BUILDING Application # 10 17r- S' 2‘ 2 7
Each section below to be filed out Harnett County Central Permitting (((
by whomever performing work
Must be owner or licensed PO Box 65 Lillington NC 27546 /J
contractor Address company 910 893 7525 Fa 910 693 2793 www harnett org /permits — <
name & phone must match ll
Application for Residential Building and Trades Permit
Owners Name 403 t • C "" Date 37 / 1
Site Address .f >1 'ael LOT PLOT , Phone 56-60g-3007 ne
Directions to fob site from Lillington i/0 I Aine Ttt R,17%- r n-1.� fey A l lavzL Ki
3 471 {douse 00 /,v F-t a I . (AN t tv
Subdivision /� Lot
Description of Proposed Work 1 aLad -I 1 cttfsQ-- # of Bedrooms /
Heated SF � Unheated SF 7��5 Finished Bonus Roomy C� Crawl Space _ Slab V
3 `� 2- General Contractor Informati
(Own)tr) Moo id a! Au5keg 9M- 605- 3001
Bui ng Contractor s ompany Name Telephone
( ref Fes[/ It d1' s
A d ess Email Address
Si ature of Owner /Contractor /O(s) of Corporation License #
//��
Electrical Contractor Information /
Description of Work Avsk y 4 #- Service Size 60 Amps T Pole _Yes 2CNo
Electrical Contractor s kName /J Telephone
ct
5705 /. s cd W r /- lot t ; S erNDS r�{G.� ss
ss
Ad „ 1 Email Address
.1� �� 02
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
Description of Work # Baths
Plumbing Contractors Company Name Telephone
Address Email Address
Signature of Owner /Contractor /Officer(s) of Corporation License #
Insulation Contractor Information
■4Sa thud -vim j /779 -70V
Insulation Contractor s Company Name & Address Telephone
NOTE General Contractor must fill out and sign the second page of this application
2e 1 nti I Id pp c it r 1 of 6
Homeowners Applying to Build Their Own Home
Please answer the following questions then see a Permit Technician to determ ne f you q al fy for permit under Owners E emption
Questionnaire per G S 87 14 Regulations as to Issue of Budding Permits (Memo avail j ble 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 supenntend 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? J 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 ay 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 ye. permit re issue fee is $150 00 After 2 years re issue fee
is .: per went fee, ::f le
Sig ature of Owner/Contractor/Officer(s) of oration Date
Affidavit for Workers 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
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 orNamf at 1.../ s� c A4 1 teas
• r • Sign w/Title _ u 1 � ._.. Date 3-02i1-11
< i i i kit iiJ ppi von 2 of
1
Plan Box Number D Job Name Mv+rit, ✓r «rh#2
Date 3/11/1/
Required Inspections for SFA/SFD
Appl # // .5 7'1
Valuation4f et
Sq Feet // Yy
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/ 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 ai 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