SC_18-04_ Pelon (2)

Issued by WiRO SC18-04
Surf City Permit Number
CAMA
MINOR DEVELOPMENT „:„
PERMIT Coastal Management
ENVIRONMENTAL QUALITY
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 Bill Pelon authorizing development in the Ocean Hazard Area (AEC) at 1202 N. Shore Drive, in Surf City,
Pender County as requested in the permittee's application package, dated January 9, 2018. This permit, issued on
January 24, 2018, is subject to compliance with the application and site drawing (where consistent with the permit)
dated and received by DCM on January 22, 2018, and 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: Construction of a beach access walkway, deck and gazebo.
(1) All proposed development and associated construction must be done in accordance with the permitted drawing dated and
received by DCM on January 22, 2018.
(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, and/or land use activities will require re-evaluation and
modification of this permit.
(4) A copy of this permit shall be posted or available on site throughout the construction process. Contact this office at(910)
796-7221 for a final inspection at completion of work.
(Additional Permit Conditions on Page 2)
This permit action may be appealed by the permittee or other qualified persons
within twenty (20) days of the issuing date. 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 modification not covered under
this permit,require further written permit approval.All work must cease when this Jason all
permit expires on:
CAM CAL PERMIT OFFICIAL
December31,2021 127 Cardinal Drive Extension z
Wilmington, NC 28405-3845 z
In issuing this permit it is agreed that this project is consistent with the local Land 0 0 c'e,
Use Plan and all applicable ordinances. This permit may not be transferred to (1)
WNanother party without the written approval of the Division of Coastal }N� — a'
Management.

Name: Bill Pelon
Minor Permit#SC18-04
Date: January 22, 2018
Page 2
(5) The permittee is required to contact the Local Permit Officer [phone], shortly before he plans to begin
construction to arrange a setback measurement that will be effective for sixty (60) days barring a major shoreline
change. Construction must begin within sixty (60) days of the determination or the measurement is void and must
be redone.
(6) Any structure(s) constructed within the Ocean Hazard area shall comply with the NC Building Code, including the
Coastal and Flood Plain Construction Standards of the N. C. Building Code, and the Local Flood Damage
Prevention Ordinance as required by the National Flood Insurance Program. If any provisions of the building code
or a flood damage prevention ordinance are inconsistent with any of the following AEC standards, the more
restrictive provision shall control.
(7) The authorized gazebo shall be a free-standing structure and shall not be structurally connected to the
authorized deck.
(8) This permit does not authorize the removal of sand or vegetation on/in the frontal dune, with exception of that
necessary for piling installation.
(9) With exception of the beach access walkway, 500 sq. ft. or less of elevated uncovered decking and 200 sq. ft.
gazebo, all other structure(s) must be set back a minimum of 60 feet from the First Line of Stable Natural Vegetation
(FLSNV), as determined by the DCM, the LPO, or another assigned agent of the DCM.
(10) 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 vegetated and stabilized (planted and
mulched)within 14 days of construction completion.
(11) Any structure authorized by this permit shall be relocated or dismantled when it becomes imminently threatened by
changes in shoreline configuration. The structure(s) shall be relocated or dismantled within two years of the time
when it becomes imminently threatened, and in any case upon its collapse or subsidence. However, if natural
shoreline recovery or beach renourishment takes place within two years of the time the structure becomes
imminently threatened, so that the structure is no longer imminently threatened, then it need not be relocated or
dismantled at that time. This condition shall not affect the permit holder's right to seek authorization of temporary
protective measures allowed under CRC rules.
(12) Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold or otherwise
disposed of to a third-party.
L(16
SIGNATURE. (29DATE: g- /r
PERMITTEE RECEIVED
DCM WILMINGTON,NC

