TB_19-06_ Goldbach

Issued by WiRO TB19-06
Topsail Beach Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT
NORTH CAROLINA
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 Robert Goldbach et. al authorizing development in the Ocean and Inlet Hazard Areas of Environmental
Concern (AEC) at 105 Godwin Avenue, Topsail Beach, Pender County as requested in the permittee's application
package, dated February 14, 2019, and received by DCM on February 28, 2019. This permit, issued on March 18,
2019, is subject to compliance with the application and site drawing (where consistent with the permit) received by DCM
on February 28, 2019, 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 dwelling with stormwater collection system.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat drawing
sealed by Weston Lyall on February 21, 2019. The authorized work plat was received by the Division of Coastal
Management on February 28,2019.
(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)
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This permit action may be appealed by the permittee or other qualified persons III `" j
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within twenty (20) days of the issuing date. This permit must be on the project Jason Dail
site and accessible to the permit officer when the project is inspected for LLl eat
compliance. Any maintenance work or project modification not covered under CAM LOCAL PERMIT OFFICIAW Q '
this permit,require further whiten permit approval.All work must cease when this 127 Cardinal Drive Extension cc
permit expires on: Wilmington, NC 28405-3845
December 31,2022
In issuing this permit it is agreed that this project is consistent with the local Land i2,b-vl`—Atit 4,4/4
Use Plan and all applicable ordinances. This permit may not be transferred to PERMITTEE
another party without the written approval of the Division of Coastal
(Sinnatiira reniiireri if rnnriitinns ahnve annly to nermitl

Name: Robert Goldbach
Minor Permit#TB 19-06
Date: March 18, 2019
Page 2
(5) The permittee is required to contact the LPO at [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/all structures 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 Area of Environmental Concern
(AEC)standards,the more restrictive provision shall control.
(7) 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. Any excess sand held in storage shall be re-distributed
throughout the site; However, no material shall be deposited any further seaward than the landward toe of
the frontal dune.
(8) This permit does not authorize the removal and/or transportation of sand from the subject property.
(9) The total floor area of the permitted dwelling shall not exceed 1,440 square feet, per the authorized workplan
drawings.
(10)All buildings must be elevated on pilings with a diameter of at least 8 inches in diameter if round, or 8 inches to a
side if square; and the first-floor level of the sills and joists must meet the 100-year flood level elevation.
(11)All pilings shall have a tip penetration greater than eight feet below the lowest ground elevation under the structure.
(12)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 Coastal Resources Commission (CRC) Rules.
(13)Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold or otherwise
disposed of to a third-party.
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Locality I Permit Number
. Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other
(for q/Jiciul use only)
GENERAL INFORMATION
LAND OWNER- MAILING ADDRESS
/�Namc_.._�l(�\�OP A Ga.\i QA 0-II
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Address _. _ --- � _ �
City. �� ..-_-- State 13L Zip Vslyphone qfr 36,91 o0 4'l40A
Email .0 - enol .Car_..._
AUTHORIZED AGENT
Name �� ,_Z as �\111 c\e_. . 0 . ._ �-/ le _ 1 f 1 112Scd S
Address �� j ..-i iocjr t1l S1 • S c
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City ` L�
_ �f_1E State )( � Zip S Phone Qj, ' � ` - S
Entail_ / - 5L(.C.,_��M LOCATION OF PROJECT: (Address,street name and/or directions to site;name of the adjacent waterbody.)
