TB_16-08_ Taylor

V
Issued by WiRO TB16-08
Topsail Beach Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT Coastal Management
ENVIRONMENTAL QUALITY
as authorized by the State of North Carolina, Department of Environmental Quality
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 Luther and Rhonda Taylor authorizing development in the Ocean Hazard (AEC) at 1422 Ocean Blvd., in
Topsail Beach, Pender County as requested in the peimittee's application, dated July 13, 2016. This permit, issued on
July 25, 2016, is subject to compliance with the application and drawing dated and received by DCM on July 13, 2016
(where consistent with the permit), all applicable regulations and special conditions and notes set forth below. Any
violation of these terms may subject the permittee to a fine, imprisonment or civil action, or may cause the permit to be
null and void.
This permit authorizes: Construction of a single family residence.
(1) All proposed development and associated construction must be done in accordance with the permitted site drawing dated
received by DCM on July 13,2016.
(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)
766-7221 for a final inspection at completion of work.
RECEIVED
DCM WILMINGTON,'�`
(Additional Permit Conditions on Page 2)
0 16
f,U
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 Jason Dail
compliance. Any maintenance work or project modification not covered under CAMA LOCAL PERMIT OFFICIAL
this permit,require further written permit approval.All work must cease when this
permit expires on: 127 Cardinal Drive Extension
Wilmington, NC 28405-384
December 31,2019
Z4--
In issuing this permit it is agreed that this project is consistent with the local Land bZ
Use Plan and all applicable ordinances. This permit may not be transferred to
another party without the written approval of the Division of Coastal PERMITTEE
Management.
(Signature required if conditions above apply to permit)

Name: Luther and Rhonda Taylor
Minor Permit#TB16.08
Date: July 25, 2016
Page 2 of 3
(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 vegetated and stabilized (planted and
mulched)within 14 days of construction completion.
(6) 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.
(7) 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.
(8) All development shall be located a minimum distance landward of the 60' setback line which is measured from the
First Line of Stable Natural Vegetation(FLSNV).
(9) 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.
(10) 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: ) TA 2. ! DATE: 7 029/ /6
PERMITTEE
RECEIVED
DCM WILMINGTON, NC
AUG 01 2016

-/,� j TR f/ OTHER PERMITS MAY BE REQUIRED:The activity you are planning may require permits other than the CAMA
Locality /('�Si9 J L / L4C-� Permit Number !tU /10 0 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
Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other Certification,Sand Dune,Sediment Control,Subdivision Approval,Mobile Home Park Approval,Highway Connection,and
(For official use only) others.Check with your Local Permit Officer for more information.
SENFRAI,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
LAND OWNER person authorized to act as an agent for purposes of applying for a CAMA minor development permit,certify that the person
Name Luther Eddice Taylor III and wife,Rhonda SuNivan Taylor listed as landowner on this application has a significant interest in the real property described therein.This interest can be
described as:(check one)
Address 406 Plantation Road
Elan
City Goldsboro State NC Zip 27530 Phone [phone] owner or record title,Title 0 vested in ,see Deed Book_
page in the PAS County Registry of Deeds.
Email [e-mail]
Flan owner by virtue of inheritance.Applicant is an heir to the estate of ,
AUTHORIZED AGENT probate was in County.
Name Charles F.Riggs&Associates,Inc. Fif other interest,such as written contract or lease,explain below or use a separate sheet&attach to this application.
Address P.O.Box 1570 Contract to Purchase
NOTIFICATION OF ADJACENT PROPERTY OWNERS:
City Jacksonville State NC Zip 28541 Phone [phone] 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.
Email [e-mail]
(Name) (Address)
(1) Mr.and Mrs.Benedict Fortunati,1816 Grace Street,Wilmington,NC 28405
LOCATION OF PROJECT:(Address,street name and/or directions to site.If not oceanfront,what is the name of the
adjacent waterbody.)1422 Ocean Boulevard,Town of Topsail Beach (2) Mr.and Mrs.James Ketchum,tan Olde Point Road,Hampstead,NC 28443
(3) Mr.Vann E.Winfree,Jr.,3300 Geneva Place NW,Wilson,NC 27896
DESCRIPTION OF PROJECT:(List all proposed construction and land disturbance.) Proposed Dwelling (4)
on Pilings Partially Enclosed below for Entry and Storage with Decks,Concrete Slab and
SIZE OF LOT/PARCEL: 5,996 square feet 0.138 acres Pervious Drive ACKNOWLEDGEMENTS:
I,the undersigned,acknowledge that the land owner is aware that the proposed development is planned for an area which
PROPOSED USE:Residential Q (Single-family 0 Multi-family 0) Commercial/Industrial❑ Other 0 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 stabilize-
COMPLETE EITHER(I)OR(2)BELOW(Contact your Local Permit Officer ijyou are not sure which AEC applies tion and floodproofing techniques.
to your properly):
I furthermore certify that I am authorized to grant,and do in fact grant,permission to Division of Coastal Management staff,
(I) OCEAN HAZARD AECs:TOTAL FLOOR AREA OF PROPOSED STRUCTURE:2,514 square feet(includes the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information
air conditioned living space,parking elevated above ground level,non-conditioned space elevated above ground level but related to this permit application.
excluding non-load-bearing attic space) 11 II �/
(2) COASTAL SHORELINE AECs:SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT I�, This the /. I/ day ofAid[y ,20 i�
UPON SURFACES: square feet(includes the area of the roof/drip line of all buildings,driveways,covered decks, /�/„/ 4�
concrete or masonry patios,etc.that are within the applicable AEC.Attach your calculations with the project drawing.) ` ` tf.��++((���// 0'
Landowner or person authorize• o. 17 s/her ent or purpose of filing a CAMA permit application
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 Quality? This application includes:g ne • rmation(this form),a site drawing as described on the hack of this application,the
YES= NCI ✓ I ownership statement,the O.•• • •rd AEC Notice where necessary,a check for S100.00 made payable to the locality,and
any information as may be • ••%orally by the applicant.The details of the application as described by these sources are
If yes,list the total built upon area/impervious surface allowed for your lot or parcel: square feet. incorporated without referent n any permit which may be issued Deviation from these details will constitute a violation of
any permit.Any person developing in an AEC without permit is subject to civil,criminal and administrative action.
RECEIVED
DOM WILMINGTON,NC
JU.L. 1. 3 ?016