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(41
Locality V t2Y (4.1 Permit Number��L PERMITS \\W O
OTHER MAY BE REQUIRED:The activity you arc planning may require permits other than lla<C;t ffiA
minor development permit,including,but not limited to:Drinking Water Well,Septic Tank(or other sanitary wupteZ :,
Ocean Hazard Estuarine Shoreline /ORW Shoreline Public Trust Shoreline Other
treatment system),Building,Electrical,Plumbing,Heating and Air Conditioning,Insulation and Energy Constrat ,FI4
(For official use only) Certification,Sand Dune,Sediment Control,Subdivision Approval,Mobile Home Park Approval,Highway Er.ytlntg{pn,at
others.Cheek with your Local Permit Officer for more information.
GENERAL INFORMATION
STATEMENT OF OWNERSHIP: j
LAND OWNER/� -MAILING ADDRESS I,the undersigned,an applicant for a CAMA minor development omit,heir either the owner of roc in am or a
` .ni1C ropex.% het$ I_ LCP P S property
rtf (hie
Name 0 person authorized to act as an agent for purposes of applying for a CAMA minor development permit,certify that perso
listed as landowner on this application has a significant interest in the real property described therein.This interest can be
Address Q_ Q .. A 0 X 9 0 U describe as:(check one)
City - (� �`
aw'j Sze , State N_r _ Zip2Y�—.i--fhoneq( O S 3GIt /�^►itS Non Pr es LLC
In owner or record title Title is vested in name of 0�er (
Email W ( see Deed Book Li $ pe%kit" County Registry of Deeds,
e^a Y . ts2 Q O l t Co►� /� � Page 19 c- ,the
AUTHORIZED AGENT _an owner by virtue of inheritance.Applicant is an heir to the estate of
Name ;probate was in County.
Address if other interest,such as written contract or lease,explain below or use a separate sheet&attach to this application.
NOTIFICATION OF ADJACENT RIPARIAN PROPERTY OWNERS:
City State Zip Phone
I furthermore certify that the following persons are owners of properties adjoining this property.I affirm that I have given
Email ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
LOCATION OF PROJECT:(Address,street name and/or directions to site;name of the adjacent wmerlwdy.) (Name) (A dress)
► ?� v N. % kor� Ave Skr �j` (I) Gle_h4o .y 355Ke,t� Rd_ C` _Ow
Q�IZ
c I (, 7 V.C 2$Y`f$�) way 6„e.604v, ►n rTht5 I S[ C.0_�ch—AO.- Re,4-AC10 IA ft/
kt'/4 KTI c._- 0 c-e-a t;I ( (4) �8 if�'`7
DESCRIPTION OF PROJECT:(List all proposed construction and land disturbance.)e° LCt STN6 I eX20
/� ACKNOWLEDGEMENTS:
Cj o $X1Z S`T°M /y��i�^ ( I,the undersignc[I,acknowledge that the land owner is aware that the ro osed dcvclo menu is tanned for an arcs which
F�Qf" Fla JQ�fi �`C��llt� $ b p P P P
1 / P may be susceptible to erosion and/or flooding.1 acknowledge that the Local Permit Officer has explained tomeea
[he pnricu-
SIZE OF LOT/PARCEL: f/ I �/ w & k wi 0 Oea� lar hazard problems associated with this lot.This explanation was accompanied by recommendations concerning stabiliza-
square feet acres
lion and floodproofing techniques.
PROPOSED USE:Residential(] (Single-family 0 Multi-family I) Commercial/Industrial D Other' 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
COMPLETE EITHER(1)OR(2)BELOW(Contact your Local Permit Officer ijynru are not sure which AEC applies to your property): related to this permit application.
(I) OCEAN HAZARD AECs:TOTAL FLOOR AREA OF PROPOSED STRUCTURE: ire feet(includes COL/)a(� ^ �� ^J'(/�/� This the 9thday of''�4-n ,20
air conditioned living space,parking elevated above ground level,non-conditioned space elevate above ground level but _^`
excluding non-load-bearing attic space)
Landowner or person authorized to act as his/her agent for purpose of filing a CAMA permit application
(2) COASTAL SHORELINE AECs:SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES: square feet(includes the area of the foundation of all buildings,driveways,covered decks, This application includes:general information(this form),a site drawing as described on the hack of thisapplication,the
concrete or masonry patios,etc,that arc within the applicable AEC.Attach your calculations with the project drawing.) ownership statement,the Ocean i/azard AEC Notice where necessary,a check for$100.00 made pavable to the locality,and
am,information as may be provided orally by the applicant.The details of the application as described by these sources air
STATE STORMWATER MANAGEMENT PERMIT:Is the project located in an area subject to a State incorporated without reference in any permit which may be issued.Deviation front these details will constitute a violation of
Stormwater Management Permit issued by the NC Division of Energy,Mineral and Land Resources(DEMLR)'t any permit.Any person developing in an AEC without permit is subject to civil,criminal and administrative action.
YES NO
ryes,list the total built upon arca/impervious surface allowed for your lot or parcel:_ square feet,

