BUILDING Application # 11 5.° 0 26 /57.
• Each section below to be filled out Harnett County Central Permitting
by be owner r performing work. PO Box 85 L IIIInglon, NC 27548
contractor. ow or. Addrr esss, , company w. g
Must licensed 910 -893 -7525 Fax 910- 893 -2793 wwhamea.org/permits
name 8 phone must match
Application for Residential Building and Trades Permit
Owner's Name: Royal Oaks Building Group, LLC Date: 2/2 y/4
Site Address: V6 4/Cedimiatia 4 Phone: 919.233.3886
Directions to job site from Lillington: Head South on Main St toward Front St; Turn Right at NC 210 S;
Turn Right on Overhllls Rd; Turn Left on Overhills Rd; Continue onto Nursery Rd; Turn Right at NC 24W/87N;
Turn Right at Sawyer Rd
Subdivision: Village of Lexington Lot: 71
Description of Proposed Work: Single Family Home # of Bedrooms: 3
Heated SF: 11,& Unheated SF: IISbt Bonus Room? IV/4' Crawl Space: _ Slab: 1
General Contractor Information
Royal Oaks Building Group, LLC 919.233.3886
Building Contractor's Company Name Telephone
1210 Trinity Road, Sts 102 Raleigh, NC 27607 kwesterman @royaloaksbg.com
Address Email Address
i 49775
Signature of Owner /Contractor /Officer(s) of Corpora • License #
Electrical Contractor Information
Description of Work Electrical Rough - In and Final Service Size: 200 Amps T -Pole: ✓ Yes No
Imperial Electric 919 363 - 7474
Electrical Contractor's Company Name Telephone
PO Box 162, Apex, NC 27502
Addres Email Address
19860
Signature of Owner /Contractor /Officer(s) of Corporation - License #
Mechanical /HVAC Contractor Information
Description of Work install HVAC and duct system
Stewart's Heating and Air 919- 382 -0387
Mechanical Contractor's Company Name Telephone ( L I
2430 Reliance Ave, Apex, NC 27539 AA, •T.rs.4 0 ${•. t n 411 4r t'• t u A.
Address Email Address
•
09308
Signature of Owner /Contractor /Officer(s) of Corporation License #
Plumbing Contractor Information �f c
Description of Work plumb single family home # Baths
Barbour and Pourron - 919- 533 -4455
Plumbing Contractor's Company Name Telephone
PO Box 934, Clayton, NC 27528
Address Email Address
10672
Signature of OwnerfContractorlOfticer(s) of Corporation License #
Insulation Contractor Information
Tatum Insulation II 919 - 661 - 0999
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 03/10
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 an 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 rrent fee schedule.
Signature of Owner /Contractor /Officer(s) of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87 - 14
The urtdersigned applicant being the:
J 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.)
J 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.
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 -• , / pir
Sign w/Title: I AC .4 I7 _ Date: 2/Z2/!/
Nur Residential Building Application 2 of 2 10/10