DAVIDSON COUNTY CENTRAL PERMITTING

RESIDENTIAL

PERMITTING PACKET

TOD HANCOCK INSPECTION DIRECTOR

336-242-2807

CENTRAL PERMITTING SUPERVISOR - JENNIFER GOBLE - 336-242-2911

PERMIT TECHNICIAN - - - JODIE HEDRICK - 336-242-2234

PERMIT TECHNICIAN - - - ERIKA HINKLE - 336-242-2240

PERMIT TECHNICIAN - - - STACIE STRASS - 336-242-2232

RECEPTIONIST - - - HEATHER ABBOTT - 336-242-2230

Procedure for Obtaining a Residential Permit

1. Site plan Approved by Central Permitting

2. Zoning Permit issued by Central Permitting

3. Health Permit Application issued by Central Permitting & Approved by the Health

Department

4. Approved set of Residential Plans for Structure to be built:

a. Foundation Details

b. Floor Plan of Structure being built including all levels

c. Elevation Details

5. Completed Information Sheet including:

a. Owner’s contact information

b. Correct address and direction to site

c. Contact information of responsible person

d. General, Electrical, Mechanical, & Plumbing contractors names and license

numbers

6. Signed Affidavit of Workers Compensation Coverage

7. Completed Lien Agent form (if applicable)

8. Signed Floodplain Information Sheet

9. Signed Responsibility Statement pertaining to Temporary Certificate of Occupancy

& Certificate of Occupancy

Information required to be shown on Residential Plan

Site Plan: Show location of building in relation to lot lines, other structures, utilities,

etc.

Foundation Plan: Type of footings, size (width, depth, & thick), point loads,

elevations, etc.

Floor Plan: Room layout, door and window placement, dimensions of rooms,

location of plumbing fixtures, etc.

Wall Elevation Detail: Type of footing, foundation wall, floor system, wall section,

roof system, roof coverings, etc.

Engineered Component Documents: LVL Layout Plan, TJI Layout Plan, Fire Rated

Construction Documentation, & Truss Plan

All metal building must be approved and sealed by a Licensed Design Professional

PLANS ARE REQUIRED TO BE ON SITE FROM THE

START OF THE PROJECT UNTIL THE PROJECT IS

COMPLETE

Davidson County

Planning and Zoning Department

913 Greensboro Street, Lexington, NC 27292 - Phone # (336) 242-2220 - Fax # (336) 242-2222

Requirements for Building Zoning Compliance Permit

A site plan that includes accurate distances from the proposed structure to all property lines

A site plan to include impervious surface for the entire property if located inside a water supply watershed.

Not applicable if outside of the watershed

A site plan to include total building built upon areas (Total square footage of all existing buildings as well as

the proposed building)

A parking plan for existing and proposed parking spaces

A description of what the proposed structure purpose (A floor plan will work for this if the areas inside the

proposed structure are labeled for use)

A copy of the applicable sewer permit or a letter from the applicable public sewer provider authorizing

connection to sewer.

Verification if a project is in a flood zone or not

Other relevant information required includes but not limited to: Parcel number, Owners Name, Telephone

Number and 911 Address

These do not have to be individual site plans. All information can be displayed on one site plan.

All information must be clear and legible.

Zoning Compliance Permits Fee

Residential $25.00

Nonresidential $50.00

Signs (On Site) $20.00

Signs (Outdoor Advertising) $100.00

Wireless Communication Tower $500.00

Collocation $250.00

DAVIDSON COUNTY SEPTIC TANK PERMITTING INFORMATION

(Effective July 1, 2017)

THERE ARE TWO TYPES OF PERMITS REQUIRED

1. IMPROVEMENT PERMIT – An Improvement Permit advises whether or not the site selected can be approved for a subsurface wastewater treatment and disposal system. This type of permit is not an authorization to apply for a building permit or to install the septic tank system.

2. AUTHORIZATION TO CONSTRUCT – An Authorization to Construct (ATC) is the permit that

allows approval for building permits and/or installation of a septic tank system for new construction.

THE APPLICATION

An application is required for both the Improvement Permit and the Authorization to Construct. The ATC can be applied for at the time of the Improvement Permit application or at a later time. An ATC cannot be applied for unless there is a current application for an Improvement Permit or a valid Improvement Permit exists. IF PLANNING TO BUILD OR PLACE A MANUFACTURED HOME ON THE CURRENT LOT WITHIN THE NEXT 5 YEARS, THE IMPROVEMENT PERMIT AND ATC SHOULD BE APPLIED FOR AT THE SAME TIME.