ROY COOPER
tIC ioronmr
MICHAEL S. REGAN
Secretary
Coastal Management
ENVIRONMENTAL QUALITY BRAXTON DAVIS
Director
January 24, 2018
Pelon Properties, LLC
c/o Bill Pelon
PO Box 700
Hampstead, NC 28443
Dear Mr. Pelon:
Attached is CAMA Minor Development Permit SC 18-04 for work to be done at 1202 N. Shore Drive, in Surf
City, Pender County. An electronic copy has been sent to the Pender Co. Inspections Department.
To validate this permit, please sign both copies as indicated for our records. Retain the orange copy for your
files, and return the white copy 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,
Ate-en•./
Shaun K. Simpson
Permit Support Technician
Enclosures
Cc: WiRO files
PN Inspections Dept.
State of North Carolina I Environmental Quality I Coastal Management
127 Cardinal Drive Ext.,Wilmington,NC 28405

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OCEAN HAZARD AEC NOTICE
Project is in an: Ocean Erodible Area
High Hazard Flood Area Inlet Hazard Area
Property Owner: PC..t oh • 'Proevr�les L L, C
Property Address: 17 es $ • S h Olt tD, - SusF C t �. C C . .
Date Lot Was Platted:
This notice is intended to make you, the applicant, aware of the SPECIAL NOTE: This hazard notice is required for
special risks and conditions associated with development in this development in areas subject to sudden and massive storms and
area,which is subject to natural hazards such as storms, erosion erosion. Permits issued for development in this area expire on
and currents. The rules of the Coastal Resources Commission December 31 of the third year following the year in which the
require that you receive an AEC Hazard Notice and permit was issued. Shortly before work begins on the project
acknowledge that notice in writing before a permit for site,the Local Permit Officer must be contacted to determine the
development can be issued vegetation line and setback distance at your site. If the property
has seen little change since the time of permit issuance, and the
The Commission's rules on building standards, oceanfront
ck requirement,
setbacks and dune alterations are designed to minimize,but not the LPO will einform you that you mayegin can still eet the work. Substantial
eliminate, property loss from hazards. By granting permits, the progress on the project must be made within 60 days of this
Coastal Resources Commission does not guarantee the safety of setback determination,or the setback must be remeasured.Also,
the development and assumes no liability for future damage to the occurrence of a major shoreline change as the result of a
:he development. Permits issued in the Ocean Hazard Area of storm within the 60-day period will necessitate remeasurement
Environmental Concern include the condition that structures be of the setback. It is important that you check with the LPO
.elocated or dismantled if they become imminently threatened before the permit expires for official approval to continue the
)y changes in shoreline configuration. The structure(s) must be work after the permit has expired. Generally, if foundation
elocated or dismantled within two (2) years of becoming pilings have been placed and substantial progress is continuing,
mminently threatened, and in any case upon its collapse or permit renewal can be authorized. It is unlawful to continue
ubsidence. work after permit expiration.
'he best available information,as accepted by the Coastal
,sources Commission, indicates that the annual long-term For more information,contact:
verage ocean erosion rate for the area where your property is '1
rcated is feet per year. SOBS O Y� (� a�
Local Permit Officer N G Diu 111111 e F Ce 6.C1.1 I M ft=
he rate was established by careful analysis of aerial
iotographs of the coastline taken over the past 50 years.
11 1 Caratya` b P-- EktePS10 udies also indicate that the shoreline could move as much as Address
feet landward in a major storm. �c
ie flood waters in a major storm are predicted to be about W A rtN1 191-6 h/N.C . Z e Cl°S-
feet deep in this area. Locality
eferred oceanfront protection measures are beach nourishment 9 1
d relocation of threatened structures. Hard erosion control l
uctures such as bulkheads,seawalls,revetments,groins,jetties Phone Number
i breakwaters are prohibited. Temporary sand bags may be
horized under certain conditions.
e applicant must acknowledge this information and
uirements by signing this notice in the space below. Without
proper signature,the application will not be complete. i- I IL E E V O C3
'- P L L L DGivi WIMINGTN, NC
�
k) D P-d,&.-1 /1i, ‘ I /r/2JIg JAN 1 2 2018
perty Owner Signature Date
Revised May 2010

