SC_13-16_ Bass (2)

Issued by WiRO SC13-16
Surf City Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT
as authorized by the State of North Carolina, Department of Environment,
and Natural Resources and the Coastal Resources Commission for development
in an area of environment concern pursuant to Section 113A-118 of the
General Statutes,"Coastal Area Management"
Issued to Lloyd Roger Bass authorizing development in the Estuarine Shoreline Area of Environmental Concern (AEC)
at 104 Pender Avenue, in Surf City, Pender County as requested in the permittee's application package, dated June 24,
2013 and received by DCM on July 16, 2013. This permit, issued on August 6, 2013, is subject to compliance with the
application and site drawing (where consistent with the permit), all applicable regulations and special conditions and
notes set forth below. Any violation of these terms may subject permittee to a fine, imprisonment or civil action, or may
cause the permit to be null and void.
This permit authorizes: Relocation of a single-family residence within amenities. Install new pilings.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s)dated received July 16, 2013.
(2) All construction must conform to the N.C. Building Code requirements and all other local, State and Federal regulations,
applicable local ordinances and FEMA Flood Regulations.
(3) Any change or changes in the plans for development, construction, or land use activities will require a re-evaluation and
modification of this permit.
(4) A copy of this permit shall be posted or available on site. Contact this office at [phone] for a final inspection at
completion of work.
(Additional Permit Conditions on Page 2)
RED Nr
DCM VVILMING�t'NN,
This permit action may be appealed by the permittee or other qualified persons
within twenty (20) days of the issuing date. From the date of an appeal, any AUG
work conducted under this permit must cease until the appeal is resolved. This
permit must be on the project site and accessible to the permit officer when the
project is inspected for compliance. Any maintenance work or project Jason Dail
modification not covered under this permit, require further written permit CAMA OCAL PERMIT OFFICIAL
approval.All work must cease when this permit expires on:
127 Cardinal Drive Extension
December 31,2016 Wilmington, NC 28405-3845
In issuing a this permit it is agreedo thatn this.proThis t is mayent with e the local Landdt — �JJ1�.n/,i�
Use Plan and all applicable ordinances. This permit not be transferred to � 1/

Name: Lloyd Roger Bass
Minor Permit#SC13-16
Date: August 6, 2013
Page 2
(5) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Disturbed areas shall be vegetate and stabilized (planted and
mulched)within 14 days of construction completion.
(6) The amount of impervious surface/coverage shall not exceed 30% within 75 feet of the Normal High Water line. In
this case, all impervious coverage on the property shall be limited to less than 835 square feet.
(7) Any proposed for grading within the 30' buffer from the Normal High Water level must be contoured to prevent
additional stormwater runoff to the adjacent marsh. This area shall be immediately vegetatively stabilized, and must
remain in a vegetated state.
(8) Unless specifically allowed in 15A NCAC 07H. 0209(d)(10), and shown on the permitted plan drawing, all
development/construction shall be located a distance of 30 feet landward of the Normal High Water line.
(9) Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold or otherwise
disposed of to a third-party.
SIGNATU DATE: / o r 3
PER I E
RE LM{N`G ONN,, NC
DCM W
AU G 1 5 2u13

