe
'Ina ev. : = ontractorlOfficer(s) of Corporation License 0
piumbina Contractor Information /
Description of Work CQm *m "' 3sw4 E. 9 $� C # Baths
OCvur.it. ra.- .. da ' - s•..Af��y 7 S d 1.5 yy fro 6s'•oifl•
Plumbing Contractor's Company Name _,/ Telephone
G, c•..e4 A. / Ac fli Al/ 2'o &ritoL
Add ,
'gnature of Owner/Contractor /Officer(s) of Corporation License it J
)neulatlon Contractor Information
/I/dP-•
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
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Homeowners Applying to Build Their Own Home
Please anener the fallowing questions then see a Permit Technician Icy determine If you qualify for permit under Owners Exenrpdo
Ou :. • nnaire per 0 .S. 87 -14 Regulations as to Isatie'offltiilding Permits (Memo avaliable upon re at)
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1. Do you own - _ _ ' 1 on which this building will be constructed? _ - _ No
2. Have you hired or Intend to hi = _ • dividuai to superintend a r
manage construction of the project? _ Yes _ No •
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3. Do you Intend to directly control &supervise > struction • . 'I es? Yes No
4. Do you intend to schedule, contra -. • r directly pay for all phases of
construction work to be done? _ - : No
5. Do: iou Intend to p= •naly occupy the building for at toast 12 consecutive
months followin• - • pletion of construction and do you understand that if .
you do not • - = • , it creates the presumption under law that you fraudulently
secu = • 1 e permit? Yes _ No
I hereby certify that I have the authority to make necessary applkallon, 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 g y changes occur including listed contractors, site plan,
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number of bedrooms, building and trade plans, Environmental Health•permlt changes or proposed use
changes, I certify It Is my responsibility to notify the Hamett County Central Permitting Department of
any and all changes.
EXPIRED PERMIT FEES - 8 Months to 2 years permit re-issue fee Is $150.00. After 2 years re -issue fee
is as per cu t fee schedule. •
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2 3' •
Ignatius
of Owner/Contractor/Officer(s) of Corporation Date
Affidavit for Worker's Compensation N 87 -14
The undersigned applicant being the:
General Contractor O wner Ofticer /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`ineurence
covering themselves,
Has no more than two (2) employees and no subcontractors:
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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 lime during the permitted work from any person, firm or corporation
carrying out the work.
Company or Name: �4tr""� , %"
Sign w/Title: ir.4-- Date: - -) —7 /
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Residential Building Application 2 of 2 08/10
T• 0019- C6B -OSB Xdd 13rN3SU1 dH WdEO :C tTOZ t+0 clad
Plan Box Number 1 Job Name ' hid k /I-e
Date: c y- 7-//
Required Inspections for SFA/SFD
Appl. # Z 70 y'
Valuation; ;
Sq. Feet. / / 7k
Sequence
10 � — ° R" Bldg. Footing I tic, 10 -30 R" Elec. Temp Service Pole 7� SG
20 v 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
Three Trade Rough In> 2500
''40, Two Trade Rough In
40 Two Trade Rough In> 2500
a ' 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