Loading...
BUILDING 'Each section below to be filled out Application # //S GD 4C9 J 7 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: 2 �� � ecr £✓'INc� Date: Y / _— Site Address: Ct. :c in., hi ' /N Phone: 9/0 3o 3 . J i 3 f Directions to job site from Lillington: 6/ �1 ' _ . U. Wit: __ . /..4 !.. • . /S �n /fi (rc+ i dr; ew p OCY 4 v.t 14-4:06 , c,- . / ) • Subdivision: Lot: Description of Proposed Work: sip ip # of Bedrooms: Heated SF: /L00 Unheated SF: /LDD Finished Bonus Room? 4D Crawl Space: /J /o Slab: Gene al Contractor Information 79A 42 "e ©V 'Mtn. ot. s �Ui/lof 910 . TiO3 .r / 3 r Building Contract is Co Nam Telephone / 7/b c 6 �l k.0 ,._ — a Address Email Address Sig Owner/ ontractor/Officer(s) of Corporation License # �/ Electrical Contractor Information Description of Wok s Service Size: Amps T -Pole: /Yes No (.4C /. 91 .011,Cn/n Electrical Contr ct r s C mpany Narn Telephone Address Email Address ✓A. 1-- (oaf L Signaturevf Cwner /Contractor /Officer(s) of Corporation License # Mechanical /H AC Contractor Information Description of Work ti 7 Q,mr, -i Oit Hie Own eta 91 343 . ,-1 J r Mechanical Contractor's Comp Name Telephone /7 360 r -,S•J -4ot., ,a Addres Email Address Si azure of Owner /Contractor /Officeis) of Corporation Licens # P um • ing Contractor Information I Description of Work • %'l%,u.;£iat(4A, ' # Baths d 1 _ *silks p U . fin 1,1.21 s: D, t 6 Plumbing Contractor's Company N me Telephone antis" 14 1. 4. Address Email Address cam �J l 114.0 --/ Signature of Owner /Contractor /Officer(s) of Corporation License # I - Insulation Contractor Information r !u2 .C tt ' • 919. an. 51aa Insulation Contractor's Company Na n+e & Address , Telephone NOTE: General Contractor must fill out and sign the second page of this application. '-----\\ Residential Building ApplLcatior: 1 of 2 03110 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 avail le upon request) 1. Do you own the land on which this building will be constructed? _ Yes _ No 2.• Have yob 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 my 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 years reissue fee • is as per curren ee schedule. :,.///4 . , , . . Signafre o •wner /Contractor • .- • Corporation Date Affidavit for Worker's Compensation N.C.G.S. 87 -14 The un rsigned applicant being they 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 fo rth in the permit: / v Has three (3) or more employees and has obtained workers' compensation insurance to coverthem. _ 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 cover' 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. � P - Company or Name: 'd r to o Sign w/Title: /`r� 60 m 0.46✓) Date: 04 Residential Building Application 2 of 2 03110 .