Issued by WiRO SC13-16
Surf City Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT
as authorized by the State of North Carolina,Department of Environment,
and Natural Resources and the Coastal Resources Commission for development
in an area of environment concern pursuant to Section 113A-118 of the
General Statutes,"Coastal Area Management"
Issued to Lloyd Roger Bass authorizing development in the Estuarine Shoreline Area of Environmental Concern (AEC)
at 104 Pender Avenue, in Surf City, Pender County as requested in the permittee's application package, dated June 24,
2013 and received by DCM on July 16, 2013. This permit, issued on August 6, 2013, is subject to compliance with the
application and site drawing (where consistent with the permit), all applicable regulations and special conditions and
notes set forth below. Any violation of these terms may subject permittee to a fine, imprisonment or civil action, or may
cause the permit to be null and void.
This permit authorizes: Relocation of a single-family residence within amenities. Install new pilings.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s)dated received July 16, 2013.
(2) All construction must conform to the N.C. Building Code requirements and all other local, State and Federal regulations,
applicable local ordinances and FEMA Flood Regulations.
(3) Any change or changes in the plans for development, construction, or land use activities will require a re-evaluation and
modification of this permit.
(4) A copy of this permit shall be posted or available on site. Contact this office at [phone] for a final inspection at
completion of work.
RECEIVED
(Additional Permit Conditions on Page 2) DCM WILMINGTON, NC
AUG 152013
This permit action may be appealed by the permittee or other qualified persons
within twenty (20) days of the issuing date. From the date of an appeal, any
work conducted under this permit must cease until the appeal is resolved. This
permit must be on the project site and accessible to the permit officer when the
project is inspected for compliance. Any maintenance work or project Jason Dail
modification not covered under this permit, require further written permit CAMA OCAL PERMIT OFFICIAL
approval.All work must cease when this permit expires on:
127 Cardinal Drive Extension
December 31,2016 Wilmington, NC 28405-3845
In issuing this permit it is agreed that this project is consistent with the local Land
Use Plan and all applicable ordinances. This permit may not be transferred to

Name: Lloyd Roger Bass
Minor Permit#SC13-16
Date: August 6, 2013
Page 2
(5) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Disturbed areas shall be vegetate and stabilized (planted and
mulched)within 14 days of construction completion.
(6) The amount of impervious surface/coverage shall not exceed 30% within 75 feet of the Normal High Water line. In
this case,all impervious coverage on the property shall be limited to less than 835 square feet.
(7) Any proposed for grading within the 30' buffer from the Normal High Water level must be contoured to prevent
additional stormwater runoff to the adjacent marsh. This area shall be immediately vegetatively stabilized, and must
remain in a vegetated state.
(8) Unless specifically allowed in 15A NCAC 07H. 0209(d)(10), and shown on the permitted plan drawing, all
development/construction shall be located a distance of 30 feet landward of the Normal High Water line.
(9) Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold or otherwise
disposed of to a third-party.
SIGNATURE;,/ � �^"� DATE:
c ( O (3
ERMITTEE

ATA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E.Skvarla, III
Governor Director Secretary
August 6, 2013
Mr. Lloyd Roger Bass
3079 3rd Street
Surf City, NC 28445
Dear Mr. Bass:
Attached is CAMA Minor Development Permit# SC 13-16 for work to be done at 104 Pender Avenue,
in Surf City, Pender County.
In order to validate this permit, please sign both copies of the permit as indicated for our records.
Please retain the gold copy for your files and sign front and back of the white copy then return to us within
20 days of receipt, in the enclosed, self-addressed envelope.
This is not a valid permit until it is signed and returned to our office.
Thank you for your prompt attention to this matter.
Sincerely,
Shaun K. Simpson
Permit Support Technician
Enclosures
cc: WiRO files
127 Cardinal Drive Ext.,Wilmington, NC 28405
Phone:[phone]\FAX:[phone] Internet:www.nccoastalmanagement.net