The application fee for a new Improvement Permit is as follows:

$200.00 for a septic tank system with a daily design flow equal to or less than 600 gallons per day. $300.00 for a septic tank system with a daily design flow from 601 gallons per day to 1500 gallons per day. $500.00 for a septic tank system with a daily design flow equal to or greater than 1501 gallons per day.

Once issued, the Improvement Permit can be transferred to a new applicant/property owner at no additional charge, provided the lot/land boundaries do not change and no changes in design occur to necessitate re-evaluation of the site.

The application fee for an Authorization to Construct is a follows:

$100.00 if applied for at the time of an Improvement Permit application. $160.00 if applied for at any other time.

The fee for an Authorization to Construct application can only be refunded if the Improvement Permit is denied.

ALL APPLICATIONS MUST HAVE THE SIGNATURE OF THE CURRENT PROPERTY OWNER OR THE PROPERTY OWNER’S LEGAL REPRESENTATIVE. If for any reason the owner cannot sign the application, the owner must give written permission (signed by the owner) for someone else to apply.

APPLICATIONS AND FEES ARE VALID FOR 1 YEAR FROM DATE OF SUBMISSION. APPLICATIONS THAT EXPIRE MAY BE REINSTATED WITHIN 60 DAYS OF EXPIRATION BY PAYING 25% OF THE ORIGINAL FEE. THE PAYMENT OF THIS FEE WILL GRANT A 60 DAY EXTENSION TO THE 1 YEAR VALIDITY OF THE APPLICATION. IF THE

APPLICATION IS NOT ACTED UPON WITHIN THE 60 DAY EXTENSION PERIOD, THE INDIVIDUAL MUST RE-APPLY AND PAY 100% OF THE ORIGINAL FEE.

The application for Improvement Permit must contain the following information

Property owner and applicant information: name, address, telephone number, etc. Property location information: Township, map, lot number (This can be found on the tax bill, tax office, or on

the tax department web site.), directions to the property, etc. Structure information: # of bedrooms, # of occupants, # of employees, etc. Description of existing and proposed facilities and structures. The date the site will be prepared (property corners & structures staked). A map of the property A site plan or plat of the property.

A site plan is a drawing not necessarily drawn to scale that shows the property boundaries with dimensions, the

location of the proposed facility and other proposed structures, the location of driveways, the site for the

proposed wastewater system, the location of proposed or existing wells, the location of proposed or existing

utilities, the location of any easements or right-of-ways, the location of any surface waters, and any other

feature that could affect septic tank system location. (See Example)

A plat is a property survey prepared by a registered land surveyor, drawn to a scale of one inch equals no more

than 60 feet, which includes the specific location of the proposed facility and appurtenances, the site for the

proposed wastewater system, and the location of water supplies and surface waters.

The application for Authorization to Construct must contain all information listed above and the following more specific information:

A site plan drawn to a scale of 1” = 100 ft. or less, drawn by the property owner/applicant or licensed surveyor, indicating the location of the proposed facility, appurtenances, and the site for the system showing setbacks to the property line(s) or other fixed reference point(s).

The type of wastewater disposal system preferred. A sheet will be provided that lists current approved systems in North Carolina to assist in making a decision.

PREPARING THE SITE FOR EVALUATION FOR AN IMPROVEMENT PERMIT OR ATC

All corners of the property must be clearly marked with stakes; if the property is larger than 1 acre, the property lines should be flagged. The stakes should be 30 inches high and marked with brightly colored paint or ribbon. Colored ribbon is available purchase at the Davidson County Environmental Health office at a cost of $1.00 per roll.

The exact location and size of the house/structure must be clearly staked off on the property.

On the application for Improvement Permit/ATC, you must give the date the site will be ready to evaluate. Without this information, an application will not be acted upon. The date given should in no way be considered an appointment with the Environmental Health Specialist. The time of the visit will be determined by the Environmental Health Specialist the application is assigned to. The evaluation will not occur until after the date given and applications will be processed first come, first serve.

Post the provided orange sign on the site in plain view from the road to make locating the site easier. Additional signs will be provided as needed for sites that are difficult to find.

Sites that are not properly prepared on the date a site visit is made will be assessed and additional $60 fee prior to any other site visit. Please contact the Environmental Health Specialist at least 24 hours in advance to advise that the lot will not be ready by the date indicated on the application.

