CAMDEN COUNTY INSPECTIONS DEPARTMENT
P. O. Box 190, CAMDEN, NC, 27921
BUILDING, PLUMBING, ELECTRICAL, MECHANICAL

MODULAR / MANUFACTURED HOME PERMIT APPLICATION
          Office Use Only

          PIN#   _____-_________-_____-_____-_________-0000       UDO#   ________-_____-_____

          Inspector ___________ Flood ____________ Zone ___________  Permit # ______________
 
Do You Need A Temporary Electric Pole?     Yes   No
Property Information
  Address:
  City, State, Zip:
Property Owner Information
  Name:
  Mailing Address:      
  City, State, Zip:
  Email Address:
  Phone:
Dealer Information
  Name:
  Mailing Address:
  City, State, Zip:
  Email Address:
  Phone:
Type Home
  Manufactured New Used Size:   X
    Single Wide Double Wide Triplewide
    Year Model   Make  
    Serial Number:  
OR   - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
  Modular Size:   X Number of Stories:  
    On Frame     Off Frame
Other Information
  Number of Bedrooms        
  Number of Bathrooms
  Number of Fixtures

.

General Contractor Information
  Name:
  Mailing Address:
  City, State, Zip:
  Email Address:
  Phone:      License Number:      
Setup Contractor Information
  Name:
  Mailing Address:
  City, State, Zip:
  Email Address:
  Phone:      License Number:      
  Setup Bond #:
Electrical Contractor Information
  Name:
  Mailing Address:
  City, State, Zip:
  Email Address:
  Phone:      License Number:      
Mechanical Contractor Information
  Name:
  Mailing Address:
  City, State, Zip:
  Email Address:
  Phone:      License Number:      
Plumbing Contractor Information
  Name:
  Mailing Address:
  City, State, Zip:
  Email Address:
  Phone:      License Number:      
Estimated Cost . . . . . . . . . . . . . .$    .00

      As the applicant listed below, I hereby agree to have the subject manufactured home installed in accordance with the North Carolina Building Code(s) and any local Ordinance of Camden County.
      I also understand that no inspections will be performed and no electrical utilities released, until all applicable contractors affidavits have been completed/notorized and filed with the Camden County Inspection Department. In addition, there will be properly constructed steps at least at one door for all inspections. There will be a port-a-potty on site before any work begins, as well as trash containment facilities. (NOTE: For new homes, submit manufacturers setup/ installation manuals to the Inspection Department, prior to the inspection).



  OWNER/RESPONSIBLE AGENT   DATE