Building Permit Application
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{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
Federal Employer ID Number (EIN)
Specify the Work Site address
  • Applicant
  • Project
  • Trades
  • Affidavit of Workers' Compensation
  • Notice of Requirements
  • Certification
Responsible Person Information
State Licence Number
City/State/ZIP
ZIP
Address
Architect/Engineer Information
Name
State
Address
Phone #
Name
City/State/ZIP
Cell #
City/State/ZIP
Tenant Information
Fax #
Who is the primary contact person for this project. e.g. the property owner, a project supervisor or site foreman
Phone #
Name
Fax #
Phone #
Name
Address
City
License Expiration Date
Email
Address
Name
General Contractor Information
Phone #
If this application is being made on behalf of the owner, provide the applicant's details.
Property Owner Information
Email
Cell #
Email
Email
Project Information
If yes, separated?
Flood Plain Zone
Details
Map #
Construction Type
Property Type
Date Approved
Septic Type
Application #
Est. Finish Date
Health Inspector Initials
Type of Improvement
Description of Work
Septic Information
Mixed-Use
Est. Start Date
Dev. Permit No.
Add technical sections for all applicable subcodes
has/have one or more subcontractor(s) who has/have their own policy of workers’ compensation covering themselves,
has/have not more than two (2) employees,
has/have three (3) or more employees and have obtained workers’ compensation insurance to cover them,
The undersigned applicant being the

 while working on the project set forth for which this permit is sought. It is understood that the Inspections 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, or from any corporation carrying out the work.

do hereby aver under penalties of perjury that the person(s), firms(s), or corporation(s) performing the work set forth in the permit:

has/have one or more subcontractor(s) and have obtained workers’ compensation insurance covering them,
Affidavit of Workers' Compensation Coverage N.C.G.S. § 87-14

The following is an excerpt from the 2012 North Carolina Administrative Code, Chapter 1

101.3 Scope

101.3.1 Requirement s of other state agencies, occupational licensing boards or commissions. The North Carolina State Building Codes do not include all additional requirements for buildings and structures that may be imposed by other state agencies, occupational licensing boards or commissions. It shall be the responsibility of a permit holder, design professional, contractor or occupational license holder to determine whether any additional requirements exist.

Commentary: Many State agencies, occupational licensing boards or commissions have specific design and construction requirements that are not incorporated into the North Carolina State Building Codes and are not enforced by code enforcement officials. Permit holders, design professional, contractors or occupational license holders should consult with any relevant boards or agencies to determine whether there are any additional construction and design requirement for their projects.

Notice of Requirements of Other State Agencies, Occupational Licensing, Boards or Comissions
Type Full Name :
Sign With Hand
Applicant Signature
I have read all affidavits and requirements

Permittee Information Sheet

1. Plans must be approved before permits are issued.

2. Plan approval does not guarantee inspections will pass. On-site construction takes preference over plans.

3. Permits must be paid for at the time of permit issuance.

4. The first inspection must be within six months of the date the permit was issued. If the first inspection is not done within six months of permit date the permit becomes null and void.

5. At least one inspection must be performed in each twelve-month period after permit is issued. If an inspection is not performed in a 12-month period the permit becomes null and void.

6. If an inspection is called in by 9:00am the inspector will more than likely be able to get to it that day.

7. Please note that a certain time for inspections cannot be given. Mitchell County has one building inspector. Inspections are done by geographical area not by appointment times.

 8. A final inspection will not be performed until we have a final septic approval from the health department.

 9. A final electrical inspection has to be performed before a final is completed and before a certificate of occupancy is issued.

Please click here for Owner Exemption Affidavit Pursuant to G.S. 87-14 (a) (1)

Certification
Attach any plans or supporting documents that will allow the construction department to review of this application more efficiently.
I hereby certify that the foregoing statements made by me on this application are true. I understand that if any statements is willfully false, I am subject to punishment. Additionally I understand that this application may be denied and/or voided.

I understand that this application does not constitute a permit, or guarantee that a permit will be issued. A permit will only be issued upon approval of this application, and payment of all applicable fees.