SITE DRAWING/APPLICATION CHECKLIST
Please make sure your site drawing includes the following information required for a CAMA minor development permit.
The Local Permit Officer will help you,if requested.
PHYSICAL DIMENSIONS WAS7q! APPLICATION FOR
�OF
Label roads CAMA MINOR
Label highways right-of-ways at-
/Label local setback lines DEVELOPMENT
Label any annddall structures and driveways currently existing on property �
/Label adjacent waterbody )C PERMIT
PHYSICAL CHARACTERISTICS
Draw and label normal high water line(contact LPO for assistance) In 1974,the North Carolina General Assembly passed the Coastal Area Management Act
/�
f Draw location of on-site wastewater system
(CAMA)and set the stage for guiding development in fragile and productive areas that
If you will be working in the ocean hazard area: border the state's sounds and oceanfront.Along with requiring special care by those who
/Draw and label dune ridges(include spot elevations) build and develop,the General Assembly directed the Coastal Resources Commission
Draw and label toe of dunes (CRC)to implement clear regulations that minimize the burden on the applicant.
— .1dentify and locate first line of stable vegetation(contact LPO for assistance)
Draw and label erosion setback line(contact LPO for assistance) This application for a minor development permit under CAMA is part of the
Draw and label topographical features(optional) Commission's effort to meet the spirit and intent of the General Assembly.It has been
designed to be straightforward and require no more time or effort than necessary from
If you will working in a coastal shoreline area: the applicant.Please go over this folder with the Local Permit Officer(LPO)for the
how the roof overhang as a dotted line around the structure locality in which you plan to build to be certain that you understand what information he
Draw and label landward limit of AEC or she needs before you apply.
Draw and label all wetland lines(contact LPO for assistance)
—14
Draw and label the 30-foot buffer line Under CAMA regulations,the minor permit is to be issued within 25 days once a
DEVELOPMENT PLANS complete application is in hand.Often less time is needed if the project is simple.The
process generally takes about 18 days.You can speed the approval process by making
draw and label all proposed structures certain that your application is complete and signed,that your drawing meets the
/Draw and label areas that will be disturbed and/or landscaped specifications given inside and that your application fee is attached.
—/dote size of piling and depth to be placed in ground
Draw and label all areas to be paved or graveled Other permits are sometimes required for development in the coastal area.While these
Show all areas to be disturbed are not CAMA-related,we urge you to check with the Local Permit Officer to determine
Show landscaping which of these you may need.A list is included on page two of this folder.
NOTE TO APPLICANT
We appreciate your cooperation with the North Carolina Coastal Management Program
Have you: and your willingness to build in a way that protects the resources of our beautiful and
• completed all blanks and/or indicated if not applicable? productive coast.
• notified and listed adjacent property owners?
• included your site drawing?
Coastal Resources Commission
• signed and dated the application?
Division of Coastal Management
• enclosed the S100.00 fee?
• completed an AEC Hazard Notice,if necessary?(Must be signed by the property owner) —y
FOR STAFF USE '< C
trt t-
cn
Site Notice Posted_Final Inspection Fee Received 2
LJ
Site Inspections tr
0 's
❑G
2
Date of Action - Exempted Denied Appeal Deadline(20 days from permit action) DCM Form EB1952-2010 Revised April 20t0
JUL 1 3 2016

