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JACKSON COUNTY PERMITTING & CODE ENFORCEMENT New Residential, (Jackson County)

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DATE REC’D: __________________________
PROPERTY PIN NUMBER: Office Use Only: B E P M W
NAME: PHONE:
ADDRESS:
TYPE OF CONSTRUCTION: Wood Frame Metal Masonry Modular Log
PERMIT TYPE: Residential Commercial Addition Remodel Detached Garage Demolition
Residential: Total Number of Rooms Commercial: Total Number of Rooms
Bedrooms Bathrooms
Bathrooms
Heat Type(s): A/C:
No Decks: No
Fireplaces:
Yes No
# Fireplace(s):
Yes Yes
Chimneys:
Yes No
# Chimney(s):
Square Footage Details: 1
st
Floor
2
nd
Floor Total Cost of Construction: $
Basement
Attached Garage
TOTAL SQ. FOOTAGE sq. ft.
JACKSON COUNTY PERMITTING & CODE ENFORCEMENT
New Residential, New Commercial Application
Sylva Office: 401 Grindstaff Cove Road, Suite 145, Phone: 828-586-7560 / Fax: 828-586-7563
Cashiers Office: 357 Frank Allen Road, Phone: 828-745-6850 / Fax: 828-745-6867
LIEN AGENT REQUIRED?
NO
YES LIEN ENTRY NUMBER: __________________________
(DETAILED DIRECTIONS TO JOB SITE-IF POSSIBLE, PLEASE INCLUDE A 911 ADDRESS)
POWER PROVIDER
: JOB # (if Duke Energy):
I hereby certify that all information in this application is correct and all work will comply with the State Building
Code and all other applicable State and
local laws and ordinances and regulations. The inspection Department
will be notified of any changes in the approved plans and specifications for the project permitted herein.
SIGNATURE:
DATE:
You may submit a completed, signed copy of this application to our office in person, by fax, or e-mail to
jcpermitcenter@jacksonnc.org. Fees may be required.
NC LIC # PHONE:
NC LIC # PHONE:
NC LIC # PHONE:
BUILDING CONTRACTOR:
ELECTRIC CONTRACTOR:
PLUMBING CONTRACTOR:
MECHANICAL CONTRACTOR: NC LIC # PHONE:
CITY:
STATE:
ZIP:
E-MAIL ADDRESS: ________________________________________________________________________________
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Confirmation of subcontractor for: (job name)
General contractor name:
IF PERMIT IS GRANTED I AGREE TO CONFORM TO ALL LAWS OF THE STATE OF NORTH CAROLINA REGULATING SUCH
WORK. I CONFIRM THAT THE INFORMATION LISTED BELOW IS TRUE AND ACCURATE.
Electrical Contractor
Notary Public Information
Contractor Signature
Notary Public Signed
Printed Company Name
Commission Date
NC License #
Phone #
Contractor’s E-
mail
(Notary Seal)
Date Signed
County/State Signed In
Plumbing Contractor
Notary Public Information
Contractor Signature
Notary Public Signed
Printed Company Name
Commission Date
NC License #
Phone #
Contractor’s E-mail
(Notary Seal)
Date Signed
County/State Signed In
Mechanical Contractor
Notary Public Information
Contractor Signature
Notary Public Signed
Printed Company Name
Commission Date
NC License #
Phone #
Contractor’s E-mail
(Notary Seal)
Date Signed
County/State Signed In
JACKSON COUNTY PERMITTING & CODE ENFORCEMENT
Confirmation of Subcontractor for Permitting
Sylva Office: 401 Grindstaff Cove Road, Suite 145, Phone: 828-586-7560 / Fax: 828-586-7563
Cashiers Office: 357 Frank Allen Road, Phone: 828-745-6850 / Fax: 828-745-6867
(Parcel Identification Number)
JACKSON COUNTY 9-1-1 OFFICE JACKSON COUNTY, NORTH CAROLINA
401 Grindstaff Cove Rd., (Mail) ADDRESS REQUEST FORM
Sylva, NC 28779
(828)586-7537
(828)586-7573 fax Date of Application:
The following information is required in order to assign you a permanent house number and road name.
This address is necessary for Jackson County to provide you, the homeowner, with adequate emergency
service when a 9-1-1 call is made. Your address will be assigned as soon as possible after your request is
made. (The driveway must be cut in on the property before the address can be generated.) This address
must be posted on your home or at your driveway before a certificate of occupancy can be issued. This
form must be filled out if you are building a new home or placing a mobile home on your property. Leave
this form at the building permit office. The assigned address must be posted on your home or at your
driveway before a certificate of occupancy can be issued.