Permit Number: __________________ (Office Use Only)

Davidson County Health Department Application for Improvement Permit/Authorization to Construct

Improvement Permit ________ Date Site Ready to Evaluate ___________________ Submit current site drawing & application Structure staked, property lines marked

Construction Authorization __________ Proposed System Type (required) ________________ Submit current scale drawing of site & Approved system sheet with type selected & application

Building Authorization __________ Date Application Submitted ____________________ Submit current site drawing & application

----------------------------------------------------------------------------------------------------------------------------------------- IF THE INFORMATION IN THE APPLICATION FOR AN IMPROVEMENT PERMIT IS FALSIFIED, CHANGED, OR THE SITE IS ALTERED, THE

IMPROVEMENT PERMIT AND AUTHORIZATION TO CONSTRUCT SHALL BECOME INVALID. THE PERMIT IS VALID FOR EITHER 60

MONTHS OR WITHOUT EXPIRATION DEPENDING UPON DOCUMENTATION SUBMITTED. THIS APPLICATION IS VALID FOR 1 YEAR

FROM DATE OF SUBMISSION.

APPLICANT INFORMATION: email address_______________________________________

___________________________________________________________________________________________

Permit Requested By Complete Mailing Address Daytime Phone

_____

Property Owner Complete Mailing Address Daytime Phone

-----------------------------------------------------------------------------------------------------------------------------------------

PROPERTY INFORMATION

Township____________ Tax Map ____________ Lot Number____________ Road _______________________

Subdivision____________________ Section ___________ Directions to site:_____________________________

__________________________________________________________________________________________

-----------------------------------------------------------------------------------------------------------------------------------------

DEVELOPMENT INFORMATION

House________ Manufactured Home __________ Other ____________________________________________

Repair to Existing Septic Tank System_________________ Expansion of Existing System __________________

-----------------------------------------------------------------------------------------------------------------------------------------

NEW CONSTRUCTION ONLY: REQUESTED SEPTIC SYSTEM LOCATION

Front (road facing) ____ Back ____ Do not care____ Other ___________________________________________

-----------------------------------------------------------------------------------------------------------------------------------------

Residential Info: # Bedrooms _______ Basement (Y/N) _______if Y, Fixtures _______ # of Occupants ________

-----------------------------------------------------------------------------------------------------------------------------------------

Non-Residential Info: Type of Business ______________ # of Employees __________ # of Seats ____________

Total Square Footage of building _______________ Other ____________________________________________

-----------------------------------------------------------------------------------------------------------------------------------------

Water Supply: Public ________ New Well _______ Existing Well ________ Community Well ______________

----------------------------------------------------------------------------------------------------------------------------------------

Does this property: 1) Have any designated wetlands?________ 2) Subject to approval by any other public agency(Planning &

Zoning, DOT, etc)__________ Will there be any wastewater generated other than domestic sewage?__________If yes,

explain_______________________________________________________________.

I have read this application and information sheet attached and certify that the information provided in this application is true,

complete and correct to the best of my knowledge. Authorized county and state officials are granted right of entry to conduct

necessary inspections. I understand that I am solely responsible for the proper identification and labeling of all property

lines and making the site accessible for this evaluation.

Property Owner / Legal Representatives Signature ________________________________

(Office Use Only)

Initial Site Visit Date___________________San ID____IP Date____________San ID_____ GRID___________ ATC Date ________________________San ID______BA Date____________San ID____

1. Conventional system (has gravel and plastic pipe)*

2. Accepted Systems*

a. Chamber Trench System – (1-800-221-4436) – www.infiltratorsystems.com

b. Polystyrene Aggregate Trench System – (1-800-649-0253) – www.infiltratorsystems.com

c. BioDiffuser Chamber Trench System – (1-800-821-6710) – www.ads-pipe.com

3. Shallow placement conventional (12” – 23” trench bottom)

4. Large Diameter Pipe (_______ inch)

5. PPBPS

a. The T & J Panel Wastewater Treatment System (704-924-8600) www.tjpanel.com

b. Saprolite

6. Low Pressure Pipe (LPP)

7. Fill (gravity or LPP distribution)

8. Aerobic treatment unit (list distribution method)

9. Innovative Systems

a. Tire Chip Aggregate – www.deh.enr.state.nc.us/oww

b. PTI Multi-pipe System – 11 pipe model – (1-800-821-6710) – www.ads-pipe.com

c. 4 Inch Corrugated Substitutes –www.deh.enr.state.nc.us/oww

d. Chamber Trench Systems

i. Infiltrator (1-800-221-4436) – www.infiltratorsystems.com

ii. Hancor (1-888-367-7473) – www.hancor.com

iii. Cultec (1-800-428-5832) – www.cultec.com

e. Polystyrene Aggregate Trench System – (1-800-649-0253) – www.ezflowlp.com

f. Flow Equalization – www.deh.enr.state.nc.us/oww

g. Sand Filter Pretreatment Systems

i. Pressure Dosed Sand Filter Pretreatment Systems – NCSU (919-515-7305)

