Hallquist, Brian 77191C

WCAMA /-'DREDGE & FILL W ^77191 AR r y D
ENERAL PERMIT Provious permit #__
wv Moddication Complete Reissue Partial Reissue Date previous permit Issued
As authorized by the State of North Carolina, Department of Environmental Quality /✓} ,.yy ,,.
and the Coastal Resources Commission in an area of a TWO rental concern pursuant to ISA NCAC Q. ! (_t2'-,l/0-4--..Q. �(-f.• f ��' J
_�_.. �Rulas mtathwl
Applicant Name- V t � (() � Project Location: County
Address f 4 f
1061 bV I V Street Address/ State Road/ Lot #(s) rh ✓
City__ i(rI �J .L ll n State./` ZIPt�(,,tt�g ..
Phone # E-Mail Subdivision
Authorized Agent City ZIP
Affected CW ICIEW --k PTA - -\ ES PTS
AEC(s): OEA HHF IH U8A NA
PWS
ORWyvT no d PNA yes'-r7
Type of Project/ Activity ) S
Pier(dock)length ?c
Flied Platfomt(s) 6
Floating Platform(s) -
Finger pler(s)
Groin length
-autOper
Bulkh prap length
avg distance offshore '
max datarce offshore
t
Basin, channel
cubic yards -
Boat ramp _
Boathouse( Boatk(t
Beach Bulldozing
Other
r
Phone # ( ) River Basin
Adj. Wtr. Body �� I n (/C C� gnat o� unknl
Closest Maj. Wtc / " Body C:'-e{ v fr w,-
11,
k,
(t t(�r; t,��tti V.l u'�%jtf•J /y �')
Shoreline Length ;70
Spy; not sure yes (K) n
Moratorium: tJa yes no
Photos: no
Warver Attached- yes
A building permit may be required by: ..�d.4- "slLl-,if
( Note Local Planning Jurisdiction) r J
Notes/ Special fonditlons ul6ll.!/..-L.1•Cl_
r C• t r t.. _ 1 till t....
Agent Of ph nt Printed Name
or it,
Si¢natoet s' 95er.a aOn, _ ratan back of pe�
Tjjjw(%Q Cg
ApPlKacton Feids) (Ww k 9
d f
(Scale:
—/ —
Irtw )
f
X See note on back rogardmg krver Basin i ul,,
1.41 111 if
Permit Officer's Print ro
Signal re
Isst ng6: e
r"

WXGIGE
DREDGE &FILL l N9 7719] A B © D
RAL PERMITPrevious permit#
❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of enviro en al concern pursuant to 15A NCAC 074,1 O�V_� `t 0 • /
(�t2jRules attached.
Applicant Name bt' ) S Project Location: County
Address Q Street Address/ State Road/ Lot #(s)rJ�
City A"I Piifl StateA1_6 ZIP
Phone # ( E-Mail Subdivision
Authorized Agent CityZIP
❑CW
kEW
--tPTA tM ❑PTS
Affected
AEC(s):
❑ OEA
❑ HHF
❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW:
yes no
PNA yeso
Type of Project/
Activity
Vli7opou
Pier (dock) length
Fixed Platform(s) /
Floating Platform(s)
Finger pier(s)
Groin length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
✓
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other 'L,--he
,Pr
Shoreline Length
SAV: not sureTyesn(y
Moratorium: n/a
Photos:
Waiver Attached:
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions L&
s M!
g�10��,I19,, / s f
P,gent or , h nt Printed Name
Sig at ** P e read compliance statement on back of permit's*
Zur = 9Ys
Application Fee(s) Check#
Phone # (_) ^River Basin ea-,-
Adj. Wtr. Body GP` I AA oat unkn
Closest Mal. Wtr. Body /VJfAS e- , V4? J�--
r! ^ cJr
(Scale:) ✓ 3)
..I oc 4A r/ ' .
XSee note on back regarding River Basin rules.
Signat re -�
Issuing D e Ophatiorate
!Oy/

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
❑Tar -Pamlico River Basin Buffer Rules ❑ Other:
❑ Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office (910-796-7215) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ 1-8884RCOAST
Fax: [phone]
(Serves: Carteret, Craven, Onslow -
North of New fiver Inlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax:[phone]
(Serves: Brunswick, New Hanover,
Onslow - South of New River Inlet -
and Pander Counties)
http://portal. ncden r.org/web/cm/dcm-home
Revised 7/06/ 17

