BUILDING • Each section below to be filled out Application # ^ c,79 2 6 9 0
by whomever performing work. Harnett County Central Permitting
Must be owner or licensed PO Box 65 LIIIIngton, NC 27546
contractor. Address, company 910- 893 -7525 Fax 910 - 893 -2793 www.harnett.org /permits
name & phone must match
Application for Residential Building and Trades Permit
Owner's Name: ti.,0;() SSS' nnd C ,.S Date: 02 /C - / 1
Site Address: /oq CCn ✓f, Phone: ;3,39 - & 3r3O
Directions to job site from Lillington:TO - a. ID Sts -towards
¶%a t*M;11e :turn k> o %Y ' — e-C1 - 33.1cc Pr (cl bec-orn&3
Subdivision: The (Ann (i l..[iSlli(Q'/4 ot: cQI&zi
Description of Proposed Work: Idential (1 # of Bedrooms:
Heated SF: A4Og Unheated SF:132- Finished Bonus Room? Nja- Crawl Space: _ Slab:
General Contractor Information
Caviness Land Development 910 339 - 6330
Building Contractor's Company Name Telephone
559 Executive Place, Suite 101 lori@cavInessland.com
Address Email Address
ce
37485
Signature of 0 Contractor / Officer(s) o Corporation License #
Electrical Contractor Information
Description of Work electrical Service Size: Amps T -Pole: ✓ Yes No
T &N ELECTRIC 910 - 531 - 4913
Electrical Contractor's Company Name Telephone
4341 SWINDON DRIVE FAYETTEVILLE, NC 28312 tnelectric @intrstar.net
Address Email Address
28098 -U
Signature of Owner /Contractor / Officer(s) of Corporation License #
Mechanical /HVAC Contractor Information
Description of Work HEATING AND AIR
CHACCO 910- 488 -0318
Mechanical Contractor's Company Name Telephone
1910 - B PAMALEE DRIV. FAYETTEVILLE, NC 28303 chacco @emabargmail.com
Address - Email Address
2957PHI - 3
Signature of Owner /Contractor / Officer(s) of Corporation License #
Plumbing Contractor Information
Description of Work PLUMBING # Baths aYa-d
GLOVER PLUMBING INC 919 - 868 - 0959
Plumbing Contractor's Company Name Telephone
P.O. BOX 726 COATS, NC 27521 gloverplumbinginc @rocketmail.com
Address Email Address
DG7�4Rl�ti 23160
Signature of Owner /Contractor /Officer(s) of Corporation License #
Insulation Contractor Information
CUMBERLAND INSULATION 4205 Clinton Rd Fay, NC 28312 910 424 - 7118
Insulation Contractor's Company Name & Address Telephone
*NOTE: General Contractor must fill out and sign the second page of this application.
Residential Building A,piicalion '1 of 2 08/10
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 individual to 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 information on the above
contractors is correct as known to me and if Ara 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 $150.00. After 2 years re -issue fee
is as per current fee s ule.
Signature of Ow r /Contractor /Officer(s) of oron Date
Affidavit for Worker's Compensation N.C.G.S. 87 -14
The undersigned applicant being the:
✓ General Contractor Owner Officer /Agent of the Contractor or Owner
Do hereby confirm under penalties of perjury that the person(s), firm(s) or corporation(s) performing the work
set forth in the permit:
Has three (3) or more employees and has obtained workers' compensation insurance to cover them.
Has one (1) or more subcontractors(s) and has obtained workers' compensation insurance to cover
them.
✓ Has one (1) or more subcontractors(s) who has their own policy of workers' compensation insurance
covering themselves.
Has no more than two (2) employees and no subcontractors.
VVhile working on the project for which this permit is sought it is understood that the Central Permitting
Department issuing the permit may require certificates of coverage of worker's compensation insurance prior
to issuance of the permit and at any time during the permitted work from any person, firm or corporation
carrying out the work.
Company or Name: CAVINES ND DEVELOPMENT
an
Sign w /Title: T I res i de.Yn+ Date: 02 4 /(
•
Residential Building 2 of 2 08110
Plan Box Number A Job Name &E.m. t ati.9 •
Date: — 4 , - I
Required Inspections for SFA/SFD _s (396 AppL #
Valuationq'I 2 5`$ I r
Sq. Feet 2 8"6
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 7 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