PAT MCCRORY
Governor
FirC
DONALD R. VAN DER VAART
Secretary
BRAXTON DAVIS
Coastal Management Director
ENVIRONMENTAL QUALITY
July 25, 2016
Mr. & Mrs. Luther E. Taylor III
406 Plantation Road
Goldsboro, NC 27530
Dear Mr. & Mrs. Taylor:
Attached is CAMA Minor Development Permit#TB 16-08, for work to be done at 1422 Ocean
Blvd., in Topsail Beach, Pender County. A copy of the permit has been sent to your agent and
to the Town's Inspections Department.
In order to validate this permit, please sign both copies of the permit as indicated for our
records. Please retain the orange copy for your files, sign both pages 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
Town of Topsail Beach Inspections Dept.
Charles F. Riggs, Agent
State of North Carolina I Environmental Quality I Coastal Management
117 Cardinal T]rive Rrt Wilminotnn NC 9R405

A e \ Si N() T1 (311]k\\Y
CANIA PERMIT
APPLIED FOR
To construct a single-family dwelling
PROJECT:
at 1422 Ocean Blv ., " e
. .
Pender County
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APPLICANT: FOR MORE DETAILS CONTACT
THE BELOW:
Luther & Rhonda TayloriH
NC Div ALCoastalI M
406 Plantation Road 127 CardinalLO P
O. DrERM. Extension
ER m ent
Goldsboro, NC 28541 Wilmington, NC 28405
Jason Dail, Field Representative
910-796-7221
Agent: Charles F. Riggs [phone]

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner Luther Eddice Taylor III and wife, Rhonda Sullivan Taylor
Address of Property: 1422 Ocean Boulevard, Town of Topsail Beach
(Lot or Street#, Street or Road, City & County)
Agent's Name #: Charles F. Riggs & Assoc. Mailing Address: P. O. Box 1570
Agent's phone #: [phone] Jacksonville, NC 28541
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed,you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmanagement.net/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pie , k, mooring pilings, breakwater, boathou , , or groin must be set
back a minimum distance of 1 my area of riparian ac unless waived by me. (If you
wish to waive the setback, you must ini a late blank below.)
I do wish to wai 15' setback requireme .
o not wish to waive the 15' setback requirement.
(Prop tq ner I o ion) (Adjacent Property Owner Information)
Signuntre Signature
Charles F. iggs, t for application
Print or Type Name Print or Type Name
P. O. Box 1570
Mailing Address Mailing Address
Jacksonville, NC 28541
City/State/Zip City/State/Zip
[phone] RECEIVED
Onpq vVu MINGTON,NC
Telephone Number Telephone Number
JUL 13 2016

CHARLES F. RIGGS & ASSOCIATES, INC.
Land Surveyors
Charles F.Riggs,P.L.S.L-2981 Corporate License(C-730) James A.Lewis,P.L.S.L-4562
502 New Bridge Street 502 New Bridge Street Landfall Executive Suite 217
Jacksonville,North Carolina 28540 P.O.Box 1570 1213 Culbreth Drive
[phone] Jacksonville.North Carolina 28541 Wilmington,North Carolina 28405
[e-mail] [phone] [phone]
jameslewis(a_,riggslandnc.com
July 12,2016
Mr.and Mrs. Benedict Fortunati
1816 Grace Street
Wilmington,NC 28405
Re: Luther Eddice Taylor III and wife, Rhonda Sullivan Taylor Minor CAMA Application
Dear Mr. and Mrs. Fortunati:
On behalf of Luther Eddice Taylor III and wife, Rhonda Sullivan Taylor,Charles F. Riggs&
Associates, Inc. is submitting to the Division of Coastal Management,North Carolina Department of
Environmental Quality the enclosed Minor CAMA application for the property located at 1422 Ocean
Boulevard,Town of Topsail Beach,Topsail Township, Pender County,North Carolina. We are required
to notify the adjoiners of this CAMA application. Please review the package and sign the form provided,
placing a check beside whether you have objections or no objections to this. If you have no objections,
please return the form to us in the self-addressed stamped envelope provided. If you have objections,
please send the form along with your comments to Mr.Jason Dail, Division of Coastal Management,N.C.
Dept. of Environmental Quality, 127 Cardinal Drive, Wilmington,NC 28405 within 10 days of receipt of
this notice.
Respectfully,
hr
James L. Riggs
RECEIVED
DCM WILMINGT ON,NC
.. .. 7 n nrt4r

