20231471 Ver 1_Site Plan_20231031

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DocuSign Envelope ID: 008E5EB4-5F6C-41C1-A1CC-13D6F13DA062
PREMIER PERMITS
OF THE CAROLINAS LLC
PROPERTY OWNER INFORMATION
PROPERTY OWNER:
Wayne Cherry
PHONE:
336-971-1861
EMAIL:
[e-mail]
STREET ADDRESS:
8730 Harbor Circle
Terrell, INC 28682
Property Owner's Mailing Address (if different than property above):
The undersigned, registered property owners of the above noted property, do hereby authorize
Erica McIntosh , of, Premier Permits of the Carolinas. LLC
(Contractor/ Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of this permit or certificatio n and
any and all standard and special conditions attached.
W3Ygi�y the above information submitted in this application is true and accurate to the best of our knowledge.
DocuSigned by:
fCaGIInOS�t,
C113D78AA9B943E...
Authorized Homeowner Signature Authorized Agent Signature
Date:
10/23/2023 Date: 10/16/2023

PROPERTY INFORMATION
Property Address:
Property Status:
Property owner Name
�30
.-
El For Ren
a
Mailing Address:
City, Stake, Zip:
ACCESSORY STRU URE BUILDING PERMIT APPLICATION
CATAWBA COUNTY PERMIT CENTER
25 Government Dr. / P.O. Box 389, Newton
il: permit
Phone [phone] � Ema
VbOV CIVC
t ❑ For Lease OFor Sale
A c,
(4
AV
or 6
'TP,vr�,� 4c400r Z000
CONTRACTOR INFORMATION
General
Contractor Name:
Mailing Address:
City, State,, zip: `eii
State License #:
Applicant Name:
I�G
POOLS ONLY — BARRIER CONTRACTOR INFORMATION
7rmo cis, i
NC 28658
apps@catawbacountyncogov
' #:
Nbarcel
10
0;�
7
Nod for00
rent, [ease, or sale
Telephone:
Fax:
Email.,
Iqa�-
Telephone:
Fade
Fax:
Email:!jG►�l�Yj6�M-C��S�'U�'IQVV�
ra I ID#-.
Telephone:
Barrier Contractor Name: Telephone,
Mailing Address: Fax
City., State, Zip: Email.•
PROJECT INFORMATION
Brief Description of Work: ��i�f IbY L �1' 1"' Irt, -�(�p . O}r �%({/V • M 5� n(/VV9
TYPE OF USE
SCOPE OF PROJECT
Heated Sq Ft of Project:
imp 1
9
11MA Wojib FAA!ii&_nLA
AVj MO 9
RrResidential
LIAccessory Building
El Paul Above Ground
❑ Commercia
El Hot Tub /
jpa
is
El M
[]Pool In -Ground
Retaining Walll*: dumber of continuo
UTILITIES
ctai L.ni Nui t
V(i e r
El Solar Panel(s): ElGround DRoof El Solar Farm*
s walk sections *sealed plans
required
Unheated Sq Ft of Project:CTotal Sq Ft of Project:
Power Company:
Water: El Well El Municipal/Private Sewer: ❑ Septic El Municipal/Private
Total Cost of Project:
I hereby certify that all information in this application is correct and all work w
❑ Electrical
❑ Plumbing
SUB -PERMITS
D Mechanical
1:1 Gas Piping
ill comply with the North Carolina State Buil
El Low Voltage
❑ Ventilation
ding Codes and all
applicable state any local laws. ordinances, and regulations. ! understand that a Certificate of Compiiance is required prior to accupying the pram
and I will notify the building Services Department of any changes in the approved plans and specifications for the permitted project.
eral Co Factor's Signature
non- undable $30 administrative fie is included in t
ther
ises.,
Feral Contra doesN ame (print} Date R
it cost. � IDouble Fees are charged for work started prior to obtaining permits.
he perm