S
CAletit--del-7. PA/
AFFIDAVIT OF PUBLICATI0k5
1
STATE OF NORTH CAROLINA 64.120
i ' 7
COUNTY OF NEW HANOVER ',r / : / 6'
1- l % rfN
Before the undersigned,a Notary Public of Said c&nty and State,
CAMA MINOR PERMIT NOTICE
Pursuant to NCGS 113A-119(b), the
North Carolina Division of Coastal Anita Thomas
Management,an agency authorized
to issue CAMA permits in areas of
environmental concern, hereby
gives NOTICE that the following ap- Who,being duly sworn or affirmed,according to the law,says that he/she is
plied for CAMA permits in Onslow
County:In Surf City on July 9,2013,
asmes roof at 6020 proposed
St.,adjacentto to
replace
Publisher's Assistant
canal off Stump Sound. In North
Topsail Beach,on July 16,2013,Wil-
liam Lucas proposed to enclose a of THE STAR-NEWS, a corporation organized and doing business under the Laws of the State of
deck at 235 Sandpiper Lane, adja- North Carolina,and publishing a newspaper known as STAR-NEWS in the City of Wilmington
cent to Stump Sound, and on July
18, 2013, Ronnie L. Henderson pro-
posed to construct a single-family CAMA MINOR PERMIT NOTICE Pursuant to NCGS 113A-119b,the North Carolina Division
dwelling at 1208 New River Inlet
Rd.,adjacent to the Atlantic Ocean. of Coastal Management,an agency authorized to issue CAMA permits in areas of
16,2 13rf ,Lloyd R. Bass Pender uproposed`�to environmental concern,hereby gives NOTICE that the following applied for CAMA permits in
replace house pilings at 104 Pender Onslow
Ave., adjacent to Topsail Sound
Creek; and on July 17, 2013, Evan . •
Ashkin proposed to construct a
deck and access stairs at 1106 S.
Shore Dr., adjacent to the Atlantic
Ocean.The applications may be in-
spected at the address below. Pub-
lic comments received by August 6,will be considered. Later newspaperin space,was inserted in the aforesaid news a and on dates as follows:
2013
comments will be accepted and
considered up to the time of permit
decision. Project modifications may 7/22 lx
occur based on further review and
comments. Notice of the permit de-
cision in this matter will be pro-
vided upon written request.
Jason Dof,Field Re
l Maresentative nagement And at the time of such publication Star-News was a newspaper meeting all the requirements and
Divi127 Cardinal Drive Extension qualifications prescribed by Sec.No. 1-597 G.S.of N.C.
Wilmington,NC 28405-3845
Phone:[phone]
/)
Title:Publisher's Assistant
Sworn or affirmed to,and subscribed before me this day of
,A.D., lO l3
weasaA�
In estit;ny Whereof,I have hereunto set my hand and affixed my offlgidf`�eal�tJ;e d r4,nod
year aforesaid. ."*�'' �QA/�`
U� e. 4 ii4,-.9 �®TA R y i
:.tary P licI
My commission expires I OA day of , 20 N) �.L ClB L1
/
Upon reading the aforegoing affidavit with the advertisement thereto annexed it is adjudged by the Court that friZ.-ss'aid
publication was duly and properly made and that the summons has been duly and legally served on the defendant(s).
This day of ,
Clerk of Superior Court
MAIL TO: .• }_i EIVED
DCM WILMINGTON, NC

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory, Braxton C. Davis John E. Skvarla, Ill
Governor Director Secretary
July 19,2013
Advertising @ starnewsonline.com
2 Pages
Star News
Legal Advertisement Section
Post Office Box 840
Wilmington,North Carolina 28402
Re: Minor Public Notice Combo:
• Bass &Ashkin/Pender Co.
• Barnhill, Lucas, and Henderson/Onslow Co.
Kyle/Heather: Please publish the attached Notice in the Monday,July 22, 2013 issue.
The State Office of Budget and Management requires an original Affidavit of Publication prior to
payment for newspaper advertising.
Please send the original invoice and a copy of the affidavit for payment to Shaun Simpson at Division of
Coastal Management, 127 Cardinal Drive Extension,Wilmington,NC 28405, 910-796-7226.
Paying by Credit Card (number on file with Elsa Lawrence, Ref acct # 796-7215). Please send a fax of the
credit card receipt to me.
Thank you for your assistance in this matter. If you should have any questions, please contact me at our
Wilmington office. •
Sincerely,
/ J
Shaun Simpson7741)/Z1—'
Permit Support Tec
Enclosure •
cc: File Copy
127 Cardinal Drive Ext.,Wilmington,NC 28405
OL........(Hn 7M 701C 1 CAV.(HA 9CICAOCA Interne!•unu.0 nnnnnetnlmnnonnmont nest