1t)5 G \O � ; LT 3 of 5 )1oa Ne<7�Psal,1 gem
eAn OA 14,03 its I-
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.)_ le (3J1 `�
-WC) Ska du)e. �`. , c oe cec t e ter duct( and ©(ern s-ke eA s� 1e deck
SIZE OF LOT/PARCEL: square feet __V I acres
PROPOSED USE: Residential (Single-family EX Multi-Nuttily [] ) Commercial/Industrial [] Other [�
COMPLETE EITHER(I)OR(2)BELOW(Contact your Local Permit Officer if you are not sure which AEC applies
to your property): /'/�Il
(1) OCEAN HAZARD AECs:TOTAL FLOOR AREA OF PROPOSED STRUCTURE: �`1'�IV 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)
(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,
concrete or masonry patios,etc. that are within the applicable AEC.Attach your calculations with the project drawin o-,
STATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area subject to a State j
ao
Stormwater Management Permit issued by the NC Division of Energy, Mineral and Land Resources(DEMLR)? W e�
YES NO ✓ 0 co
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OTHER PERMITS MAY HE REQUIRED:The activity you arc 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,HA
Certification, 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:
II,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)
0
__,/_an owner or rccor I title,Title is vested in name of - 1 ,
see Deed i3ook rj 9;Q page in the ' County Registry of Deeds.
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 RIPARIAN PROPERTY OWNERS:
I furthermore certify that the following persons arc 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.
(Nan e) (Address)
(l) f /6, \Cooa(nttl,urn (Isyr es Po boxU)7 50.cc G-}y f)c, 38q
(2) ic\u& - ___ 6 1 ' _- cry comocas e6 151c
(3) . tc\ . - k.L.. C V --- ► Ot S L_ -�- cc_okeeN: m_h ao(pc
(4) --��-� -�-_ 4_ _ -ACKNOWLE DGEMENTS:
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.. i A
This the iy-_ day of CeCIfuQ( ,20
Landowner or person authorized to act as hi Al •agent for purpose of filing a CAMA permit application
This application includes:general it farnmtion(this farm), a site drawing as described on the back of this application, the
ownership statement, the Ocean hazard ABC Notice where necessary, a check for$100.00 made payable to the locality, and
any injOrmation as may be provided orally by the applicant. The details of the application as described by these sources are _
incorporated without reference in any permi►which may be issued. Deviation from these details will constitute a violatigof o
any permit.Any person developing in an ABC without permit is subject to civil, criminal and administrative action. > c
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(FAX)9105149717 P.0011002
02122/2019 11:10 Kidzcare Peds Lillington
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,AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
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.). Name of Property Owner Requesting Permit: . oyfoe(-3e
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Mailing Address': . :t-- C_O, C '11
44,,i__ __IL_ ____2251E____
Email
mhoanileANddumr Address
:
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I certify that I have authorized a MAW) Y\'i(A OA ft361ii I , ' ...
gent/contract&
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to act on my behalf; for the purpose of applying for and obtaining 11 CAMA permits
, 1„ „..„," , t .1., „ ,1 i
necessary for the following proposed development: :\04.. vao lk ki - co :.. tr$y
• , 1.,L . . : ›\: Ace , k ,,,n, ., ck
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at my property located at tf (1a0-1k0 66 -- 163:tl 64)(Kiii OC ,
in Q--(NC Sourity.
I furthermore certify that I em authorded to grant, and dO in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer arid their agents to enter
on the aforementioned lands in connection with evaluating inforrfration related to this •
permit application.
Property Owner .Infor
. gignature
Fiobert.eoldbiesh,I+AD
Print or 71?):ie:Alatne
Title
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Date
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This certification is valid through Oca i Di /
RECEIVED
FEB 2 8 2019

•
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
NORTH CAROLINA.. BRAXTON DAVIS
Elm rontnental Quality Director
March 18, 2019
Robert Goldbach et. al
104 Cannon Gate Road
Cary, NC 27518
Dear Mr. Goldbach,
Attached is CAMA Minor Development Permit TB 19-06 for work to be done at 105 Godwin Ave., in
Topsail Beach, Pender County. An electronic copy has been sent to the Topsail Beach Inspections
Department and your agent.
To validate this permit, please sign both copies as indicated for our records. Retain the orange copy for
your files, and 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,
,/)Mr
Tanya K. Pietila
Permit Support Technician
N.C. Division of Coastal Management
Enclosures
Cc:WiRO files
TB Inspection Dept.