October 20, 2020
Brad Connell
NCDEO
400 Commerce Ave
Morehead City, NC 28557
Dear Brad Connell:
Enclosed is the CAMA permit signed as requested. Thank you for your assistance.
Sincerely,
Brian Jeff Hallquist
6oi6 CARDINAL DR NEW BERN, NC 28560 I BJKMHALL@a GMAIL.COM — 717-278-0680

Brian J Hallquist
6016 Cardinal Dr.
New Bern, NC 28560
October 15, 2020
Mr. Brad Connell
NC Division of Coastal Management
400 Commerce Ave.
Morehead City, NC 28557
Re: Bulkhead & Dock Replacement Permit Application
Dear Mr. Connell,
As per our email exchange please find enclose my application for replacing the bulkhead and
dock at my property. Also, please find a check in the amount of $600 payable to NCDEQ.
Thank you for your assistance,
Brian " eff" Hallquist

Fairfield Harbour Property Owners Association OFFICE USE ONLY
Application Submission Cover Sheet Permit #
Date Submitted
Print all information except signatures Date Returned
Section Number
Lot Number
a
5%
Owner Name(s):
_ —
(K
W
Fairfield Harbour Address:
Current Mailing Address:
fooiG L�+�ievs,/r�t �r
6m�F, L�r�o�.�risL 4Dr
/l�cW 3�.i✓ /11G a gSGd
/that✓ se�crrJ /I/ti 6tz� 6
Telephone Number:
j-a7
95
E-mail Address:
/
Tree Removal Permit
Residential Building Permit
Residential Building Permit - Small Project
Outbuilding
-.' House Addition
--� Driveway
O
' ' Fence
u_
Z
-' Landscape
Q
' Play Equipment
QWindows
(_)
Roof
J
' -' Siding
a
CL
- Painting
Q
' Deck
Other
' Waterfront Construction Permit
11 Certificate of Occupancy - Residential New Building
1 -' Request for Variance

I

Please take BEFORE AND AFTER PICTURES of the project and bring them into the POA
office, or email them to fhpoagen(o)suddenlinkmail com. Make sure you mark the photos with
your name, address, section and lot #.
Your project may require a County or other governmental permit. You are responsible for
obtaining any necessary governmental permit. Please contact the County for more information
prior to beginning work.
Owner Signatur Date C)
Twner Signature Date
A 30 DAY TURN -AROUND APPROVAL TIMEFRAME begins when a complete (including all
required documentation) and accurate application package has been submitted. Final review
and action by the Property Control Committee will not occur until all required documentation has
been provided.
Owner Signature Date
Owner Signatur4e t1t::: Date
CERTIFICATION
We, the undersigned, do hereby certify that we are familiar with the contents of the Declaration
of Restrictions, the Architectural Guidelines if applicable, Appendix A, and Exhibits A, B, C, and
D, and this application form. We acknowledge and promise to abide by the rules, policies and
agreements contained therein. We acknowledge and agree that should the PCC determine that
the undersigned's construction is in violation of such Restrictions and/or Guidelines, or is not in
compliance with the plans and specifications for the project as submitted to and approved by the
PCC, that the PCC will provide notification of the violation and may request the work be
stopped, other than action to correct the violation, and that, upon receipt of such a request, the
contractor and the owners shall promptly seek to correct or resolve any violation and/or
noncompliance. Failure to correct or resolve the issue may result in the Association seeking a
court order to have the violation corrected, which may halt construction, other than corrective
work, until the violation is cured.
Owner Signature G ppp Date /p •-/�
Owner Signature T � Date
Are you using a contractor?--': Yes I.- : No
Contractor Name and Title Fb)zv e'er--7Yr*z4l
Contractor Signature Date /O' r- x 0

Adjacent Riparian Property Owner's Statement
Adjacent Riparian Property Owner:
Section Number: Lot Number:_
Name: dA 5 =
Address: /g 04ma
Telephone Number: �,,� l1 30b
E-mail Address: _��
I hereby certify that I own the property adjacent to:
Section Number: _7 Lot Number:
Owners Name:
Address:
Telephone Number: �. / 7 7 R�
E-mail Address: �� �/j, 616�fl
The individual applying for this permit has described to me the scope of work as shown on the attached copy of the
"Description and Drawing of Proposed Work" form and have no objections to the proposed work. I understand that
docks, pilings, tie poles or another marine structure must beset back a minimum of fifteen feet (15'-0") from my
riparian line unless waived by me.
I do not wish to waive the setback requirement.
I do wish to waive the setback requirement.
Adjacent Riparian Property Owner:
Signature
Print NameV�
Date

