Fillable Mechanical Electrical Plumbing Com Res Permit Application REVISED-October 2019

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Mechanical Electrical Plumbing Com Res Permit Application REVISED-October 2019

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TOWN OF CLAYTON
Engineering & Inspections
111 E. Second St., P.O. Box 879
Clayton, NC 27528
Phone: 919-553-5002
Fax: 919-553-1720
MECHANICAL / ELECTRICAL / PLUMBING PERMIT
Application Review: Staff will review application for completeness within 24 hours of submission. Applicants will
be notified to pick up incomplete applications and re-submit once the application packet is complete.
Type of Permit: Commercial: ____ Residential: ____ Commercial Property Use: ___________
Applicant Name: _____________________________________________ Date: _________________
Applicant Address: _________________________ City: ____________ State: _______ Zip: _______
Subdivision/Development: ________________________________ Lot#: _________________
Property Owner: ______________________ Phone #: ____________ Email: _________________
Address: ____________________________ City: _______________ State: _______ Zip: _______
Project Contact: ______________________ Phone #: ______________ Email: _______________
Address: _______________________________City: _____________ State: ______ Zip: _______
LOCATION AND TYPE OF PERMIT INFORMATION
Project Address: ______________________________________________________________________
Description of Proposed Work: __________________________________________________________
Locations of Work: Basement ____ Crawl Space ____ Second Floor ____ Attic ____ Roof ____
Floodplain Onsite: Yes ___ No ____ Stream/wetland Onsite Yes ___ No ___
*If marked “yes” please provide Flood Plain Development Permit
UTILITY PROVIDER INFORMATION
Power: Town Of Clayton Power ____ Duke Energy Power _____
Water Source: Town Of Clayton Utility _____ Johnston County Water Utility ______ Other _____
Size of Water Service and Meter: ¾”___ 1”___ 1-1/2”___ 2”____ other? _____
Natural Gas System: Yes ___ No ___
Permit#: _______________________
Received: ______________________
CONTRACTORS INFORMATION
Place an X and complete additional information for each permit type needed.
____ Mechanical Permit Project Total Cost of Mechanical: $___________________
Contractor Name: _______________________________________ Phone #: _________________________
Address: ____________________________________________ City: ___________________________
State: _________________ Zip Code: ____________ Email: _________________________________
License #: _________________________ Classification: _____________________________________
Design Professional (if applicable): ______________________________ Phone #: _________________
Engineer: ________ Other: _______ NC Reg. #: ______________
Address: ____________________________________________ City: ___________________________
State: _________________ Zip Code: ______________ Email: _______________________________
____ Electrical Permit Project Total Cost of Electrical: $___________________
Contractor Name: _______________________________________ Phone #: _________________________
Address: ____________________________________________ City: ___________________________
State: _________________ Zip Code: ____________ Email: __________________________________
Electrical License #: _________________________ Classification: ____________________________
Design Professional (if applicable): ______________________________ Phone #: _________________
Architect: _______ Engineer: ________ Owner: ________ Other: _______ NC Reg. #: _____________
Address: ____________________________________________ City: ___________________________
State: _________________ Zip Code: ______________ Email: _______________________________
CONTRACTORS INFORMATION
Place an X and complete additional information for each permit type needed.
_____Plumbing Permit:
Total Cost of Plumbing Project $_______________
Contractor Name: _______________________________________ Phone #: _________________________
Address: ____________________________________________ City: ___________________________
State: ___________ Zip Code: ____________ Email: _______________________________________
NC PLUMBING License #: ___________________ Classification: _____________________________
Design Professional (if applicable): ______________________________ Phone #: _________________
Architect: _______ Engineer: ________ Owner: ________ Other: _______ NC Reg. #:
______________
Address: ____________________________________________ City: ___________________________
State: _________________ Zip Code: ______________ Email: ________________________________
Total Combined Project Cost of Mechanical, Electrical and Plumbing: $______________________
The following documents are required prior to permit issuance:
[ ] Cost of construction provided
[ ] All plan reviewers have signed off on approvals
[ ] Fee paid at pick-up
SIGNATURES
I/We hereby certify that all information in this application is correct and all work will comply with the
State Mechanical and NEC Electrical Code and all other applicable State and local laws and ordinances
and regulations. The Inspection Department shall be notified of any changes in the approved plans and
specifications for the project permitted herein.
I/We further certify that I/We have full legal right to request such action and that the statements or
information made in any paper or plans submitted herewith are true and correct to the best of my
knowledge. I/We understand this application, related material and all attachments become official
records of the Town of Clayton, North Carolina, and will not be returned.
_______________________________________ _______________________________
Applicant’s Signature Date
_______________________________________ _______________________________
Owner’s Signature Date
*Note: If owner’s signature is not applicable, must provide copy of signed contract or have property owner provide email for
verification to Chrissy Freeman at Cfreeman@townofclaytonnc.org or to Cindy Batten at Cbatten@townofclaytonnc.org
.
Staff Approval:
_______________________________________ _______________________________
Inspector’s Approval Date
_______________________________________ _______________________________
Inspector’s Approval (Fire) Date
_______________________________________ _______________________________
CO Final Date
Permit Number: ______________________________________________
Property Address: _____________________________________________
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Mechanical Electrical Plumbing Com Res Permit Application REVISED-October 2019

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Completed 15 July 2020

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