ii. Pressure Dosed Intermittent Sand Filter – (1-800-348-9843) – www.orenco.com

h. Subsurface wastewater drip systems

i. Perc-Rite Drip System (1-800-345-3132) – www.americanonsite.com

ii. Geoflow Drip System (1-800-828-3388) – www.geoflow.com

iii. Delta Drip System (1-800-219-9183) – www.deltaenvironmental.com

iv. E-Z Set Drip System (1-866-753-4700) – www.e-zset.com

i. Peat Filters

i. Puraflo – Bord Na Mona (1-800-787-2356) – www.bnm-us.com/puraflo.html

ii. Ecoflo (418-867-8883) – www.premiertech.com

j. Aerobic Treatment Units

i. Norweco Singular ATU/Sand Filter Unit (419-668-4471) – www.norweco.com

k. Other Filters

i. GAG Sim/Tech Filters (888-999-3290) – www.gag-simtech.com

ii. Norweco Bio-Kinetic System (419-668-4471) – www.norweco.com

iii. Bioclere Modified Trickling Filter Syst. (508-998-7577) – www.aquapoint.com

iv. Advantex Treatment Systems (1-800-348-9843) – www.orenco.com

l. Bed Systems

i. Brunswick Bed/Fill System (Brunswick Co. Health Dept.) – (910-253-2388)

m. Components

i. Pressure Activated Liquid Controllers – (1-800-363-5842) – www.chandlersystemsinc.com

ii. Aquaworx Pressure Bell – (1-800-221-4436) – www.infiltratorsystems.com

The Law requires that you select a wastewater system type with the application for an Authorization to Construct Wastewater

System. Select one system type that you prefer from these wastewater system types. Choice # _________________________

___________________________________ ___________________

Applicant/Legal Representative’s Signature Date

*When a permit is issued for a conventional system an accepted system may also be used without permit authorization or

modification

DOCUMENTATION TO AUTHORIZE AN OWNER’S LEGAL REPRESENTATIVE

Applications for permits require the “signature of the owner or owner’s legal representative” (15A

NCAC 18A .1937). If the owner does not sign the application himself or herself, they can submit

any one of the following documents to designate their legal representative:

1. Power of Attorney

2. Real Estate Contract

3. Estate executor

4. Bankruptcy trustee

5. Court ordered guardianship

In the absence of the above documentation, the property owner may provide the local health

department with documentation that designates a legal representative. A property owner may:

1. Complete this form to document his or her legal representative, or

2. Provide his or her own form that contains the information in this form.

If there are multiple property owners, then all property owners must sign the form that designates a

legal representative.

By signing a form that designates a legal representative for purposes of 15A NCAC 18A .1937, the

property owner authorizes that representative to act on their behalf in matters pertaining to the

application and permitting process, including signing or receiving any application, document or

permit. The owner retains full responsibility to meet all permit conditions specified by the local

health department.

I, ________________________________________, am the legal owner(s) of the property located

at_________________________________________________________________, identified as

PIN (Parcel Identification Number) _________________________________, located in Davidson

County, North Carolina.

I do hereby authorize (print legal representative/company name) ___________________________,

____________________________________, to act as an agent on my behalf in applying

for/signing/obtaining any of the documents described below.

Application for Improvement Permit (IP) / Authorization to Construct (AC)

Improvement Permit (IP) / Authorization to Construct (AC)

Application for soil-site evaluation (new/repair)

Application/permit for private drinking water well/well abandonment

Application for Building Authorization/Compliance Inspection

Application for Manufactured Home connection

I agree to abide by all decisions and/or conditions between the legal representative acting on my

behalf and the Davidson County Department of Public Health, Environmental Health Division.

______________________________ __________ ___________________________ __________

Signature of Owner(s) Date Signature of Witness Date

SITE PLAN EXAMPLE This elevation is an example of some of the information required on a Wall Elevation Plan.

FOUNDATION PLAN EXAMPLE

This plan is an example of some of the information required on a Foundation Plan.

