BUILDING Application # ` / 5- _ U / / /
•
Each section below to be filled out Harnett C Central Permitting
by whomever performing Work. y g
Must be owner or licensed PO Box 65 Llllington, NC 27546
contractor. Address, company 9104893 -7525 Fax 910- 893 -2793 www.harnett.org /permits
-name 8 phone must match
Application for Residential Building and Trades Permit
Owner's Name: IA S - N- ?'- i- rw - -SH /14-S d - _.._ - -- Date: - 3/7///—
Site Address: 4 . A VS / //N Ave CI; n tJ �AA, MC Phone: 9/9-029/
Directions to job site from Lillington: Mkt /4o//017 fa rA,ri golf P7, Tian) Le nice./
&cffo /o AAteAl. ) m 4fiteor 3 '4 n-r; /es -tun) Leff Jae Cees/Uirw Sah.elhi. Oat teas/ X eft
�t� Them+ Res/ ,e/ ARire fl/Ror ,Asides 'I-0 'T 1 Nrae- seckoM(Tutr�ler94t rr
ap5e
Subdivision: CRCST IIiew Ly1: ONL[FT
DeI«tvaoli of Prattled Wok C Nueet KM 'eWAN sfoiay e +oTitzo_ ooma: 3
Heated SF: Unheated SF: Finished Bonus Room? Yes Crawl Space: ✓ Slab:
v General Contractor Information
/GYNo &c; /dues i VC. 9f 9 a 9/ -690o
Building Contractor's Company Name Telephone
360 n AJe1 k, 5Met* /QNJ)ei, nit 275O/ SGossAyeapw @ Yg600, Con,
Address Email `dd 9
Signatu rs) of Corporation license 9
/ / Elgctrical Contractor Information
Description of Work ned Zedi eA,4'/ C'A /,'Aa Service Size: ow Amps T -Pole: _ No
A/iyL 'ee,' i .- 1; ,.'s eel' /c 9/7- 0
Electrical Con m*tor•s Company Name Telephone p
3 rotesrlcoey h/. FpA, - U•ffe /Nf1,NC TieUSl1/funew (' Cr,9/giL. /dm
Address Email Address
aspy
Signature of Owner /Contractor/OHioer(s) of Corporation License 9
/ Mechanical /HVAC Contractor Information
Description of Work 41 ONE Suhol/ i..ilk '1" AceT /l / 2li /2" 6gil/ / eletk-
St's Hu fie_ rNc.. y//- SS) - 3o5Y
Mechanical Con actor's Company Name Telephone
/539 &ae 5> %4 e N ii y sp id s,r Email Address
Address ,, .,..1-- /266
/
Signature of Owner ntractor /Officer(s) of Corporation _. - -_ .__ License #
Peunrtdaa Contra ctor iafforttragan
Description of Work /V//9 # Baths
Plumbing Candarlor's Company Name Telephone
Address Email Address
Signature of Owner /Contractor/Officer(s) of Corporation Licensed
Insulation Contractor Information
66 Ti; b �n
e ..dSu /S ionl fhudFzesfop
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 oato
i
Homeowners Applying tei Bend 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._Ha_ye you hired or intend _ an individual to superintend and
manage construction of the project? _ Ye
es 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 Me presumption under law that you fraudulently
secured the permit? _ Yes _ No
1 Hereby certify that 1 have the authority to make necessary appiic8US , that Ole app thfion is'coriect
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 ;ox changes occur including listed contractors, site plan,
Sitter of bedrooms, building and trade plans. £rnlrtmmtnital tieatth pertriit 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-isaue feet $ 150.00. After 2 years re=issue fee
is as per current fee schedule.
of • • _, • , : • • is -: oer(s) of Corporation 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.
While working on the project for which this permit is sought it is understood that the Central Permitting
Dept issuing the permit may recjiiire certificates of coverage of workers 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: j%'INC et-4 / / �S JNC
Sign w(Title:_,„ # / 4 0e. Date: , �
Residential Building Appktalion 2 of 2 oa110
J
Plan Box Number F Job Name
Date: 3 - 7 -
Required Inspections for SFA/SFD
Appl. # l� SQL 2 //4
Valuation (� 43
Sq. Feet Lib
Sequence
10 R* Bldg. Footing
10 R* Mono Slab
10 -30 R* Elec. Temp Service Pole
20 Foundation Survey
20 R* Building Foundation
20 Address Confirmation Slab
30 -999 Open Floor
30 -999 R* Bldg. Slab Insp. Mono
30 -999 R* Elec. Under Slab
30 -999 R *Plumb. Under Slab Crawl
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