. . •os a ervice
CERTIFIED MAIL° RECEIPT
Domestic Mail Only
9
-i For delivery information,visit our website at www.usps.com®.
WILi1IN61`ON:` NC 23405
9 Certified Mail Fee $3.30 �y 0600
• Extra Services&Fees(check box,add fee a pr Ptte) 13'
• El Return Receipt(hardcopy) $ !fl_fI1 1 RECEIVED
] ❑Return Receipt(electronic) $ rM VI Lr.,1�y�t(11k1 N, NC
] ❑Certified Mail Restricted Delivery $ $0.00 er8 V I V I V
] ❑Adult Signature Required $ $0 a 00
0 Adult Signature Restricted Delivery$ J U L 13 .2 016
• Postage $1.36
` $ 07/13/2016
Total Postage and Fees
$ $7.36
a m r
Sent To j (f t
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I A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail
I A unique identifier for your mailpiece. associate for assistance.To receive a duplicate
I Electronic verification of delivery or attempted return receipt for no additional fee,present this
delivery. USPS®-postmarked Certified Mail receipt to the
I A record of delivery(including the recipient's retail associate.
signature)that is retained by the Postal Service'" -Restricted delivery service,which provides
for a specified period. ,nI fialivery to the ire psp ipg f by name,or
tddihe address a ddddzz�b8 adeh4'
Important Reminders: -Adult signature service,which requires the
You may purchase Certified Mall service with signee td_Ig a1;t 21 years of age(not
First-Class Mail°,First-Class Package Servce',_c, available at retail).
or Priority Mail®service. Adult signature restricted delivery service,whict
I Certified Mail service is notavailable for 0•GZ requires the signee to be at least 21 years of ag
International mail. (Iii•Of f and provides delivery to the addressee specified
I Insurance coverage is not available for purgl}ce j l: by name,or to the addressee's authorized agent
with Certified Mail service.However,the pgic Iy (not available at retail).
of Certified Mail service does not change ttld i To ensure that your Certified Mail receipt is
insurance coverage automatically included with accepted as legal proof of mailing,it should bear s
certain Priority Mail items. USPS postmark.If yt,would like a postmark on
I For an additional tee,and with a proper this Certified Mail receipt,please present your
endorsement On the mailpiece;you may request Certified Mailjtem.at a Post Office' for
the following services: postmarking:4 yob 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.
>.c c..,,..'AR 111 e..ai om c ioe,.ene.,oeM,c,n.no_nnn enn7

CHARLES F. RIGGS & ASSOCIATES, INC.
Land Surveyors
Charles F. Riggs,P.L.S.L-2981 Corporate License(C-730) James A.Lewis,P.L.S.L-4562
502 New Bridge Street 502 New Bridge Street Landfall Executive Suite 217
Jacksonville,North Carolina 28540 P.O.Box 1570 1213 Culbreth Drive
[phone] Jacksonville,North Carolina 28541 Wilmington,North Carolina 28405
[e-mail] [phone] [phone]
[e-mail]
July 12, 2016
Mr.and Mrs.James Ketchum
186 Olde Point Road
Hampstead,NC 28443
Re: Luther Eddice Taylor III and wife, Rhonda Sullivan Taylor Minor CAMA Application
Dear Mr. and Mrs. Ketchum:
On behalf of Luther Eddice Taylor III and wife, Rhonda Sullivan Taylor,Charles F. Riggs&
Associates, Inc. is submitting to the Division of Coastal Management,North Carolina Department of
Environmental Quality the enclosed Minor CAMA application for the property located at 1422 Ocean
Boulevard,Town of Topsail Beach,Topsail Township, Pender County,North Carolina. We are required
to notify the adjoiners of this CAMA application. Please review the package and sign the form provided,
placing a check beside whether you have objections or no objections to this. If you have no objections,
please return the form to us in the self-addressed stamped envelope provided. If you have objections,
please send the form along with your comments to Mr.Jason Dail, Division of Coastal Management,N.C.
Dept. of Environmental Quality, 127 Cardinal Drive, Wilmington,NC 28405 within 10 days of receipt of
this notice.zRe ectfully,
James L. Riggs I
RECEIVED
DCM WILMINGTON,NC
JUL 13 2016

I. . •os a ervice
... CERTIFIED MAIL® RECEIPT
3 Domestic Mail Only
q
1 For delivery information,visit our website at www.usps.com®.
- HAWSTE A I)? tiC 28443
,
- Certified Mail Fee
$3.30 RECEI ,rr!,
3 $
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I El Return Receipt(hardcopy) $ 1
3 El Return Receipt(electronic) $ $0 AO .11 it 1p04815
3 El Certified Mail Restricted Delivery $ go . Here
3 0 Adult Signature Required $
0 Adult Signature Restncted Delivery$
$0.00
3 Postage
$1.36
_ $
i Total Postage and Fees 07/13/2016
$ $7.36 • -
1
Sent To
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Street and Apt.No.,orrt.No.0 ike -T> ,ki----24-- ,... .d
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I A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail
I A unique identifier for your mailpiece. associate for assistance.To receive a duplicate
I Electronic verification of delivery or attempted return receipt for no additional fee,present this
delivery. USPS®-postmarked Certified Mail receipt to the
I A record of delivery(including the recipients retail associate.
signature)that is retained by the Postal Service'" -Restricted delivery service,which provides
for a specified period. delivery to,fbe addiesseasaegAeti py name,or
to'ihe addr4isek thbjited
Important Reminders: -Adult signature service,which requires the
I You may pfycflise Certified Mail service with signee tR dt.at Veit 21 years of age(not
First-Class Mail,First-Class Package Servicl@®, S: available at retail).
or Priority Mail®service. Adult signature restricted delivery service,whicl
I Certified Mail service is notavailable for IQ�.d1 requires the signee to be at least 21 years of ag
international mail. UU.O j and provides delivery to the addressee specifies
I Insurance coverage is not available for pu ri h by name,or to the addressee's authorized agent
with Certified Mail service.However,the puff (not available at retail).
of Certified Mail service does not change fiat •l iJTo ensure that your Certified Mail receipt is
insurance coverage automatically included with accepted as legal proof of mailing,it should bear r
certain Priority Mail items. USPS posture ..lt you would like a postmark on
I For an additional•fee,{m[l with a proper this Certified Mail receipt,please present your
endorsemehtod thefiralipiece,you may request Certified Mail gem at a Post Office-for
the following services: postmarkinghtf you font 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.