FLOOR PLAN EXAMPLE

This elevation is an example of some of the information required on a Wall Elevation Plan.

WALL ELEVATION EXAMPLE This elevation is an example of some of the information required on a Wall Elevation Plan.

PERMIT # ________________________

DAVIDSON COUNTY CENTRAL PERMITTING DEPT.

*FORM FOR BUILDING PERMITS*

PHONE: (336) 242-2230 FAX: (336) 249-9703

OWNERS NAME (OR) COMPANY: _______________________________________________

______________________________________________________________________________

JOB ADDRESS FOR THE PROPERTY WE ARE INSPECTING: ________________________

______________________________________________________________________________

______________________________________________________________________________

TYPE OF BUILDING BEING BUILT: ______________________________________________

______________________________________________________________________________

RESIDENTIAL: _____ (OR) COMMERCIAL: _____ NEED LIEN# _______ IF OVER $30,000

PERSON TO CALL: ______________________ DAY TIME PHONE # ___________________

TOTAL HEATED SQ FT: _______________ CARPORT / GARAGE SQ FT: ______________

SUNROOM SQ FT: ________________ BASEMENT SQ FT: _________________

TOTAL PORCH / DECK SQ. FT IF (OVER) 12’X12’: _______________________

# OF STORIES: _________ # OF BATHROOMS: _________ # OF BEDROOMS: _________

GAS COMPANY NAME: _______________ POWER COMPANY NAME: ________________

VALUE OF JOB NOT INCLUDING LAND $: ______________________________________

DIRECTIONS: _________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

SELF AS GENERAL CONTACTOR: YES ______ NO ______

GENERAL CONTRACTOR: ___________________________ LIC. # ____________________

ELECTRICAL CONTRACTOR: ________________________ LIC. # ____________________

MECHANICAL CONTRACTOR: _______________________ LIC. # ____________________

PLIMBING CONTRACTOR: ___________________________ LIC. # ____________________

APPENDIX D

AFFIDAVIT OF WORKERS’ COMPENSATION COVERAGE N.C.G.S. §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 to cover them,

__________ has/have one or more subcontractor(s) who has/have thier own policy of

workmens’ compensation covering themselves,

__________ has/have not more than two (2) employees and no subcontractors,

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: ______________________________________________________________

Signature: _______________________________________________________________

Title: ___________________________________________________________________

Date: ____________________________________________________________________

HOW TO FILE A LIEN AGENT The mechanics' lien agent system was created to facilitate Chapter 44-A, Article 2, of the NC General Statutes. The

law affects all projects commenced on or after April 1, 2013.

Step 1 Sign up to use the LiensNC system or login with your existing user credentials.

Step 2 Select the Appointment of Lien Agent option.

Step 3 Choose a Lien Agent from the drop-down menu. (All provide the same service)

Step 4

Provide the contact information for the owner of the project property, including:

Name

Address

Email

Phone

Note: This should be the owner's contact information. (NOT a contractor, agent, or authorized representative who

may be completing the Appointment on the owner's behalf.)

Step 5

Give details about the project property location, including:

Street Address

Other legal description (Such as PIN, Tax map/block/lot, etc.)

DEFINITION: Property (i.e. Real Property) refers to the real estate that is being improved. (This includes:

structures, lands, leaseholds, tenements, driveways, private roadways, accessory structures, pools, etc. and

any furnished materials, such as trees and shrubbery.)

Step 6 If you had/have a contract with any design professionals prior to appointing the Lien Agent for this project, select

'Yes' and provide their contact information. (Example: an architect that drew design plans) Otherwise, choose 'No' if

this section does not apply to your project.

Step 7 Choose the property type of the project. (Either 1-2 Family Dwelling or Other)

Step 8 Provide the date on which the furnishings began or plan to begin. (If known)

Step 9 (for 1-2 family dwellings only) Skip this step if the property type is Other. If you are a Custom Home Contractor authorized to designate a Lien Agent on behalf of the owner under a written

contract, answer Yes to this question and provide your contact information.

Step 10 List up to three recipients to receive email notifications whenever future project activity occurs. (i.e. Notice filing or

comments added)

Step 11 Select the Continue button.

(Note: If any errors are encountered, they will display in red text and let you know how to resolve them.)

Step 12 It is very important that you carefully review the information you are about to submit before continuing, since this

will be the LAST OPPORTUNITY TO EDIT project information.

Step 13

Choose whether you want to Pay Now or Pay Later.

Pay Now - will advance you to the checkout.