CAMA MINOR PERMIT NOTICE
Pursuant to NCGS 113A-119(b), the North Carolina Division of Coastal Management, an
agency authorized to issue CAMA permits in areas of environmental concern, hereby gives NOTICE
that the following applied for CAMA permits in Onslow County: In Surf City on July 9, 2013, James
Barnhill proposed to replace a roof at 6020 6lh St., adjacent to a canal off Stump Sound. In
North Topsail Beach, on July 16, 2013, William Lucas proposed to enclose a deck at 235
Sandpiper Lane, adjacent to Stump Sound, and on July 18, 2013, Ronnie Henderson proposed
to construct a single-family dwelling at 1208 New River Inlet Rd., adjacent to the Atlantic
Ocean. In Surf City, Pender County: On July 16, 2013, Lloyd R. Bass proposed to replace
house pilings at 104 Pender Ave., adjacent to Topsail Sound Creek; and on July 17, 2013, Evan
Ashkin proposed to construct a deck and access stairs at 1106 S. Shore Dr., adjacent to the
Atlantic Ocean. The applications may be inspected at the address below. Public comments received
by August 6, 2013 will be considered. Later comments will be accepted and considered up to the
time of permit decision. Project modifications may occur based on further review and comments.
Notice of the permit decision in this matter will be provided upon written request.
Jason Dail
Field Representative
Division of Coastal Management
127 Cardinal Drive Extension
Wilmington, NC 28405-3845
Phone: [phone]

NOTICE
CAMA PERMIT
APPLIED FOR
PROJECT: A • • . I • I • * - - - • - • - I - - - ing
house pilings at 104 Pender Ave., adjacent to
i County.
COMMENTS ACCEPTED THROUGH August 6, 2013
APPLICANT: FOR MORE DETAILS CONTACT
THE LOCAL PERMIT OFFICER BELOW:
Lloyd Roger Bass NC Div. of Coastal Management
3079 3' Street 127 Cardinal Dr. Ext.
Surf City, NC 28445 \�.i Wilmington, NC 28405
Jason Dail, Field Representative
910-796-7215

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GENERAL INFORMATION
LAND OWNER Name 2-i--a d gorier (3Q55
Address .?U ^7 9 3 rd. �`t c." l�T. �-
City Ls t C. kl State jJ C Zip 2811 1 S Phone 9 IC S I Z- 631 y
Email
AUTHORIZED AGENT
Name
Address
City State Zip Phone
Email
LOCATION OF PROJECT:(Address,street name and/or directions to site.If not oceanfront,what is the name of the
adjacent waterbody.) /o q P er (Aut. <u r-C 'Ca7 — Ti,p 54' 1 -So u.^d C i tk_
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) ?'--41-:an fle.4 ` 1,nc,
k�A.er lek.I� ho .(<
SIZE OF LOT/PARCEL: j 1. c 3 (/ square feet i) , 2.,?O acres
PROPOSED USE: Residential 0 (Single-family[f Multi-family ❑ ) Commercial/Industrial 0 Other ❑
COMPLETE EITHER(1)OR(2)BELOW(Contact your Local Permit Officer if you are not sure which AEC applies
to your property):
(1) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: f1:4
1 square feet(includes
air conditioned living space,parking elevated above ground level,non-conditioned space elevated above ground level but
excluding non-load-bearing attic space)
1' <- 5y FT
O0ASTAL SHORE AECs: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
i SURFACES: -.-.-.. are feet(includes the area of the roof/drip line of all buildings,driveways,covered decks,
)
concrete or masonry patios,etc. that are within the applicable AEC.Attach your calculations with the project drawing.)
STATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area subject to a State Stormwater
Management Permit issued by the NC Division of Water ality L 7
as NO DCM WILMINGTON NC �; G
f yes, list the total built upon area/impervious surfatO lipOd our lot or parcel: / square feet.