CHARLES F. RIGGS & ASSOCIATES, INC.
Land Surveyors
Charles F.Riggs.P.L.S.L-2981 Corporate License(C-730) James A.Lewis,P.L.S.L-4562
502 New Bridge Street 502 New Bridge Street Landfall Executive Suite 217
Jacksonville,North Carolina 28540 P.O.Box 1570 1213 Culbreth Drive
[phone] Jacksonville.North Carolina 28541 Wilmington,North Carolina 28405
[e-mail] [phone] [phone]
[e-mail]
July 12, 2016
Mr. Vann E. Winfree,Jr.
3300 Geneva Place NW
Wilson,NC 27896
Re: Luther Eddice Taylor III and wife, Rhonda Sullivan Taylor Minor CAMA Application
Dear Mr. Winfree:
On behalf of Luther Eddice Taylor III and wife, Rhonda Sullivan Taylor,Charles F. Riggs&
Associates, Inc. is submitting to the Division of Coastal Management,North Carolina Department of
Environmental Quality the enclosed Minor CAMA application for the property located at 1422 Ocean
Boulevard,Town of Topsail Beach,Topsail Township, Pender County,North Carolina. We are required
to notify the adjoiners of this CAMA application. Please review the package and sign the form provided,
placing a check beside whether you have objections or no objections to this. If you have no objections,
please return the form to us in the self-addressed stamped envelope provided. If you have objections,
please send the form along with your comments to Mr.Jason Dail, Division of Coastal Management,N.C.
Dept. of Environmental Quality, 127 Cardinal Drive, Wilmington,NC 28405 within 10 days of receipt of
this notice.
Res ectfully,
s.,4t----)
cli
ames L. Riggs
RECEIVED
DCM WILMINGTON, NC
JUL 13 2016

. . •os a ervice
CERTIFIED MAIL° RECEIPT
Domestic Mail Only
For delivery information,visit our website at www.usps.com®.
WINE=278
r Certified Mail Fee
$ $3.30 RECEIVEl0600 .
O Extra Services&Fees(check box,add fee Mdh®le1 WILMI N G CIVj
q ❑Return Receipt(hardcopy) $ $ ,LLJJ44/kVnVf 11���,��
] ❑Return Receipt(electronic) $ t0.00 P"Q,($J(�R�,��Cg
] ❑Certified Mail Restricted Delivery $ so.oct {'vI L 1 3 t `r
] ❑Adult Signature Required $ V V
0 Adult Signature Restricted Delivery$' _
]I Postage
$1.36
Total,Postage and Fees 07/13/2016
$7.36
Sent To
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I A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail
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for a specified period. deliitwy.tothe add(essee,sgecified by name,or
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'mportant Reminders: -Adult signature service,which requires the
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complete PS Form 3811,Domestic Return
Receipt attach PS Form 3811 to your mailplece; IMPORTANT:Save this receipt for your records.
IC Fnrm 38OO_Anril 9n15/Rnvnrenl PCN 75q(VM4W OnA7

OCEAN HAZARD AEC NOTICE
Project is in an: Ocean Erodible Area High Hazard Flood Area Inlet Hazard Area
Property Owner
Luther Eddice Taylor Ill and wife, Rhonda Sullivan Taylor (C p it r lfciW lc)
1422 Ocean Boulevard, Town of Topsail Beach
Property Address:
Date Lot Was Platted: March 1952
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 stones.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
"1 he 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 re-measured.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 re-measurement
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 structures)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.
I he 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
located is feet per year.
Local Permit Officer
.1 he rate was established by careful analysis of aerial
photographs of the coastline taken over the past 50 years.
Studies also indicate that the shoreline could muse as much as Address
feet landward in a major storm
The flood waters in a major storm are predicted to be about
feet deep in this area. Locality
Preferred oceanfront protection measures are beach nourishment
and relocation of threatened structures. Hard erosion control
structures such as bulkheads,seawalls. revetments,groins.jetties Phone Number
and breakwaters are prohibited. Temporary sand bags may be
authorized under certain conditions.
The applicant must acknowledge this information and
requirements by signing this notice in the space below. Without
the proper signature.the application will not be complete
7-/2—/6
Property Owner Signature v' Date
RECEIVED
DCM wiLmINGTotoke,16,May2010
JUL 13 2016