Pay Later - will place the filing in your Cart and will not be valid until you submit payment.

Step 14

Choose the payment method you will be using:

Credit Card, or

eCheck (i.e. checking account).

Step 15

Provide billing and payment information and submit payment for processing.

Provide the customer billing information. (Hint: Customer address must match what the bank/credit card company

has on file)

Provide the payment information.

Select Continue.

Verify information is correct.

Select Submit to process payment. (Note: Do not refresh the page or use the back arrow. Refunds will not be given

due to user error.)

Select the final Continue option to advance to the user History area of your account. (History is where all of your

submitted filings will be listed.)

Step 16 On your History page, you should see a blue Entry Number for each of your submitted filings. (The most recent

filing should be located on top.)

Select the printer icon located below the Entry Number. Once you advance to the project details, select the Print

Appointment option located at the bottom of the page.

We suggest making two copies of the project details: one to post at the job site, and one for your records. (Note:

This proof of Lien Agent is required to be continuously posted at the job site.)

Step 17 You will want to share the Appointment Entry Number with any potential lien claimants that become involved in the

project. This gives them an opportunity to file a related Notice to Lien Agent filing. The QR code located on the

project details printout is a convenient way for PLCs to file their Notice quickly.

Step 18 The LiensNC system will automatically send the Lien Agent and any notification subscribers an email to let them

know the Appointment was successfully filed.

PERMIT # _______________________

DAVIDSON COUNTY CENTRAL PERMITTING DEPT.

*FLOODPLAIN FORM*

PHONE: (336) 242-2230 FAX: (336) 249-9703

IS THE PROPERTY IN THE DAVIDSON COUNTY FLOOD HAZARD AREA?

*NO: ____________

*YES: ____________

(IF YES) THE PROPERTY IS IN A FLOOD HAZARD AREA, FILL OUT THE

“APPLICATION FOR PERMIT TO DEVELOP IN A FLOOD HAZARD AREA” *FEE

FOR A RESIDENTIAL OR COMMERCIAL FLOOD PERMIT IS $100.00

__________________________________________________________________

SIGNATURE

____________________________

DATE

DAVIDSON COUNTY CENTRAL PERMITTING DEPT.

*RESPONSIBILITY STATEMENT*

PHONE: (336) 242-2230 FAX: (336) 249-9703

I have signed as Owner, Contractor, or Applicant for this

Permit # ______________________________________

(For Office Use Only)

And I fully understand that by doing so I take full responsibility for making sure final

Inspections are obtained on this and all other permits pertaining to this job. As applicant, I will

make sure the Owner or Contractor is aware of this signed statement and that responsibility for

this action still reverts back to them. Failure to obtain final inspection on this or occupying a

structure without a TCO (Temporary Certificate of Occupancy) or CO (Certificate of

Occupancy) will result in a penalty charge by the Inspections Department of $100.00. This

penalty once applied will be due before a TCO or CO will be issued.

Signature of Applicant: ______________________________

Date: ______________________________

Please check one

You are the:

Owner: _________

Licensed Contractor: _________

Applicant for Owner: _________

Applicant for Contractor: _________

Davidson County Central Permitting

P.O. Box 1067, Lexington, NC 27293

912 Greensboro St. Lexington, NC 27292

Office Cell

Central Permitting Supervisor Jennifer Goble (336) 242-2911 (704) 245-9376

Permit Technicians: Jodie Hedrick (336) 242-2234

Erika Hinkle (336) 242-2240

Stacie Strass (336) 242-2232

Receptionist Heather Abbott (336) 242-2230

Office Cell

Director: Tod Hancock (336) 242-2807 (336) 471-9893

Assistant Director Beau Chollett (336) 242-2239 (336) 240-0278

Plans Examiner Chris Whaley (336) 242-2237 (336) 425-2978

Inspectors C. Dale Terry (336) 242-2238 (336) 202-3398

Curtis Allman (336) 242-2347 (336) 247-7066

Ken Hepler (336) 242-2808 (336) 309-3702

Kirby Swing (336) 242-2938 (336) 906-5694

Vacant (336) 242-2231

Frequently Called Numbers

Davidson County Fire Marshal (336) 242-2270

Davidson County Planning & Zoning (336) 242-2220

Davidson County Environmental Health (336) 242-2310

Davidson County Tax Department (336) 242-2160

Department of Environmental and Natural Resources (336) 776-9800

City of Lexington Inspections (336) 248-3900

City of Thomasville Inspections (336) 475-4255