OTHER PERMITS MAY BE REQUIRED:The activity you are planning may require permits other than the CAMA
minor development permit,including,but not limited to:Drinking Water Well,Septic Tank(or other sanitary waste
treatment system),Building,Electrical,Plumbing,Heating and Air Conditioning,Insulation and Energy Conservation,FIA
Lertification, Sand Dune,Sediment Control, Subdivision Approval,Mobile Home Park Approval,Highway Connection,and
others. Check with your Local Permit Officer for more information.
STATEMENT OF OWNERSHIP:
I,the undersigned,an applicant for a CAMA minor development permit,being either the owner of property in an AEC or a
person authorized to act as an agent for purposes of applying for a CAMA minor development permit,certify that the person
listed as landowner on this application has a significant interest in the real property described therein.This interest can be
described as:(check one)
57
an owner or record title,Title is vested in l-t-o G� lg o c e r t�r15> ,see Deed Book 3
page 2 S(' in the 4,_ ,<J c'r Count) Registry/of Deeds. 3 4/2 y
2-21'
an owner by virtue of inheritance.Applicant is an heir to the estate of
probate was in County.
if other interest,such as written contract or lease,explain below or use a separate sheet&attach to this application.
NOTIFICATION OF ADJACENT PROPERTY OWNERS:
I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that I have given
ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
(Name) (Address)
(1) Chc.rle5 -Tu,c,- e 120E Ne Pc- Sus Cr4
(2) D(\ i/a u-t P S "7 2 L5 lair( r--t s v; Ile_ 6 02- ern
(3) lc/- %.n�,1tt�,� CvC
(4)
ACKNOWLEDGEMENTS:
I, the undersigned,acknowledge that the land owner is aware that the proposed development is planned for an area which
may be susceptible to erosion and/or flooding.I acknowledge that the Local Permit Officer has explained to me the particu-
lar hazard problems associated with this lot.This explanation was accompanied by recommendations concerning stabiliza-
tion and floodproofing techniques.
I furthermore certify that I am authorized to grant,and do in fact grant,permission to Division of Coastal Management staff,
the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information
related to this permit application. , M N TQEL)
N, ,
This the 2 H day of ,20 j'UL 1 6 2D13
..andowner or rson authorized to 's/her agent for purpose of filing a CAMA permit application
''his application includes:general information (this form), a site drawing as described on the back of this application, the
iwnership statement, the Ocean Hazard AEC Notice where necessary, a check for$100.00 made payable to the locality, and
ny information as may be provided orally by the applicant. The details of the application as described by these sources are
7corporated without reference in any permit which may be issued.Deviation from these details will constitute a violation of
ny permit.Any person developing in an AEC without permit is subject to civil, criminal and administrative action.

Receipts for
Certified Mail
'Stapre here)
7- / - 2o13
Date
1cm vc,_Aft^Ms
Adjacent Property Owner
-72-2c bo. arts',Ile dui Qw•c
Mailing Address
It h 1 vnbet 16e% Iv.C- 223 403
City, State,Zip Code
Dear Adjacent Property:
This letter is to inform you that I, Z L- cj d Ro y'Q!` ems have applied for a CAMA Minor
/ Property Owner Permit on my property at /b Z/. Pc_i4 e r iA✓t` <,u tp
� Cv-t-i ,in Pe i/Onslow
Property Address
County. As required by CAMA regulations, I have enclosed a copy of my permit application and project
drawing(s)as notification of my proposed project.No action is required from you or you may sign and return
the enclosed no objection form. If you have any questions or comments about my proposed project,please
contact me at 910 5-1 i' O 34y ,or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the Surf City CAMA Minor Permit Program,you may submit
them to:
Jason Dail,Field Representative
NC Division of Coastal Management
Town of Surf City Local Permit Program
127 Cardinal Drive Extension
Wilmington,NC 28405
Since ly,
Property er
30 7 3r4 S{'
Mailing Address
S us-C ('aka-( jJ , C. 1$4 NS
City, State,Zip Cone RECEIVE D
DCM WILMINGTON, NC
JUL 16 2013