U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008
Natrona!Flood 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 LUTHER E.TAYLOR,III&WIFE, RHONDA S.TAYLOR Policy Number:
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg. No.)or P.O.Route and Box No. Company NAIC Number.
1422 OCEAN BOULEVARD
City TOPSAIL BEACH State NC ZIP Code 28445
A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.)
LOT 21,BLOCK 36,NEW TOPSAIL BEACH
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL
A5. Latitude/Longitude: Lat. 34d21'17"N Long.77d38'33'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 6
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) 167 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
Bl. NFIP Community Name&Community Number B2.County Name B3.State
TOWN OF TOPSAIL BEACH 370187 PENDER NORTH CAROLINA
B4. Map/Panel Number B5.Suffix B6.FIRM Index Date B7.FIRM Panel B8.Flood B9 Base Flood Elevation(s)(Zone
3720420200 J 02116/07 Effective/Revised Date Zone(s) AO,use base flood depth)
02/16/07 VE 14.0
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
❑ FIS Profile Z FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item 89: ❑ 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: CO 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,ARIA,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:NC CORS Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a)through h)below. O NGVD 1929 ®NAVD 1988 Cl 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) 7.1 ®feet ❑meters
b)Top of the next higher floor 19.1 ®feet ❑meters
c) Bottom of the lowest horizontal structural member(V Zones only) 17.1 ®feet ❑meters
d)Attached garage(top of slab) N.A ❑feet ❑meters
e) Lowest elevation of machinery or equipment servicing the building 17.1 ®feet ❑meters :IVED
(Describe type of equipment and location in Comments) �1GTCN, NC
f) Lowest adjacent(finished)grade next to building(LAG) 6.4 ®feet Lib meters
g) Highest adjacent(finished)grade next to building(HAG) 6.6 ®feet ❑meters .; 2016
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 \ t I I I I I I /
information. /certify that the information on this C,� f�ffrcate represents my best efforts to interpret the data available. \N\\ -(H CA ? '/,,
I understand that any false statement maKNgA MR hMbie py fine or imprisonment under 18 U.S. Code, Section 1001. S S �//
® Check here if comments are prov qn a lony�//, Were latitude and longitude in Section A provided by a ��'.... ° 70,�'•,2
❑ Check here if attachments. .O�E s s,0' .J(/�'ycensed land surveyor? ® Yes ❑ No _ . Q. SEAL
EwL
Certifier's Name JAMES A. LEWIS,PIS.• Q'q' • '• y ` License Number L-4562 - L-4562
Title PROJECT MANAGER - a Name: CHARLES F. RIGGS&ASSOCIATES,INC. 'y
Address 502 NEW BRIDGE ST ET,••� �Jk&SQNVILLE State NC ZIP Code 28540 ,9 URv�•• \�
C. �
Signature 71 A `-- -0.•.�DlaterI.ISG4t'.C-1 Telephone [phone] '/i i. S A._I-,l".Je.

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:
1422 OCEAN BOULEVARD
City TOPSAIL BEACH 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 TWO STORY ON PILINGS,PARTIALLY ENCLOSED BELOW.SURVEYOR HAS NOT REVIEWED FINAL
CONSTRUCTION DRAWINGS. THE TOWN OF TOPSAIL BEACH ADDS A 3.0'FREEBOARD TO THE BASE FLOOD ELEVATION,THEREFORE THE
BOTTOM OF THE LOWEST HORIZONTAL STRUCTURAL MEMBER MUST HAVE AN ELEVATION OF AT LEAST 14.0'+3.0'= 17.0'(PROPOSED
ELEVATION= .1')
etorte. t t t I l l l t IT�
Signature \� N CA..... //ate
SECTION E-BUILDING ELEVATION INFQ*:rle rkT' 2EQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE),complete Items 1-E, . If the AEA, is intend)to support a LOMA or LOMR-F request,complete Sections A, B.
and C. For Items E1-E4, use natural grade, if available.Check tLe.48e rrgnt usect In Puerto Rico only,enter meters.
El. Provide elevation information for the following aDd cheTftthe appropri�®1:7oxes.t.p show whether the elevation is above or below the highest adjacent
grade(HAG)and the lowest adjacent grade(LAG .v O lG •• • C
a)Top of bottom floor(including basement,craw spa t•e}f S ire) k' A` . . ❑feet ID meters ❑above or ID below the HAG.
b)Top of bottom floor(including basement,crawlsp2'9 ) �cAsu Gs\ �`� . ❑feet ID meters ❑above or El below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openinfjeiprprr+qq & ection 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 El 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)
he 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
f 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.
;1 ❑ 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.)
;2. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO.
;3. ❑ 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
;7. This permit has been issued for: ❑ New Construction ❑Substantial Improvement
;8. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑meters Datum
;9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters Datum
;10. Community's design flood elevation: ❑feet ❑meters Datum
Local Official's Name Title RECEIVED
U/II_MIRIG f{?N, NC
Community Name Telephone
Signature Date JUL 13 2016
Comments
❑Check here if attachments.