Adjacent Riparian Property Owner's Statement
Adjacent Riparian Property Owner:
Section Number: _ 02 Lot Number:
Name: 3.?,n ✓ ,1 j7 l2
Address: /� <z
Telephone Number: 25 a - , i _ 77/(
E-mailAddress:
I hereby certify that I own the property adjacent to:
Section Number: Lot Number: 5_7
Owners Name: \, ��4Ep� f�
Address: j p// 9�W " i
Telephone Number:
E-mail Address:
The individual applying for this permit has described to me the scope of work as shown on the attached copy of the
"Description and Drawing of Proposed Work" form and have no objections to the proposed work. I understand that
docks, pilings, tie poles or any other marine structure must be set back a minimum of fifteen feet (I T-0") from my
riparian line unless waived by me.
✓ \ I do not wish to waive the setback requirement.
I do wish to waive the setback requirement.
Adjacent Riparian Prope Cvy r:
Signature
Print Name / \� (v f r
l
Date _ (!-�,

Description and Drawing of Proposed Work
Property Owner:
Section Number: v2 Lot Number:
Owners
Telephone Number: 7/7— 2}s3 _ 6ge
E-mail Address: ,,�f�r3rri
Contractor:
Company
Contact F
Address:
Telephone Number: — l 6 . ,575--
E-mail Address:
Detailed description of proposed work: //
-� tee. G2-t c�+ �ivvZi d`, ,.. �.DaN r�o G�at4t� i�jzo
,ao,-/z -/� Q6�
/7�i�-c�v( O�dvrS c!P
"To -scale" drawing of proposed work:
a. Lla-ck w dl o r '—/—C 3c>i7t- - Pgo
If
Nis✓ �1 r l� �t d s �-g/ dUl� 4 N !iC •(/%/v •BccC:cS

Dan Foley
816 Airport Rd
New Bern, NC28560
252-636-2515
for:
Customer Name
Brian Hallquist
6016 Cardinal Dr
New Bern, NC 28560
October 8, 2020
Property Address
Item#
Detailed Description
Amount
1
Owner will supply lower whaler.
Owner
2
Install 125'ft of bulkhead to FFH Spec. @ $186.00 per foot.
23,250.00
3
Excavator to install tie back rods.
1400.00
4
Remove existing dock and haul away.
495.00
5
Build new dock 6'ft x 20'ft frame only with boards on outside of piling and dock piling to
6ft over dock. (Owner will deck dock)
505.00
6
Two new outer piling 25'ft long 10" inch butt.
1200.00
7
Owner to supply all permits.
Owner
Note
Bid good for (7) days of contract date.
Note: If contact is by the hour on any of our equipment, the owner in encouraged to be on -
site to read the equipment meter reading on equipment or have someone else if they feel it
necessary.
Note: All piling are Bid with 81ft Penetration (required by NC Building Code) 16'ft being
the longest piling any longer required is a Change Order With Extra Charge will be
issued to the customer for signature.
Note: Owner is contractor and over see project.
Total
We hereby propose to famish material, labor & equipment of complete the above in
accordance with the specifications excluding items that maybe shown above as being
26,850.00
completed on a "Cost Basis" for the sum of.

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Pam(nt to be made as follows : (Made all payments payable to Dan Foley)
#
Terms
Amount
1
A beginning deposit in the amount of shall be paid to Dan Foley upon the execution this !�
agreement. 1 ' QSa
Wk
4500.00
2
A draw in the amount of shall be paid to Dan Foley at the time Equipment is on job site.
4000.00
3
A draw in the amount of shall be paid to Dan Foley at the time Material is on job site.
6000.00
4
A draw in the amount of shall be paid to Dan Foley request of productivity.
5000.00
5
A draw in the amount of shall be paid to Dan Foley request of productivity.
5000.00
6
The balance shall be paid in full to Dan Foley at time notified completion of the agreement. The
Owner's or agent should make arrangement for finial payment to be picked up, mailed or on-
site at the completion of the job.
2350.00
Material
All material are guaranteed to be specified, and the above work to be performed in accordance with standard practice
and drawing & specifications submitted for above work and completed in a substantial workman like manner.
Item# I Description I Dimensions I Retention Level
All specifications & code shall meet or exceed all State/Local requirements under the codes.
Change Orders
Any alteration or deviations from specifications involving extra cost will be executed and will become an extra charge
over and above this quote. At finial invoice with description of dock, bulkhead, poles and etc.
Before the work of any installation has commenced, Owner shall furnish Dan Foley with the location and character of
any underground wires, pipes, sewer, conduit, obstructions, other conditions or restrictions of any nature which might
interfere with or be damaged by the contractor's work or be cause or occasion of injuries or other damage. If owner
shall to do so, owner agrees to release, indemnity, save harmless & defend the Dan Foley from and against all liability,
loss, damage and expense caused or occasioned thereby.