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1. . •os a ervice
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January 6, 2018
Mr. Glen Horay
353 Keim Road
Boyertown, PA 19512
Dear Mr. Horay,
This letter is to inform you that I,William D. Pelon,have applied for a CAMA Minor
Permit on my property at 1202 North Shore Drive, Surf City NC in Pender County.
As required by CAMA regulations,I have enclosed a copy of my permit application and
project drawings 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 910-538-2455, or by mail
at the address listed below. If you wish to file written comments or objections with the
Local Government CAMA Minor Permit Program, you may submit them to:
N. C. Division of Coastal Management
Jason Dail
127 Cardinal Drive Extension
Wilmington NC 28405
Sincerely,idfr‘-\-
William OYU
D. Pelon
P. O. Box 700
Hampstead NC 28443
7EC: ,:i VED
DGivM WILMINGTON, NC

ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PERMITS
Cw.J7. PEL,oN>
I hereby certify that I own property adjacent to 1',EL,1N IQ pE1QiTL&� l.��, °L 's
I (Name of Property Owner)
property located at /,A 0 4 Al. S !0 LE G U
Address, Lot, Block, Road, etc.)
on A4- Anne__ , in .5GLQ- ( .l 4-LI /YEWcvEe_,N.C.
(Waterbody) (Town and/or County)
He has described to me as shown in the attached application and project drawing(s), the development
he is proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
Signature
Print or Type Name
Telephone Number
Date
SEC.Th VED
DGIvi WILMINGTON, NC

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Total Postage and Fees 01/11/2018
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of Certified Mail service does not change the •To ensure that your Certified Mail receipt is
insurance coverage automatically included with accepted as legal proof of mailing,it should bear a
certain Priority Mail items. LISPS postmark.If you would like a postmark on
For an additional fee,and with a proper this Certified Mail receipt,please present your
endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for
the following services: postmarking.If you don't need a postmark on this
-Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion
of delivery(Including the recipient's signature). of this label,affix it to the mailpiece,apply
You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.
electronic version.For a hardcopy return receipt,
complete PS Form 3811,Domestic Return
Receipt,attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records.

January 6,2018
Mr. William G. Mathis
151 Carr Avenue
Rocky Point NC 28457
Dear Mr. Mathis,
This letter is to inform you that I,William D. Pelon,have applied for a CAMA Minor
Permit on my property at 1202 North Shore Drive, Surf City NC in Pender County.
As required by CAMA regulations,I have enclosed a copy of my permit application and
project drawings 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 910-538-2455, or by mail
at the address listed below. If you wish to file written comments or objections with the
Local Government CAMA Minor Permit Program,you may submit them to:
N. C. Division of Coastal Management
Jason Dail
127 Cardinal Drive Extension
Wilmington NC 28405
Sincerely,
w p�Q
William D. Pelon
P. O. Box 700
Hampstead NC 28443
1E� iVED
DCM WILMINGTON, NC

ADJACENT RIPARIAN PROPERTY OWNER
STATEMENT FOR CAMA MINOR PERMITS
�';') �,Li�.z. PEI-6 N)
I hereby certify that I own property adjacent to PE{�,p/� 'Pie()log e. 4 g� t LC 's
(Name of Property Owner)
property located at / I AA Al. Fn O I.E
Address,Lot, Block, Road, �Q etc.)
on �4-1 iN *U! , in d u.lil� 0 4 4-1J / T E ,D6-4.N.C.
(Waterbody) (Town and/or County l)
He has described to me as shown in the attached application and project drawing(s), the development
he is proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
Signature /�
Lt), I I IA M U'. 01/4 T 4 i S
Print or Type Name
Telephone Number
Date
D 1M WILMINGTON, NC