CHARLES F. RIGGS &ASSOCIATES, INC.
Land Surveyors
Charles F.Riggs,P.L.S.L-2981 Corporate License(C-730) James A.Lewis,P.L.S.L-4562
502 New Bridge Street 502 New Bridge Street Landfall Executive Suite 217
Jacksonville,North Carolina 28540 P.O.Box 1570 1213 Culbreth Drive
[phone] Jacksonville,North Carolina 28541 Wilmington,North Carolina 28405
[e-mail] [phone] [phone]
[e-mail]
July 12,2016
To: Mr.Jason Dail
Division of Coastal Management
North Carolina Department of Environmental Quality
127 Cardinal Drive
Wilmington,North Carolina 28405
Re: Luther Eddice Taylor III and wife,Rhonda Sullivan Taylor Minor CAMA Application
Dear Mr. Dail:
)On behalf of Luther Eddice Taylor III and wife, Rhonda Sullivan Taylor,Charles F. Riggs&
ssociates, Inc. submits for your review the enclosed Minor CAMA application for the property at 1422
Ocean Boulevard,Town of Topsail Beach,Topsail Township,Pender County,North Carolina.
ectfully,
OP
James L. Riggs /
RECEIVED
DCM WILMINGTON,NC
JUL 13 2016

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
July 12, 2016
Date
Name of Property Owner Applying for Permit:
Luther Eddice Taylor III and wife, Rhonda Sullivan Taylor(C &rci pa rcikt
Mailing Address:
406 Plantation Road
Goldsboro, NC 27530
I certify that I have authorized (agent) Charles F. Riggs & Assoc. to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct(activity) proposed dwelling, as shown on map
at (my property located at) 1422 Ocean Boulevard, Town of Topsail Beach
This certification is valid thru (date) July 12, 2017
July 12, 2016
Property Owner Signature ' Date
RECEIVED
DCM WILMINGTON, NC
JUL 13 2016

OFFER TO PURCHASE AND CONTRACT-VACANT LOT/LAND
[Consult"Guidelines"(form 12G)for guidance in completing this form]
NOTE: This contract is intended for unimproved real property that Buyer will purchase only for personal use and does not have
immediate plans to subdivide. It should not be used to sell property that is being subdivided unless the property has been platted,
properly approved and recorded with the register of deeds as of the date of the contract. If Seller is Buyer's builder and the sale
involves the construction of a new single family dwelling prior to closing, use the standard Offer to Purchase and Contract—New
Construction (Form 800-T) or, if the construction is completed, use the Offer to Purchase and Contract (Form 2-T) with the New
Construction Addendum(Form 2A3-T).
For valuable consideration, the receipt and legal sufficiency of which are hereby acknowledged, Buyer offers to purchase and Seller
upon acceptance agrees to sell and convey the Property on the terms and conditions of this Offer To Purchase and Contract and any
addendum or modification made in accordance with its terms(together the"Contract").
1. TERMS AND DEFINITIONS:The terms listed below shall have the respective meaning given them as set forth adjacent to each
term.
(a)"Seller": PATRICIA C.KETCHUM AND HUSBAND.JAMES RICHARD KETCHUM
(b)"Buyer": LUTHER EDDICE TAYLOR III AND WIFE. RHONDA SULLIVAN TAYLOR
(c)"Property": The Property shall include all that real estate described below together with all appurtenances thereto including the
improvements located thereon. NOTE: If the Property will include a manufactured (mobile) home(s), Buyer and Seller should
consider including the Manufactured(Mobile) Home provision in the Additional Provisions Addendum (Standard Form 2A1 l-T)
with this offer.
Street Address: 1422 OCEAN BLVD.
City: TOPSAIL BEACH Zip: 28445
County: PENDER, North Carolina
(NOTE:Governmental authority over taxes,zoning,school districts,utilities and mail delivery may differ from address shown.)
Legal Description:(Complete ALL applicable)
Plat Reference: Lot/Unit 21 .Block/Section 36 ,Subdivision/Condominium
,as shown on Plat Book/Slide 4 at Page(s) 2
The PIN/PID or other identification number of the Property is: 4202-92-7858
Other description:
Some or all of the Property may be described in Deed Book 1093 at Page 130
(d)"Purchase Price":
$ _ paid in U.S.Dollars upon the following terms:
$ BY DUE DILIGENCE FEE made payable and delivered to Seller by the Effective
Date
$ BY INITIAL EARNEST MONEY DEPOSIT made payable and delivered to Escrow
Agent named in Paragraph 1(0 by ❑ cash O personal check O official bank check
O wire transfer, EITHER ❑ with this offer OR ❑ within five (5) days of the
Effective Date of this Contract.
$ BY(ADDITIONAL)EARNEST MONEY DEPOSIT made payable and delivered to
Escrow Agent named in Paragraph 1(1)by cash or immediately available funds such
as official bank check or wire transfer no later than
, TIME
BEING OF THE ESSENCE with regard to said date.
BY ASSUMPTION of the unpaid principal balance and all obligations of Seller on
the existing loan(s)secured by a deed of trust on the Property in accordance with the
attached Loan Assumption Addendum(Standard Form 2A6-T).
$ BY SELLER FINANCING in accordance with the attached Seller Financing
Addendum(Standard Form 2A5-T).
$ BALANCE of the Purchase Price in cash at Settlement(some or all of which may be
paid with the proceeds of a new loan)
Should Buyer fail to deliver either the Due Diligence Fee or any Initial Earnest Money Deposit by their due dates, or should any
check or other funds paid by Buyer be dishonored,for any reason,by the institution upon which the payment is drawn, Buyer shall
DCM VIIEM NIGTDON,NC
Page 1 of 12
STANDARD FORM 12-T
JUL 13 2016 Revised 7/2015