Respectfully Submitted:
Dan Foley
816 Airport Rd
New Bern, NC 28560
/ 0 —
As owner (s) of the property to be improved, Uwe promise to pay the quoted price associated with the improvements to
be made. Payment shall be made according to payment schedule outlined above. Final payment is to be paid to
Dan Foley in full upon completion of the construction.
The above prices, specifications and conditions are satisfactory and hereby accepted. Uwe certify that we are the legal
Owners of this property and therefore you are authorized to complete the work as specified.
Payment will be made as outlined above
Accepted: Date:
Accepted: — Date:

Pion recorded in Book 3245,Page 672); that thervey
as drawn from information found'in Map
�j J4 J✓
Book 13, Page 5;
hat this survey is Of on existing parcel or parcels of land
d%(o
vge on existing street; and this map meets the
Ice for Laid Surveying in North Carolina (21 NCAC
S Ee rfr Oki
2014.
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Gicdo .rot�n�-/-o CArJ1,? -t- FF4 PoA- Spcc��ic.4-�'/ate'
LOA,—
4. "L "
tc5 Showvj
Iection 2 FAIRFIELD HARBOUR
laded X d X per Flood
00, Community Number
Effective Date: July 2,
Square Feet
)btained. DAK 9
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LINE
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V NAIL
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/FRIOOOPLAIN 80UNDARY
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2ND STORY DECK OVER ^Ui of
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incu�'leN, "" sign 6 5 7 6� 55 56 ,a. G.�----- 's
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Fairfield Harbour Waterfront Bulkhead Appearance Standards
Repair and maintenance of a refaced, wooden bulkhead requires that the property owner adhere to appearance
standards set by the Fairfield Harbour Property Control Committee. These standards require a bulkhead to remain in
its original alignment and that any added vertical posts be equally spaced and plumb. Materials and design
requirements are specified in the Fairfield Harbor Waterfront Regulations and Guidelines. The current edition of the
Fairfield Harbour Waterfront Regulations and Guidelines is available at http://tinyurl.com/yvg3b8
Minor repairs, such as tieback rod replacement, may mitigate more serious problems from developing in the future.
Broken tieback rods will result in bulging bulkhead walls and bowed walers. In severe cases the corrective repair of
this problem requires the removal of the concrete cap, removal of the original bulkhead and installation of a new
bulkhead in order to bring the bulkhead back into alignment.
Removal of the concrete cap is considered a major bulkhead repair by the POA and requires the addition of new 6" x
6" vertical posts, new tieback rods and new deadmen installed between all existing vertical posts to additional support
and bracing of the existing bulkhead. The maximum spacing (center to center) of all vertical posts on a repaired
existing bulkhead (new and existing) is 5'4". The concrete cap that is removed from the original bulkhead is usually
buried on -site .
Even though the removal of the existing concrete cap, addition of new 6"x6" vertical posts with new tieback rods and
new deadmen between existing vertical posts does not require a CAMA permit, it does require a "PCC Waterfront
Construction Permit".
The following bulkhead appearance standards must be met upon completion of the repair:
I. The existing wooden bulkhead must be brought back to its original alignment and position as when first
constructed in front of the original concrete bulkhead. On any straight sections, the repaired bulkhead must
be realigned in a straight line. Construction standard: +/- I" as measured from fronts of new and existing
vertical posts along entire length of wall.
1. New vertical posts are to be plumb. Construction standard: +/- 3/4" in 4'-0" as measured on sides of new
posts.
1. New vertical posts must be centered between existing vertical posts. Construction standard: +/- 2" as
measured between existing vertical posts.
1. New TV" cap board must be installed in a straight line for the entire length of the bulkhead. Construction
standard: +/- 3/4" as measured from front of new cap board along entire length of wall.
The physical condition of a bulkhead cannot always be accurately assessed prior to the start of repair work. Repair of
some vertical tongue & groove boards, addition of backftll, replacement of some existing vertical posts, tieback rods
and deadmen, or complete reconstruction of some bulkhead sections may be required. The property owner's
discovery of such conditions when affecting repairs does not relieve the property owner from adherence to these
appearance standards or from the necessity to obtain additional construction permits from the PCC or from CAMA.
Property Owner: 7 Contractor: (�
Signatur� Signature p
Print Name Print Name 7tw T -F01A-
Date 1C _.Q0 Date