N. King-Agent
•
State of North Carolina I Environmental Quality I Coastal Management
127 Cardinal Drive Ext.,Wilmington,NC 28405
01090K 111C

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PIN: 4202-70-6907-0000 Sale Price: $120,000 Acres:0.13 Pender County
Owner: GOLDBACH ROBERT et al Sale Date: 2015-06-09 Land Value:$176,330
104 CANON GATE DR Plat: 00120051 Building Value: $0
CARY, NC 27518 Account No: 967150 Total value: $176,330 1.1,476
0 0.01 0.02 0.04 n
Township: TOPSAIL Deferred Value:$0 I Deed Ref: 4592/085
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Subdivision: NEW TOPSAIL BEACH Exempt Amount: 0 0.0175 0.035 0.0
Tax Codes: G01 C54 R40 PCL Class:R 1 inch = 123 feet
Property
Address: 105 GODWIN AVE Heated Sq Feet:
R
February 25, 2019
Description: LT 3 PB 15/62 NEW TOPSAIL BEACH BLK 2 PB 12/51

NOTES: +0
TOPSAIL BEACH ‘j*.
1.THIS PROPERTY IS SUBJECT TO RESTRICTIVE
COVENANTS, EASEMENTS OF RECORD,
ZONING ORDINANCE,AND UNDERGROUND ;1-�,
UTILITIES,IF ANY. J cf. Is,
- LEGEND- Er
��
5 ��
2. NO TITLE SEARCH BY SURVEYOR. EIR-Existing Iron Rod
EIP-Existing Iron Pipe
3.AREA BY COORDINATE METHOD. EIPD-Existing Iron Disturbed
SIR-Set Iron Rod
4.THIS SUBJECT PROPERTY IS LOCATED IN CP-Calculated Point
FLOOD ZONE VE(EL 12), NCFIRM COMMUNITY TEL-Existing Telephone Pedestal ATLANTIC OCEAN
PANEL#3720-420200-J(EFFECTIVE DATE PP-Existing Powerpole
FEBRUARY 16,2007) LP-Existing Ughtpole VICINITY NAP(NTS)
R/W-Right-of-Way
5.REFERENCES: DB 4592,PG 85; MB 12,PG 51 MEL-Minimum Building Line
6.ZONE:R-4-TOPSAIL BEACH -Property Line Surveyed
SETBACKS:FRONT-20', SIDE-5', REAR-15'
— --- — — -Property Line Not Surveyed
GODWIN AVE (60' R/W)
EIP 1.546°11'03"E 54.95' AEIP
S46°07'1"E 55.15' EIP.1 • o EIP S46'20'14"E 55.06'
(NTS) (NTS)
• t945
? PROPOSED /
a . . 20'MBLAEPTIC AREA 7
(PROPOSED •, (PER PLANS
'.•1 20'WIDE . / Y OTHERS) IVED
• . I GRAVEL •/ j
•, 1 DRIVEWAY
/5.11... FFR 2 R '19
,, {I . co 16.9' 1 1 F-
g T 4'PROPOSED DECK .�.,, ili/ 2 RICFigIbiQ i.MiNGTON, NC
RICHARD BULCAVAGE w m / - DB 638,PG 84
DB 4333, PG 218 2 c 1
eo a PROPOSED }� 91' °'
1 SIDENCE% U
22'6"x32'0 Z
j 5.0' o
<z
8'PROPOSED PORCH
5.5-...f __to _J
15'MBL
LOT 3 o a
in
0.13AC. r
Eel�V/` S46°06'33"E 54.80' EIPD N46°33'16"W 55.27' %P
(NTS) SERENITY POINT PROPERTY INFORMATION:
CONDOMINIUM OWNER-ROBERT GOLDBACH
DB 1098,PG 67 104 CANON GATE DR
�..® �__�-.__.� CARY,NC 27518
IMPERVIOUS CALCULATIONS:
TOTAL AREA:0.13 AC.
LOT AREA-5,522 SF(0.12 AC) MAP BOOK 12,PAGE 51
PROPOSED BUILDING-gob SF DEED BOOK 4662.PAGE 85

uzizzuzulu 11:10 Kidzcare Peds Lillington (FAX)9105149717 P.002/002
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4 .OCEAN HAZARD AEC NOTICE 1 .
