BUILDING • Each section below to be filled out by
wh,me•xtr performing work. Must be owner Application # 115 CO ,A`// o IA
or licensed contractor. Address, company Harnett County Central Permitting
name 8 phone must match Information on
license. PO Box 85 Lillington, NC 27518
910 -893 -7525 Fax 910 -893 -2793 www.hamed.org /permits
A . • Ilcation for Residentl Building and Trades Permit
Owner's Name: 1 `. r.... r.... -1 \ C- (-- Date: - 1C-1\
Site Address: J„tr\ OA tt5 i Nr e � e y l Phone: l Ii - \ 9-A
Yi
Directions to job site from Lillington: <1 - (5 - Yfla -?\A..
& �c�.
/ S CA.
Subdivision: A - Shcn r t\ Lot:
Description of Proposed Work: RC/Li r \ -+Z #Bedrooms:
Heated SF 0 1 le Unheated SF a3 R \ Finished Rec Room? L/'5 () j Crawl Space Slab r(�
General Contractor Informa
inArke -T1 a., 7.: \ � t c s tt `1 c(`l c 9A no
Building Contractor's Company Name i Tele h ne
Addre License #
Must sign & fill out second page
gnature of Owner /Contractor / Officer(s) of Corporation
Electrical Permk information
Description of Work Service Size: - Amps p � TPole:OM no
- �ic `t 10 3 01\� 0 Electrical Contr j or's Company ame 1 4 j Telephone
K as,\ \c__ N c . - SS3n t_, 6 7 Q-
��� s License #
/ ;- L-- •.-- --'��� �-T' -C-
L Sigrtature of�Ofticer(s) of Corporation
Mechanical /HVAC Permit Information
Description of Work (� p
l ien en i. cto s o pa N me `I e h o 1 ac o Tlepone
C :011X 1 �C o (,) /t-j 95.3
A s License #
l / -6
Si ature of O cal (s of Corporation
Plumbing Permit Information
Description of Work # Baths
Dell r`Le_ Ask till 4,w PI *5 9i0 s ia? Y560
Plumbing ontractor's Company ame Telephone
74/ 2 (Aec4ne...1 key D&" ter Ai, Askk ;got t /0s #
74) vat 6G✓K0i_.,
Signature of Officer(s) of Corporation
___- In let on Per it Information
5 l .r ,
Insulation Contractor's Company Name & Address Telephone
8/21/08
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
3. Do you intend to directly control & supervise construction activities? _ es _ no
4. Do you intend to schedule, contract, or directly pay for all phases of co ruction 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 ✓fio
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 Any 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 FEES - 6 Months to 2 years permit re -issue fee is $150.00. After 2 years re -issue fee `
is as pe urre9LEa e. _ n
J 3 — I C
Signature of Owner /Contractor /Officer(s) of Corporation Date
Affidavit for Worker's Compensation N.C.G.S. 87 - 14
The undersi d 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
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: J f 1 6-(-11-e I 1-P \ rti--\\ re-3 LAX,'
Sign wfTitle: _ J- - Date: 1 1 E 0
8/21/08
Plan Box Number cM3 Job Named r DLa C2_
ELk oilo r
Date:
Required Inspections for SFA/SFD
Appl. # 11 c( . t xD 109
Valuation ,AILS, 35 Z
Sq. Feet ,;l S
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 2 11—
R* Elec. Under Slab
30 -999 R *Plumb. Under Slab
40 Four Trade Rough In
40 L--- " 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 L -- 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