a party herein,and any fee, deposit of other payment to be delivered to a party herein, may be given to the party or to such party's
Agent. Seller and Buyer agree that the "Notice Information" and"Acknowledgment of Receipt of Monies" sections below shall not
constitute a material part of this Contract. and that the addition or modification of any information therein shall not constitute a
rejection of an offer or the creation of a counteroffer.
19. EXECUTION: This Contract may be signed in multiple originals or counterparts. all of sshich together constitute one and the
same instrument.
20. COMPUTATION OF DAYS/TIME OF DAY: Unless otherwise provided, for purposes of this Contract, the term "days"shall
mean consecutive calendar days, including Saturdays, Sundays. and holidays, whether federal, state, local or religious. For the
purposes of calculating days,the count of"days"shall begin on the day following the day upon which any act or notice as provided in
this Contract was required to he performed or made. Any reference to a date or time of day shall refer to the date and/or time of day in
the State of North Carolina.
THE NORTH CAROLINA ASSOCIATION OF REALTORS*. INC. AND THE NORTH CAROLINA BAR ASSOCIATION
MAKE NO REPRESENTATION AS TO THE LEGAL VALIDITY OR ADEQUACY OF ANY PROVISION OF THIS FORM IN
ANY SPECIFIC TRANSACTION. IF YOU DO NOT UNDERSTAND THIS FORM OR FEEL THAT IT DOES NOT PROVIDE
FOR YOUR LEGAL NEEDS, YOU SHOULD CONSULT A NORTH CAROLINA REAL ESTATE ATTORNEY BEFORE YOU
SIGN IT.
This offer shall become a binding contract on the Effective Date. Unless specifically provided otherwise, Buyer's failure to timely
deliver any fee, deposit or other payment provided for herein shall not prevent this offer from becoming a binding contract, provided
that any such failure shall give Seller certain rights to terminate the contract as described herein or as otherwise permitted by law.
Date: ___0111( 5 - /7-- J/6 Date: 5 / 7 16
Buyer: Seller e *-j ut�
Date: c / 7 /G Date: 5 /
` 7 6._.
Buyer:(/ \ tt j .I. - Seller: ___
Entity Buyer: Entity Seller:
(Name of LLC/Corporation/Partnership/Trust/etc.) (Name of LLC/Corporation/PartnershipTTrust/etc.)
li`:
Name: Name: —it
Title: Title: --__- —____
Date: Date: __- .___.___
[THIS SPACE INTENTIONALLY LEFT' BLANK]
RECEIVED
DCM WIL M!NGTCN, NC
Buyer Initia;le (` eller Initials__- -- JUL 1 3 2016
Page 9 of 12
Association Form No 12T IC`Res ised 7/2015 This standard form has been approved jointly by North Carolina
Printed by Agreement with the NC Bar Association North Carolina Bar Association—NC Bar Form No 12T
North Carolina Association of Realtors*,Inc.—Standard Form 121

MA Daily Check Log for WIRO
Date
Deposite Check Receipt or
1 d Check From(Name) Name of Permit Holder Vendor Check Number amount Permit Number/Comments Refund/Reallocated
I6', Charles F.Riggs&Associates Inc Luther E.Taylor III/Rhonda S Taylor First Citizens Bank 14623 $100.00 minor fee,1422 Ocean Blvd,TB,Pender JD rct.2503D