BUILDING Application # 11 5 74 24
Each section below to be filled out Harnett County Central Permitting
by whomever performing work.
Must be owner or licensed PO Box 65 Tylin 9 ton, NC 27546
contractor. Address, company 910- 893 -7525 Fax 910- 893 -2793 www.hamett.orglpermits
name & phone must match
Application for Residential Building and Trades Permit
Owner's Name: Sj t eh o -, + h o rnh / 0ASo Date: 3 - / 0 - I
Site Address: aS' C 1- Cinif ,t STv- -. •" c as Phone: 552 - 4J'97
Directions to job site from Li lington: YO/ 0 Tb ( 2 a / O ec - le. n d. Tva r L F
Cr 5h 1 y h o e 4 i ' 120. r On Sae 1 Grape ' i , L r .^,
o!4 1_ evto;e $'1p- I j2 C), /Sr,;(O -$f QA 4t er
Subdivision: 5 ea - \ 3 1'\ ea- Jo w A€ 1 Lot: z 0
Description of Proposed Work: 10 X a-• a- 5 Tc2Y (r.,0. gc # of Bedrooms: X-
0
Heated SF: Unheated SF: '7.j'0 Finished Bonus Room? Crawl Space: Slab:
General Contractor Information
(;e�t�� � ' utis rift) c{ 'T V,( Lit- 5 3 Gel'
Building Contractor's Company Name Telephone G
P 0 .Ao F Yvan' Cory lit ? t 1 (o5t"'rn y jbe /JstiA 4, a /ef
Address Email Address
52-iec
Signature of wner /Contractor /Officer(s) of Corporation License #
Electrical Contractor Information
Description of Work 150_ } c o 4 c Service Size: Amps T -Pole: _Yes No
2.i -eC_ti(ct1 X €24'f *3/09-2-10 Electrical Contractor's C ompany Name Telephone
'll M■si'y ri-oo 4 2 RV, y (- 1 (a
Ads c Email Address
i' 'Y 1. G 29 C
Signature of Owner /Contractor /Officer(s) of Corporation License #
Mechanical /HVAC Contractor Information
Description of Work
Mechanical Contractor's Company Name Telephone
Address Email Address
Signature of Owner /Contractor /Officer(s) of Corporation License #
Plumbing Contractor Information
p Ca t<� � ¢U 5ftee- 4 1" Z
Des ri lion o f Work 1 d- I � R � # /
4 s LPG/ O13, 4-1 /4, L -Ili) 36Q- 6 33
l umbing Contractor's Company Name / Telephone
I 0°t Eatit4 Pie Cr CAI/UP / /SO
Address Email A dress
e ,. ( 9 Gi3d5�
Sign 're o • ;r; er , ontractor /Officer(s) of Corporation License #
Insulation Contractor Information
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 Obi I0
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. 1 state the information on the above
contractors is correct as known to me and if psi 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 Hamett County Central Permitting Department of
any and all changes.
EXPIRED PERMIT EgS - 6 Months to 2 years permit re -issue fee is $150.00. After 2 years re -issue fee
is as per curr- schedule.
- 'AJ- 3_j v r 7
Signatu f o . - ontractor /Officer(s) of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87 -14
The undersigned applicant being the:
General Contractor Owne 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
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. n • I
Company or Name: P %�S 07 `ao C- toA -r r •
S Sign wiTitle /9 w Date: - 4 - l0 - (r
3 2
Plan Box Number F Job Name / 9 //i ert
Date — 11
Required Inspections for SFA/SFD
Appl kit 5-7 _22‘
Valuation .r6 8 2 Z_
Sq Feet 12 y g'
Sequence
10 R* Bldg Footing (,Z Y
10 R* Mono Slab 465
10 30 R* Elec Temp Service Pole / 28
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 • e7 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