PCC Waterfront Construction Permit Application Process
The current edition of the Fairfield Harbour Waterfront Regulations and Guidelines is available at
http://tinyurl.com/yvg3b8
The following is a list of documents that must be submitted with the Waterfront Permit Application:
1. The "PCC Waterfront Construction Permit Application" form. This form must be signed by the Owner and
Contractor. Attach a copy of the contractor's Certificate of Insurance with the property owner named as
Additional Insured.
1. A detailed description and a "to -scale" drawing(s) showing complete scope of work. Description and drawing
to show removal of any existing structure(s) and installation of any new structure(s), Drawing(s) to have all
necessary dimensions, including but not limited to, property lines, riparian lines, bulkheads, docks, tie poles,
piers, walkways and shoreline.
] . A signed copy of the "Adjacent Riparian Property Owners Statement" form from each adjacent property
owner. A signed copy of the "Description and Drawing of Proposed Work" form is to be attached to the
"Adjacent Riparian Property Owners Statement" form.
1. If an "Adjacent Riparian Property Owners Statement" needs to be mailed to an adjacent property owner, then
use the "Certified Mail - Return Receipt Requested - Adjacent Riparian Property Owners Statement". A
copy of the "Description and Drawing of Proposed Work" form is to be attached to the "Certified Mail -
Retum Receipt Requested - Adjacent Riparian Property Owners Statement" form.
If the "Certified Mail - Return Receipt Requested - Adjacent Riparian Property Owners Statement" is used,
then the following must be attached to the "PCC Waterfront Construction Permit Application":
a. A copy of the Certified Receipt from the post office signed by the adjacent property owner.
The original goes to CAMA if a CAMA permit is required.
b• A copy of the "Certified Mail - Return Receipt Requested - Adjacent
Riparian Property Owners Statement" form that was sent to the adjacent property owner.
b• A copy of the "Description and Drawing of Proposed Work" form that was
sent to the adjacent property owner.
5. A signed copy of the "Fairfield Harbour Waterfront Bulkhead Appearance Standards"
5. A signed copy of the "Permission to Use Adjacent Property" form (if applicable).
5. A signed copy of the CAMA permit (if required).
If a CAMA permit is required, contact CAMA at [phone] to schedule an on -site inspection. Signed
copies of "Adjacent Riparian Property Owners Statement" form(s) and/or "Certified Mail - Return Receipt
Requested - Adjacent Riparian Property Owners Statement" form(s) must be obtained prior to CAMA's site
visit.
5. The final permit application package should be sent or hand delivered to the POA Office. Review and
approval of the permit application may require up to 30 days depending upon completeness and accuracy of
the submitted application information.
5. If there are questions regarding the permit application process please call the POA office for Waterfront
Committee contact person referral.

PCC Waterfront Construction Permit Application
Property Owner:
Section Number: Lot Number:_
Owners Name:
Address: Z>D/6 CQ"—,-� ,F3rr,1 /l�t� Ss�a
Telephone Number: 7Z7 - a79 OF 840
E-mail Address: -Lik—mhrll Awld-aw
Contractor:
Company Name: C 2";z zZ ,rC
Contact Person: \ f%W }i %y
Address: &(e la ,Q/1J de, Qa- -6o
Telephone Number:
E-mail Address:
Dredging: Attach a copy of the "Description and Drawing of Proposed Work" form indicating area to be
dredged, depths of dredging, cubic yardage of dredged materials, how the dredged materials
will be removed from the site and where the dredged materials will be disposed.
V Docks: Attach a copy of the "Description and Drawing of Proposed Work" form.
//-
�i r
Maximum dock distance to the bulkhead or shoreline: / 8 feet/inches
Dock distance from Riparian Line (facing water from land): Left Side /$�' I feet/inches
Right Side S;!s: / feet/inches
r
Maximum distance from tie pole to bulkhead or shoreline: . 3�K/ feet/inches
Tie pole distance from Riparian Line (facing water from land): Left side �ifeet/inches
Right Side $* Ifeet/inches
Dock platform: Width _�� feet/inches, Length p96 feet/inches
i
Walkway/Pier: Width _�_ feet/inches, Length i9' �S' f feet/inches
p h p
Dock piling diameter p inches Tie pole diameter inches
Floating dock _Yes, No
JBulkheads: Attach a copy of the "Description and Drawing of Proposed Work" form.