• - • • - - TM
CERTIFIED MAILTM RECEIPT
u7 (Domestic Mail Only;No Insurance Coverage Provided)
HR
R! For delivery Information visit our website at www.usps.com®
rn WILttINGTON NC 2803:
H
m $1.52 0445
Postage $
Certified Fee $3.10 05
rn Postmark
p Return Receipt Fee $0.00 Here
p (Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
p•�l�
- Total Postage&Fees $ $4.62 07/12/2013
Sent To ti
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Street,Apt.o �. �� � 7
or PO Box No. ? 2S �c' // tale Ae geS
f`-
City,Sta ZIP+4
paggif;wViLam„-,s 40f7 (.. L L �Llo3

',ertified Mail Provides:
I A mailing receipt
I A unique identifier for your mailpiece
I A record of delivery kept by the Postal Service for two years
mportant Reminders: r' •
I Certified Mail may ONLY be combined with First-Class Mail®or Priority Mailt
I Certified Mail is notavailable for any class of international mail.
I NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. Foi
valuables,please consider Insured or Registered Mail.
I For an additional fee,a Return Receipt may be requested to provide proof of
delivery.To obtain Return Receipt service,please complete and attach a Return
Receipt(PS Form 3811)to the article and add applicable postage to cover the
fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for
a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is
required.
I For an additional fee, delivery may be restricted to the addressee of
addressees authorized agent.Advise the clerk or mark the mailpiece with the
endorsement"Restricted Delivery".
r If a postmark on the Certified Mail receipt is desired,please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed,detach and affix label with postage and mail.
MPORTANT: Save this receipt and present it when making an inquiry.
'S Form 3800,August 2006(Reverse)PSN 7530-02-000-9047

Receipts for
Certified Mail
(Staple Here)
!- 2b13
Date
nick r IDS Tufr.e.r
Adjacent Property Owner
IvD'd w NeLI IZiVC_ pr
Mailing Address N C. Z N4c
City, State,Zip Code
Dear Adjacent Property: ff ��G
This letter is to inform you that I, L Le 'Property
" 1 Qc S5 have applied for a CAMA Minor
roperty Owner
Permit on my property at /P 1 P 4er A u e_ S(C� (\\y ,in Ender/Onslow
Property Address
County. As required by CAMA regulations, I have enclosed a copy of my permit application and project
drawing(s)as notification of my proposed project. No action is required from you or you may sign and return
the enclosed no objection form. If you have any questions or comments about my proposed project, please
contact me at $D 512_ 639(1+ ,or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the Surf City CAMA Minor Permit Program,you may submit
them to:
Jason Dail,Field Representative
NC Division of Coastal Management
Town of Surf City Local Permit Program
127 Cardinal Drive Extension
Wilmington, NC 28405
Sincer ly,
Property er
3,0 `/ 3r) 5- -
Mailing Address
1VC'i (
City, State,ZipC RECEIVED ty
DCM WILMINGTON, NC
JUL16 2013

■� , - • . ATM
CERTIFIED MAILT,., RECEIPT
ti (Domestic Mail Only;No Insurance Coverage Provided)
U
ZI For delivery Information visit our website at www.usps.coms
TI .t +
T Postage MEM
Certified Fee
$3.10 05
T1 Postmark
Return Receipt Fee $0.Ciii Here
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required) #�'�I�
$4.62 07/12/2013
7• Total Postage&Fees $
rrt
ru Sent To
C1tav(es rrdrnec
Street Apt.No.;
or PO Box No. t 2(2g itI r.cJ f•. //C pI Or
City,State,z/P+a r r(I 1 L C Z o O U,(`

