BUILDINGCCU
Each section below to be idled out Application # J by whomever performing work. Harnett County Central Permitting
Must be owner or licensed PO Box 65 Llliington, NC 27546
contractor. Address, company 910- 893 -7525 Fax 910 -893 -2793 www.hameltorglpermits
name & phone must match
Application for Residential Bulldina and Trades Permit
Owner's Name: Royal Oaks Building Group, LLC Date:
Site Address: Cn/D A' !'y • Phone: 919.233.3886
Directions to job site from Lillington: Head South on Main St toward Front St; Turn Right at NC 210 S;
Turn Right on Overhills Rd: Turn Left on Overhills Rd; Continue onto Nursery Rd; Turn Right at NC 24W/87N:
Turn Right at Sawyer Rd
Subdivision: 'Vi112gQ Q9 1.9KIRP1 '- 745 42144- Lot:
Description of Proposed Work: Single Family Home # of Bedrooms: �5—
Heated SF: Unheated SF: 13357- Finished Bonus Room? NO Crawl Space: Slab: _
General Contractor Information
Royal Oaks Building Group, LLC 919.233.3886
Building Contractor's Company Name Telephone
1210 Trinity Road, Ste 102 Raleigh, NC 27607 kwesterman ®royaloaksbg.com
Address / Email Address
„tiS�1 �? f� 49775
Signature of Owner/Contractor/Officer(g) of Corporation License #
Electrical Contractor Information
Description of Work Electrical Rough -in and Final Service Size: 200 Amps T -Pole: L Yes _No
Imperial Electric 919 -363 -7474
Electrical Contractor's Company Name Telephone
PO Box 162, Apex, NC 27502
Addres Email Address
19850
Signature of Owner /Contractor /Officer(s) of Corporation License #
Mechanical /HVAC Contractor Information
Description of Work install HVAC and duct system
Stewarrs Heating and Air
Mechanical Contractor's Company Name
2430 Reliance Ave, Apex, NC 27539
Address
Signature of Owner /Contractor /Officer(s) of Corporation
Plumbingt Contractor Information
919 - 362 -0387
Telleepphone r t
Email Address
09308
License #
Description of Work plumb single family home # Baths 3 • S
Barbour and Pourron
919 - 5334455
Plumbing Contractor's Company Name Telephone
PO Box 934, Clayton, NC 27528
Address Email Address
10672
Signature of Owner /Contractor /Officer(s) of Corporation License #
Insulation Contractor Information
Tatum Insulation II 919- 661 -0999
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 03110
Homeowners Applying to Build Their Own Home
Pleaso answerthe following questions then see a Permit Technician to determine if you qualify fer 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. 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 Harnett County Central Permitting Department of
any and all changes.
EXPIRED PERMIT FEES - S Months to 2 years permit re- issue fee is $150.O0. After 2 years re -issue fee
is as per rent fee schedule.
Sign ture of Owner #ContractorfOffcer(s) of Corporation Dat
Affidavit for Worker's Compensation N.C.G.S. 87 -14
The undersigned applicant tieing the:
J 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:
d 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
Sign
Royal Oaks Building Group, 11C
Residential Building Application 2 of 2 03110
LEXINGTON PLANTATION INVESTORS, LLC
14131 NC Highway 50/210
Surf City, North Carolina 28445
Phone: (910) 328 -5257
Fax: (910) 328 -5452
December 7, 2010
Royal Oaks Building Group
Attn: Paige Lowder
1210 Trinity Road
Suite 102
Raleigh, North Carolina 27607
Dear Paige:
As owner of lots in The Gate at Lexington Plantation subdivision in Harnett County,
North Carolina, we hereby grant Royal Oaks Building Group permission to disturb land for the
purposes of new home construction and development in The Gate at Lexington Plantation
subdivision. We are happy to provide any additional documentation you require in order to
secure your proper permits.
Sincerely,
Lexington Plantation Investors, LLC
By:
Jimmy fflPierce
Manager