Repair to existing bulkhead Yes _ No Re'r ave— 4
Removal and reconstruction of existing bulkhead ✓ Yes, _ No
Length of bulkhead to be repaired or replaced _1A�K rfeet/inches
Existing concrete cap and/or cement bulkhead removed Yes, No ��rrid u6/yy
Backfill required —Yes, ---,, No
Length of bulkhead behind a walkway or dock: feet/inches
A Certificate of Completion is required upon completion of work. An inspection will be made to verify that the
completed work complies with the scope of work identified on the "Description and Drawing of Proposed Work"
form, the "Fairfield Harbour Waterfront Guidelines and Regulations" and approved changes to the work (if
any). Upon completion of work the Owner or Contractor is to contact the PCC Waterfront Committee to schedule
this inspection.
The Contractor is to carry liability insurance with a minimum $1,000,000.00 coverage. Attach to this application a
copy of the Contractor's Certificate of Insurance with the property owner listed as "Additional Insured".
I understand that I am responsible for any damage to an adjacent lot caused by construction activity. I agree to repair
restore any damage to its original condition to the satisfaction of the owner of the adjacent property.
I certify that the "Fairfield Harbour Waterfront Guidelines and Regulations" will be adhered to on this project
and that any deviation to the "Fairfield Harbour Waterfront Guidelines and Regulations" requires review and
approval from the Property Control Committee and the PCC Waterfront Committee.
I also certify that the wood to be used on this project complies with Tables D-2 and D-4 in Appendix D of the
"Fairfield Harbour Waterfront Guidelines and Regulations".
Property Owner's
Contractor's Sigm
Date
Date /U-7-20

Permission to Use Adjacent or Other Property
Initiating property owner seeking permission to utilize adjacent or other property:
Section Number: Lot Number:
Owners Name:
Address:
E-mail: ... // (
Telephone Number: y j 7 - _R 7,q _ e>d&O
Adjacent owner or other owner of lot to be utilized:
Section Number: Lot Number:..
Owners Name: 42hz_ � 1)
Address: lea /& /1
r'-
E-mail: //n/.fi��✓ n/ .il tr
Telephone Number:
As the initiating property owner, I understand that I am responsible for any damage to the lot identified above caused
by any activity of the contractor. I agree to repair any damage to the ground and ground cover by regrading and
seeding, and, if waterfront property, sodding any areas within 40 feet of the water. I have attached a copy of the
"Description and Drawing of Proposed Work" form for the adjacent or other property owner's information.
Initiating Property Owner:
10,
Signatur - a
Print Name
Date
Adjacent or Other Property Owner:
I agree to allow my property, as identified above, to be used during the course of construction with the understanding
that any damage will be repaired as stated above.
Signature J /��
Print Name
Date /e,�-

Permission to Use Adjacent or Other Property
Initiating property owner seeking permission to utilize adjacent or other property:
Section Number: ^ Lot Number: _�j z_
Owners Name:
Address: is_ r%ris�l�iL �f-
E-mail: �_h, f
Telephone Number: -7/9--C-)76F 04,&9
Adjacent owner or other owner of lot to be utilized:
Section Number: Lot Number:
Owners Name:
Address: /y �f��;�,rl✓}G-���
E-mail: -ems ✓ 'j-, i_- _ _
Telephone Number: -R - -7 7/C
As the initiating property owner, I understand that I am responsible for any damage to the lot identified above caused
by any activity of the contractor. I agree to repair any damage to the ground and ground cover by regrading and
seeding, and, if waterfront property, sodding any areas within 40 feet of the water. I have attached a copy of the
"Description and Drawing of Proposed Work" form for the adjacent or other property owner's information.
Initiating Property Owne� V
Signature
Print Name l'
Date /y - /4_ �2�
Adjacent or Other Property Owner:
I agree to allow my prop , as t fied
that any damage will be aired as stated
Signature
Print Name A I ✓ V)9 r
Date kks % (i --2-Q
used during the course of construction with the understanding