;edified Mail Provides:
A mailing receipt
i A unique identifier for your mailpiece
i A record of delivery kept by the Posta„Service for two years
nportant Reminders:
r Certified Mail may ONLY be combined with First-Class Mail®or Priority Mello
r Certified Mail is not available for any class of international mail.
r NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables,please consider Insured dr Registered Mail.
r For an additional fee,a Return Receipt may be requested to provide proof of
delivery.To obtain Return Receipt service,please complete and attach a Return
Receipt(PS Form 3811)to the article and add applicable postage to cover the
fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for
a duplicate return receipt,a USAS®postmark on your Certified Mail receipt is
required.
I For an additional fee, delivery may be restricted to the addressee or
addressee's`authorized agent.Advise the clerk or mark the mailpiece with the
endorsement"Restricted Delivery".
I If a postmark on the Certified Mail receipt is desired,please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed,detach and affix label with postage and mail.
MPORTANT:Save this receipt and present it when making an inquiry.
'S Form 3800,August 2006(Reverse)PSN 7530-02-000-9047

U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008
.\ai,onal hMor d Insurance Program Important: Read the instructions on pages 1-9. Expiration Date:July 31,2015
SECTION A-PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name LLOYD ROGER BASS Policy Number:
A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Company NAIC Number.
104 PENDER AVENUE
City SURF CITY State NC ZIP Code 28445
A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description.etc.)
0.230 ACRE TRACT ON PENDER AVENUE, RECORDED IN D.B.3359, PG.256&D.B. 3424,PG.276 PENDER COUNTY
A4. Building Use(e.g.,Residential,Non-Residential.Addition.Accessory,etc.)RESIDENTIAL
A5. Latitude/Longitude: Lat.34d26'32"N Long.77d31'24'W Horizontal Datum: ❑ NAD 1927 ® NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 5
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) N/A sq ft a) Square footage of attached garage N/A sq ft
b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage
or enclosure(s)within 1.0 foot above adjacent grade 0 within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes ® No
SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION
B1. NFIP Community Name&Community Number B2. County Name B3.State
TOWN OF SURF CITY 370186 PENDER NORTH CAROLINA
B4. Map/Panel Number B5.Suffix B6. FIRM Index Date B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s)(Zone
3720424500 K 02/16/07 Effective/Revised Date Zone(s) AO,use base flood depth)
11/03/05 AE 11.0
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item 139: ❑ NGVD 1929 ® NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes ® No
Designation Date: ❑ CBRS ❑ OPA
SECTION C-BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based on: ® Construction Drawings* ❑ Building Under Construction` ❑ Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations-Zones Al-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO. Complete Items C2.a-h
below according to the building diagram specified in Item A7. In Puerto Rico only.enter meters.
Benchmark Utilized: RM2 Vertical Datum: NGVD 1929
Indicate elevation datum used for the elevations in items a)through h)below. 0 NGVD 1929 ® NAVD 1988 0 Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a)Top of bottom floor(including basement.crawlspace,or enclosEaECEIVED 14.0 Z feet ❑meters
b)Top of the next higher floor DCM WILMINGTON ft El feet ❑meters
c) Bottom of the lowest horizontal structural member(V Zones only) ' ❑feet ❑meters
d)Attached garage(top of slab) JUL 1 6 2013 N. (2 feet ❑meters
e) Lowest elevation of machinery or equipment servicing the building 12.1 ®feet ❑meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent(finished)grade next to building(LAG) 4.2 ®feet ❑meters
g) Highest adjacent(finished)grade next to building(HAG) 4.3 ®feet ❑meters
h)Lowest adjacent grade at lowest elevation of deck or stairs,including structural support N.A ❑feet ❑meters
SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer, or architect authorized by law to certify elevation WO. -'M
information./certify that the information on this Certificate represents my best efforts to interpret the data available. ��N Ce n�S4