OCEAN HAZARD AEC NOTICE
Project is in an: Ocean Erodible Area t� High Hazard Flood Area Inlet Hazard Area
Property Owner: Pam. on 'ProeerTIes L L C
11
Property Address: O 1. • S h o r t) ,r` S�.r F C l 1 � C .
Date Lot Was Platted:
This notice is intended to make you, the applicant, aware of the SPECIAL NOTE: This hazard notice is required for
special risks and conditions associated with development in this development in areas subject to sudden and massive storms and
area,which is subject to natural hazards such as storms, erosion erosion. Permits issued for development in this area expire on
and currents. The rules of the Coastal Resources Commission December 31 of the third year following the year in which the
require that you receive an AEC Hazard Notice and permit was issued. Shortly before work begins on the project
acknowledge that notice in writing before a permit for site,the Local Permit Officer must be contacted to determine the
development can be issued vegetation line and setback distance at your site. If the property
has seen little change since the time of permit issuance, and the
The Commission's rules on building standards, oceanfront proposed development can still meet the setback requirement,
setbacks and dune alterations are designed to minimize, but not the LPO will inform you that you may begin work. Substantial
eliminate, property loss from hazards. By granting permits, the progress on the project must be made within 60 days of this
Coastal Resources Commission does not guarantee the safety of setback determination,or the setback must be remeasured.Also,
the development and assumes no liability for future damage to the occurrence of a major shoreline change as the result of a
the development. Permits issued in the Ocean Hazard Area of storm within the 60-day period will necessitate remeasurement
Environmental Concern include the condition that structures be of the setback. It is important that you check with the LPO
relocated or dismantled if they become imminently threatened before the permit expires for official approval to continue the
by changes in shoreline configuration. The structure(s) must be work after the permit has expired. Generally, if foundation
relocated or dismantled within two (2) years of becoming pilings have been placed and substantial progress is continuing,
imminently threatened, and in any case upon its collapse or permit renewal can be authorized. It is unlawful to continue
subsidence. work after permit expiration.
The best available information,as accepted by the Coastal For more information,contact:
Resources Commission, indicates that the annual long-term
average ocean erosion rate for the area where your property is SOBS C Irk. D a`
Located is feet per year. -
Local Permit Officer N C. Div's to Pt of Ce esZrt l M fr.
the rate was established by careful analysis of aerial
mhotographs of the coastline taken over the past 50 years.
1111 C&Patl ak 6 r„ 2cleps►o
itudies also indicate that the shoreline could move as much as Address
feet landward in a major storm. !.,r
he flood waters in a major storm are predicted to be about w�`�1'�l���1^,��C le ��
feet deep in this area. Locality
'referred oceanfront protection measures are beach nourishment 91 d _ n �O
9 1' II,/ '
nd relocation of threatened structures. Hard erosion control /
tructures such as bulkheads,seawalls,revetments,groins,jetties Phone Number
nd breakwaters are prohibited. Temporary sand bags may be
uthorized under certain conditions.
he applicant must acknowledge this information and
:quirements by signing this notice in the space below. Without
ie proper signature,the application will not be complete.
P. P-t .4. L L C IM
W D P4,69.,--x oto,,„ILI/4444 1 I r
'roperty Owner Signature I Date ui;Ni WILMINGTON, NC
JAN 1 2 2018
Revised May 2010

U.S.DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008
Federal Emergency Management Agency Expiration Date: November 30, 2018
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for(1)community official, (2)insurance agent/company,and(3)building owner.
SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name Policy Number:
Felon Properties, LLC
A2. Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Company NAIC Number:
Box No.
1202 N. Shore Drive
City State ZIP Code
Surf City North Carolina 28445
A3. Property Description(Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Lots 25 and 26 Block 3 Del Mar Beach
A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory, etc.) Accessory
A5. Latitude/Longitude: Lat.34-26-11.7 Long.77-31-34.1 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):
a) Square footage of crawlspace or enclosure(s) 0 sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b sq in
d) Engineered flood openings? ❑Yes ❑ No
A9. For a building with an attached garage:
a) Square footage of attached garage 0 sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade
c) Total net area of flood openings in A9.b sq in
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
Surf City 370186 Pender North Carolina
B4. Map/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s)
Number Date Effective/ (Zone AO, use Base
Revised Date Flood Depth)
3720424500K 02/16/2007 02/16/2007 VE 14.0'
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 B9: ❑ NGVD 1929 0 NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPAR-1]Ye$ 0142:
Designation Date: ❑ CBRS ❑ OPA DU iii WILMINGTON, NC
JAN 1 2 2018

OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 2018
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:
1202 N. Shore Drive
City State ZIP Code Company NAIC Number
Surf City North Carolina 28445
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevations are based on: © Construction Drawings* ❑ Building Under Construction* 0 Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations-Zones A1-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: Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a)through h)below.
❑ NGVD 1929 0 NAVD 1988 ❑ 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 enclosure floor) 0 feet ❑ meters
b) Top of the next higher floor ❑x feet ❑ meters
c) Bottom of the lowest horizontal structural member(V Zones only) ❑x feet ❑meters
d) Attached garage(top of slab) ❑x feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 14. 0 0 feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent(finished)grade next to building(LAG) 7. 5 0 feet ❑ meters
g) Highest adjacent(finished)grade next to building(HAG) 17. 0 Q feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including 7. 5 ❑x feet ❑ meters
structural support
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 information.
I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false
statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? ©Yes ❑No 0 Check here if attachments.
Certifiers Name License Number
Danny Marco Padgett L-2639
Title
Registered Land Surveyor J C
..a
Company Name . <- PIace -
•
a i
Address :VP'.�yy �r,
P.O. Box 130 .•�fi •,Q
CityState ZIP Code s��yA;•SUR QP�``��
Surf City North Carolina 28460 ,���0411110���`
Signature Date Telephone
`� 12/21/2017 [phone]
Copy all pages of this Elevati rtificate and all attachments for(1)community official, (2)insurance agent/company,and(3)building owner.
Comments(including type of equipment and location, per C2(e), if applicable)
Elevation Certificate for Electrical Panel on Gazebo
�ECThVEtD
DC•M WILMINGTON, NC
JAN 1 2 2018

•
•
•
._ .: ,.s
it
r
is ri

OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 2018
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:
1202 N. Shore Drive
City State ZIP Code Company NAIC Number
Surf City North Carolina 28445
SECTION E—BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED)
FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AO and A(without BFE), complete Items El—E5. If the Certificate is intended to support a LOMA or LOMR-F request,
complete Sections A, B,and C. For Items El—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only,
enter meters.
El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below
the highest adjacent grade(HAG) and the lowest adjacent grade(LAG).
a) Top of bottom floor(including basement,
crawlspace, or enclosure) is ❑feet ❑meters ❑above or ❑below the HAG.
b) Top of bottom floor(including basement,
crawlspace, or enclosure) is ❑feet ❑meters ❑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 1-2 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 or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
DCM WILMINGTON, NC
JAN122018
17 Check here if attachments.

OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 2018
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:
1202 N. Shore Drive
City State ZIP Code Company NAIC Number
Surf City North Carolina 28445
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: [1] feet 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
Community Name Telephone
Signature Date
Comments(including type of equipment and location, per C2(e), if applicable)
GGM WILMINGTON, NC
JAN 1 2 2018
n Check here if attachments.

BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date: November 30, 2018
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:
1202 N. Shore Drive
City State ZIP Code Company NAIC Number
Surf City North Carolina 28445
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the
instructions for Item A6. Identify all photographs with date taken; "Front View"and"Rear View"; and, if required, "Right Side View"and
"Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or
vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page.
Photo One
Photo One Caption
44,
„t,A
i
EC ThVEC
i WILMINGTON, NC
JAN 1 2 2018
Photo Two
Phnfn Vein(`mn+inn

Date Da Check From Name of Vendor Check Check Permit Rct. ,
Received to Permit Holder Number amount Number/Comment
De s
po
sit
ed
1/12/18 William or Lee same First 5181 $100.00 minor fee, 1202 N. JD rc
Pelon National Shore Dr., SC PnCo 5753
Bank