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County of Moore Planning and Transportation (County of Moore)

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BROWSE COUNTY OF MOORE (NC) FORMS

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Revised 4/16/2020 1
County of Moore
Planning and Transportation
Inspections/Permitting: (910) 947-2221
Planning: (910) 947-5010
Transportation: (910) 947-3389
Fax: (910) 947-1303
EXTERNAL CHECKLIST FOR RESIDENTIAL BUILDING PERMIT APPLICATION
Completed residential building permit application. Applications can be obtained from our department, Planning and
Transportation located at 1048 Carriage Oaks Drive, Carthage, NC 28327, or online at www.moorecountync.gov
, De-
partment Planning & Transportation, Applications. If you would like to speak with someone regarding the application
our phone number 910-947-5010 or 910-947-2221.
If you are installing an irrigation system you will need to complete a separate irrigation application. This application
can be can be obtained from our department, Planning and Transportation located at 1048 Carriage Oaks Drive,
Carthage, NC 28327, or online at www.moorecountync.gov
, We cannot process any irrigation permits without the
proper documentation being provided to our office.
For a new septic system, an improvement permit issued by the Moore County Environmental Health Department for
the proposed use. The Environmental Health Department is located at 1042 Carriage Oaks Drive, Carthage, NC
28327. Their phone number is 910-947-6283.
Existing septic systems: A septic system recertification permit is required by the County of Moore Heath Department,
Environmental Health Division for the following:
Additions extending outside the existing foundation.
Interior renovations that result in an increased number of bedrooms.
Replacement or addition of storage buildings, swimming pools, decks, concrete pads, irrigation systems, geother-
mal systems, driveways, etc.. when in the area of septic system and/or repair area.
The Environmental Health Department is located at 1042 Carriage Oaks Drive, Carthage, NC 28327. Their
phone number is 910-947-6283.
A completed residential plot plan included within residential building permit application. The purpose of the residen-
tial plot plan is to clearly identify where the proposed and existing structure(s)/building(s) are/ will be located on the
property. The residential plot plan shall identify the structure(s)/buildings distances measured to all property lines. The
residential plot plan also ensures the proposed structure(s)/building(s) are not being located on top of the existing sep-
tic system, septic lines or septic repair area.
One set of building plans.
A copy of the Soil and Erosion Control approval from NCDEQ.
One copy of the designated lien agents contact information per NC §44A-11.1 See www.liensnc.com for further details
and registration of your project.
A copy of recorded deed to verify ownership. A survey may also be required if lot configuration does not reflect the
current records of the county.
A zoning permit may be required if the subject property is located within one of the following municipalities or their ETJ.
Cameron: 910-245-3212 Taylor Town: 910-295-4010
Carthage: 910-947-2331 Vass: 910-245-4676
Foxfire: 910-295-5107 Whispering Pines: 910-949-3141
Robbins: 910-948-2431
Revised 4/16/2020 *NOTE: The General Contractor must fill out and sign page 3 of this application. 2
Site Built Home Modular Home Additions Renovations Accessory Building
Application Date:
Description of Proposed Work: __________________________________________________________________________________________
______________________________________________________________________________________________________________________
Applicant (Your Name): Phone:
Property Owner: Phone:
Property Owner Address: Zip: St: City
Location/Address of Property:
Type of Project:
Area (sqft) Total: Finished Heated: Unnished: Garage: Porch(es): Deck(s):
Bldg Height (ft): # of Stories: # of Bedrooms: Total Project Cost: $
Utilities: AND
Private Well Public Water Private Septic System Public Sewer
# of Amps: _______________ Temporary Pole Generator Additional Wiring
# of Systems________ Type of Systems _____________________ Size _________ Fuel Gas Piping
# of Baths ____________ # of 1/2 Baths __________ # Water Heaters _________ # Clothes Washers _______
# Additional Sinks ________ # of Spas ______________ # Dishwashers _________
Irrigation System
General Contractor: License: Phone:
Address: City St Zip
Plumbing Contractor: License: Phone:
Address: City St Zip
Mechanical Contractor: License: Phone:
Address: City St Zip
Electrical Contractor: License: Phone:
Address: City St Zip
Insulation Contractor: License: Phone:
Address: City St Zip
I hereby certify that all information in this application is correct and all work will comply with the State Building Code and other
applicable State and local laws, ordinances and regulations. The Inspection Department will be notied of any changes in the
approved plans and specications for the project permied herein. I understand if this application is incomplete, no inspections will
be performed on the project. By signing below I aest that I have obtained all subcontractors permission to obtain these permits.
Owner/Agent Signature: _____________________________________________________________ Date: ___________________________
Residential Building Permit Application
(Site Built Homes, Modular Homes, Additions, Renovations and Accessory Buildings)
Electric:
Mechanical:
Plumbing:
Fuel Gas Contractor: License: Phone:
Address: City St Zip
Inspections/Permitting: (910) 947-2221
Planning: (910) 947-5010
Transportation: (910) 947-3389
Fax: (910) 947-1303
County of Moore
Planning and Transportation
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Revised 4/16/2020 3
County of Moore
Planning and Transportation
Inspections/Permitting: (910) 947-2221
Planning: (910) 947-5010
Transportation: (910) 947-3389
Fax: (910) 947-1303
AFFIDAVIT FOR WORKER’S 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 subcontractor(s) and has obtained workers compensation insurance to cover them.
_____Has one (1) or more subcontractor(s) who have their own policy of workers compensation insurance to
cover 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 Depart-
ment issuing the permit may require certificates of coverage of workers compensation insurance prior to issu-
ance of the permit and at any time during the permitted work from any person, firm or corporation carrying
out the work.
____________________________________________________________________________________
Company or Owners Name
________________________________________________ ___________________
Owner / Agent Signature Date
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Completed 18 July 2020

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