Homeowner’s Name: Telephone: ______________________
Contractor’s Name: Telephone: ______________________
Road Name: PIN # __________________________
Building Permit #: Lot # (if applicable): ________________
Directions to building site:
Name of nearest neighbor: ____________________________________________________________
Description of new home: (example: 2-story gray house)
If this home is not to be your permanent full-time residence, please list an out of town mailing
address and telephone number where you can be reached.
Mailing Address:
Telephone:
FOR OFFICE USE ONLY
NEW HOME ADDRESS:
Per North Carolina General Statute 87-14
The undersigned applicant for Building Permit # ________ being the
______ Contractor
______ Owner
______ Officer/ Agent of the Contractor or Owner
do hereby aver under penalties of perjury that the person (s), firm (s), or corporation (s) 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 subcontractor (s) and have obtained workers’
compensation insurance covering them,
______ has/have one or more subcontractor (s) who has/have their own policy of
workman’s compensation covering themselves,
______ has/have not more than two (2) employees and no subcontractors,
______ has/have applied for permit where the cost is under $30,000 and I am, therefore, exempt
from Licensed General Contractor requirements specified by G.S. 87-14,
while working on the project for which this permit is sought. It is understood that the Inspection
Department issuing the permit may require certificates of coverage of workers’ 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.
Firm name: __________________________________ By: __________________________________
Signature: __________________________________ Title: __________________________________
Sworn to (or affirmed) and subscribed before me in ____________________________ County, this,
the ________day of __________________________, 20_____.
Notary Public: ____________________________ Signed: __________________________________
Printed Name Signature of Notary
My commission expires: _______________________________
(SEAL)
JACKSON COUNTY PERMITTING & CODE ENFORCEMENT
Affidavit of Worker’s Compensation Coverage
Sylva Office: 401 Grindstaff Cove Road, Suite 145, Phone: 828-586-7560 / Fax: 828-586-7563
Cashiers Office: 357 Frank Allen Road, Phone: 828-745-6850 / Fax: 828-745-6867
Section R-318 Protection Against Termites
ATTENTION
A COPY OF TERMITE TREATMENT MUST BE SUBMITTED TO THE
BUILDING PERMIT OFFICE BEFORE A CERTIFICATE OF OCCUPANCY
CAN BE ISSUED FOR ANY NEW RESIDENTIAL WORK.
R-318.1 Subterranean termite control methods. In areas subject to damage from termites as
indicated by Table R301.2(1), methods of protection shall be one of the following methods or a
combination of these methods:
1. Chemical termiticide treatment, as provided in Section R318.2.
2. Termite baiting system installed and maintained according to the label.
3. Pressure-preservative-treated wood in accordance with the provisions of Section R317.1.
4. Naturally durable termite-resistant wood.
5. Deleted
6. Cold-formed steel framing in accordance with Sections R505.2.1 and R603.2.1.
R-318.1.1 Quality Mark. Lumber and plywood required to be pressure-preservative-treated in
accordance with Section R318.1 shall bear the quality mark of an approved inspection agency which
maintains continuing supervision, testing, and inspection over the quality of the product and which
has been approved by an accreditation body which complies with the requirements of the American
Lumber Standard Committee treated wood program.
R-318.2 Chemical Soil Treatment. The concentration, rate of application, and
treatment
method of the termiticide shall be consistent with and never less than the termiticide label and
applied according to the standards of the North Carolina Department of Agriculture.
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JACKSON COUNTY PERMITTING & CODE ENFORCEMENT New Residential, (Jackson County)

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Completed 14 December 2020

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