BUILDING gq(0 Ac
Application #
Each sadron below t be sued out Hamett County Central Permitting
by varomeve pogo= g wo I PO Box 65 [Anton NC 27548
Must conb bo owner o licensed company 910- 893 -7525 Fait 910.893-2793 yam hamattarglpermha
nem 8 Add m , & t atc
rem 8 phone match
Amolleafan for nfisi Bufidina and Trades Pannil
Owrlar s Name Blackwell Homes Inc Date //
Sate Address .')19 rik /lpr s. 0 :. _ a_ .. Phone 91
Directions to lob site from Lilb I rigton '' N to Nursery Road Left on Nursery Anderson Creek Entrance is 3 miles
on led •
Subdivftion Anderson Creek Lot B
Description of Proposed � posed Wotk New Construction # of Bedrooms 7
Heated SF 2L1 /h Unheated SF Ba/ Finished Bonus Room? d Crawl Space _ Slab V
General Contractor Information
Blackwell Homes Inc 919-359-0079
Building Contractor's Company Name Telephone
PO Box 189 Clayton NC 27528
Addre Email Address
,Yn, J�.`.._- '"' "_ 52830
Signature �off /Contractor /Officer(s) of Corporation License #
I
Description of Work New Construction Service Size Amps T-Pole 1 Yes No
Pioneer Electric 919 7767
Electrical Contractor's Company Name Telephone
80 Neill Thomas Rd Ullington NC 27546
Address Email Address
21843 0
Signature of Owner/Contrector /OHlcer(s) of Corporation License #
hiechanicalIHVAC Contractor Information
Description of Work New Conetructlpn
Carolina Comfort 919 - 934 - 1080
Mechanical Contractor's Company Name Telephone
Hwy 70 Business West Clayton NC 27527
Addr � Email Address
29077
Signature r /-r?� Ow6nerfContrector/Officer(s) of Corporation License #
Plumbina Contractor Information
Descnpton of Work New Construction # Baths 3 5
Jamie Johnson Plumbing 910 2794742
Plumbing Contractor's Company Name Telephone
1490 Clark Rd Ullington NC 27546
Email Address
21649
Sig re roof nedConlractorlOfficer(s) of Corporation License #
Tricoy insulation 910
Insulation Contractor's Company Name & Address Telephone
*NOTE General Contractor must fill out and sign the second page of this application
896 'ic
Homeowners Applying to Build Their Own Home
Pie se snows tit following questions then see Permit Technician to delemane r you qualify to permit miler Owners Exemption
p Questionnaire per G S 87 14 Regulations as to Issue of Building Permits (Memo available upon request)
� 1 Do you own the and 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 actwibesA Yes _ No
4 Do you intend to schedule contract or directly pay for all phases of
constriction 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 tt creates the presumption under law that you fraudulently
secured the permit _ Yes _ No
1 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 Batt 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 8 Months to 2 years permit re issue fee Is $150 00 After 2 years re issue fee
is a perlurrent fee schedule
kiterr Signature of Owner /Contractor /Officer(s) of Corporation Dal
Affidavit for Worker s Compensation N C G S 87 14
The undersigned applicant being the
d 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
1 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 waking 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 pnor
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 Ne i Blac Homes Inc
kleis
Sign Wilde Date // .
Plan Box Number 5 _ 2 Job Name fl �(it ' 4-1
Date ✓ - Z 3 Jr/
Required Inspections for SFA/SFD 1/ /
Appl # !/ � �9 Z b 3&
Valuation ;
Sq Feet ,.
Sequence
10 l/ R* Bldg Footing
10 R* Mono Slab
10 30 R* Elec Temp Service Pole
20 Foundation Survey
20 R* Building Foundation
20 Qi Address Confirmation Slab
30 999 Open Floor
30 999 R* Bldg Slab Insp Mono
30 999 (1 ,— 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