I understand that any false statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001. • • , '....7c
® Check here if comments are provided Nr Were latitude and longitude in Section A provided by a •�,C) •• t �/
❑ Check here if attachments. e- '(�1's �!77, licensed land surveyor? ® Yes ❑ No ?'QQO E �
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Certifier's Name JAMES A. LEWIS,#•It►'•. Ott • .s, License Number L-4562 ; SEAL i •
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Title PROJECT MANAGER $ •
CseAgy Namk CtRLES F. RIGGS&ASSOCIATES. INC. •
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Address 502 NEW BRIDGE STRUT: ti44562CSONLILLE State NC ZIP Code 28540 �.1,9 $ .y,�
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IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit,Suite.and/or Bldg. No.)or P.O. Route and Box No. Policy Number:
104 PENDER AVENUE
City SURF CITY State NC ZIP Code 28445 Company NAIC Number:
SECTION D—SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official, (2)insurance agent/company.and(3)building owner.
Comments DWELLING IS PROPOSED ONE STORY ON PILES,OPEN BELOW. THE TOWN OF SURF CITY ADDS A 1.0'FREEBOARD TO THE BASE
FLOOD ELEVATION,THEREFORE THE ELEVATION OF THE FINISH FLOOR AND THE LOWEST ELEVATION OF THE MACHINERY OR EQUIPMENT
SERVICING THE BUILDING MUST HAVE AN ELEVATION OF ATLEAST 11.0' + 1.0' = 12.0'(PROPOSED FINISH FLOOR=14.0';PROPOSED BOTTOM
OF HEAT PUMP= 2.1') sNNlil.
,-L. "I $' cA R . z 1Signature �` •''•E3.SIp'� Oat
SECTION E—BUILDING ELEVATIO=INFbRM/Ma(SURVEY OT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE),complete Soms€fES If he Ce - - ite i intended to support a LOMA or LOMR-F request,complete Sections A,B,
and C. For Items El—E4, use natural grade, if droailabte. eck the s e nt used. In Puerto Rico only,enter meters.
•El. Provide elevation information for the follow aq•�bhgr •( ,ap i�te boxes to show whether the elevation is above or below the highest adjacent
grade(HAG)and the lowest adjacent grade(t -40 fL,�G��•`
a)Top of bottom floor(including basement,crawiffgloStire)is ❑feet ❑meters ❑above or❑below the HAG.
b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters 0 above or❑ below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions),the next higher floor
(elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or ❑ below the HAG.
E3. Attached garage(top of slab)is . ❑feet ❑meters ❑ above or ❑below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is ❑feet ❑meters ❑above or❑below the HAG.
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management
ordinance? ❑Yes ❑ No ❑ Unknown.The local official must certify this information in Section G.
SECTION F—PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B,and E for Zone A(without a FEMA-issued or community-issued BFE)
or Zone AO must sign here.The statements in Sections A, B,and E are correct to the best of my knowledge.
Property Owner's or Owner's Authorized Representative's Name
---------.---------
Address City State ZIP Code
Signature Date Telephone
Comments
❑Check here if attachments.
SECTION G—COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G
of this Elevation Certificate.Complete the applicable item(s)and sign below.Check the measurement used in Items G8—G10. In Puerto Rico only,enter meters.
G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who
is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO.
G3. ❑ The following information(Items G4—G10)is provided for community floodplain management purposes.
G4.Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued
G7. This permit has been issued for: ❑ New Construction ❑Substantial Improvement
G8. Elevation of as-built lowest floor(including basement)of the building. ❑feet ❑meters Datum
G9. BFE or(in Zone AO)depth of flooding at the building site: . ❑feet ❑ meters Datum
G10.Community's design flood elevation: . ❑feet ❑meters Datum
Local Official's Name Title
RECEIVED
Community Name DCM WILMINGTON, NC Telephone
Signature Date
JUL 16 2013 ----__--
Comments
0 Check here if attachments.

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LLOYD ROGER BASS 1359
PH.910-328-3078
3079 3RD ST 66-112/531
SURF CITY,NC 28445-8628 /
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BB&T BRANC V BANKMOKAND TRUST
BBT BBT.COMPANY
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