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STATE OF NORTH CAROLINA
COUNTY OF
V
Parcel Identification Number and address where the building k tn hp- constructed
sip
Address K,,5.b A1A,��Y V1voorclU e�/irG� � , IV(i
nspection Department
sib
Type of construction.. 5rResidenfial
OWNER EXEMPTION AFFIDAVIT
PURSUANT TO G.S. 87m*14 (a) (1)
040p5z qi
gloom
❑ Commercial ❑IndustdalV(Other P1i�'
Intended use after completion (e.g. Personal residence
Building permit number associated with this application
r 1 0
(Print Full Name)
(F-,none Number)
hereby claim exemption from 1hicensure under G.S. 87-1 (b)(2) by initiall the relevant provision in paragraph 1
and initiahng- -- EEEEMW�paragraphs 2-5 below attesting to the following:
1 _ I certify 1 am the owner of the property set forth above on which a building is to b
e constructed or
altered and for which application for a building permit is hereby
OR
2_
3.
C41
5_
am legally authorized to act on behalf of the firm or
corporation that is constructing or altering this
building on the pi upei Ly owned by the firm or corporation as set forth above:
Cons �Tn�
(Name, of firm or Corporation)
1 will personally superintend and manage all aspects of the construct -ion or alteration of the.. Building
and that duty will not be delegated to any person not duly licensed under the terms of Article 1. Chapter 87
of the General Statues of North Carolina.
I will be on site regularly during construction and I will be personally present for all inspections required
by the North Carolina State Building Code, unless the plans for the construction or alteration of the building werc...,
drawn and sealed by an architect licensed pursuant to Chapter 83A o
f the General Statutes of North Carolina.,
understand that by executing this licensing exemption AFFIDAVIT pursuant to G.S. 87-1(b)(2), I am
required oy iaw to occupy the building for which the licensing exemption is granted for rivelve months after
completion, during which time it may not be offered for rent., le -case or sale.
eov I understand a copy of this AFFIDAVIT will be transmitted to the Noilh Carolina Licensing Board T'FOr
General Contractors for verification I am validly entitled tO claim an exemption under G.S. 87-1 (b)(2) for the
building construction or alteration specified herein. I further undefSt2ndi'ic the North Carolina Licensing Board
for General Contractors determines I am not entitled to claim this exemption the building Pe it issued Tor the..
con alteration specified herein sh d pursuant. to G.S 16OD-1 115.
61 R
------ 0� / I
(S-IonatureIEW of Atriantj (Date)
mor afflirmed and subscribe ore me this the f �- day of �-P�Q . 20 a`
Gam--
P
(Signature of Notary ublic)
r� r�����PWLING
ota oSary PU lic - orth Carolina
� V � L-4 5 %� � �� I '. ✓` Iredell Countyt(
(Printed Name of Notary Publics My Commission Expires Mar 27, 20Z7
!f is 2 class F felonyto �:•illfull� comma.peq'uryrn anyaffidavit takenpufsuant to NC G.S. 14-209)
(NOTE �' '

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AFFIDAVIT OF WORKERS' COMPENSATION COVERAGE
N.C.G.S. §87=14
The undersigned applicant for Building Permit # being the
Contractor:
Owner:
�V
M its I V-1 0 e�
Officer/Agent of the Contractor or Owner:
eWII�V
6 VM Ito 44�
I "
1 Y[6(5
Do hereby aver under penalties of Derjury that the Pierson(s), firms) or corporations)
performing the work set forth in the permit:
has/have three (3) or more employees and have obtained workers' compensation
insurance to cover them,
has/have one or more subcontractors) and have. obtained workers' compensation
insurance to cover them,
has/have one or more subcontractors) who has/have their own policy of
workmen's compensation covering themselves,
has/have not more than two (2) employees and no subcontractors,
while working on the project for which this Pernut is sought. It is understood that the
Insp0
ection De partment issuing the permit may require certificates of coverage of workers,
compensation insurance Drior t issuance of the permit and at any time during the
pemutted work from any person, firm or corporation carrying out the work.
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