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ri Project.is•In an • Qqeart. 0601ble Area .. High'Hazard Plodd Mel a . Inlet Hazard Area
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Property Owner 0-. . , *
•••.:......se UA
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.PropertY Address P 0' 4
.,I .,.• . ,Date.Lot Was Plgted:—421jailli2.4_" .• 6‘r' '
;
This=dee.is intended to Make YOH,:the applicant!,aware elite. •SPECIAL 'NOTE: Tf4s hazard notice Is required far
• special risks and conditions associated with development in this developnient in:areas.stihject to sudden and massive storms and
• area,.which is subject.to ttattital hazards.such sas storms .eroSitat errision. Permits issued:fOr:dev.elopment in this:area expire on
. and currents. tilt rues Of'Me:Coastal'Resources Commission Decenther 31 of the.third year following the year In which the
,
require that you receive an A:UC: Hazard Notice :and permit was issued,'$hotly before work begins•on the project
aeknowled0 iha_t. notice in writing before a permit for site,the Local Officermust be contacted to determine rhe
development can be issued,
vegetation line and setback distance at:your aite..1f the property
. has-seen little chew since the time of permit issuanee„:and the
The •COMMission's. rtiles on, building standards,. oceanfront proposed deolopitent can still meet the setback requirement,
setbacks and dune alterationS are i:lesignect to Itiblimizoi but net the LPO will inform you Otat you may begin-work,Substantial
eliminate,sproperty loss.ficm hazards,'gy.granting permits, the progress:On the project rust be made within:60. days of this
: k .. .. . . . .. . . •
Coastal Resources Commission does notguareince•tite!safety of setback•neterminationior te•setbsck must be Also,
the development and assumes no liability-for.fOture damage to the occurrence:of a maj•er shoreline change as the result of
the &Wei-opulent. Permite issued in the,Oceart.•Hazard Area of sterns within the 60-day 0..rioci will necessitate re-measurement
• 1
Environmental Concern include the cendilion that s(ruCtures be. of the setback. It is ittipertant that you check with the LPO
relocated or dismantled if they become inunittently threatened before the perritit expires 14er official approval to continue the
by change:S.in:Shoreline configuration,The atrueture(s)'mist be work. after the .permit 11 expired. Generally; if fbundation
relocated or diernaittled 'within two :(2). years. of becoming inlings have beert placed Ind substantial progress is continuing,
imminently threatened, and in 'any-ettee upon Its Collapse. or permit renewal' can b.e authorized. It is unlawful to continue
subsidence.
work after'pennit expiration.
•
•The'bestaVellable.infOrinatietis accepted by thoCeastal: Fiv morehtformallall,ronImo:
•1
Resources •Commiesion, indicates that the annual kingqerin.
average.6cea erosion rate for the area where your property is • .t. liei-S.0)s.) 7). Aq'L.— '
located is i4.. 'feet:per:year.
Local.Permit(Veer
The rate. 'was established by careful analysis of aerial.
photographs of the coastline taken.overi*past 10 years, '
N.O. Dept of Erwironmelntal Quality
. .
„,,I
:Sttislies.also indicate'that the sherelitte could Move as much as .Dityision of Coastal'management
V rd 0,feet landward in a MajOr Storm, 117 Qardinal Drive Exiti elision
Mrningtqa, /VC 2805-3845
Thpbod waters in.a nutor stortli are predieted to:be about
d.., feet deep in this area, au.w.. mesign sp.-lbes _
Preferred oceanfront protection Measnres.are beach notatiihnien( 9.1.e) —.71'1:6 - -7- r.1-.7-7
and relocation of threatened.structures,..:Hard. erosion.0ontrol ..
'
• structures such as bulkheads,.settivalls.,revetinents,:grolim jetties 16,xtee.Number es4A.-1' D\
and breakwaters are prohibited,.Temporray fsend bags may be •
authorized:outhsr tertaia Condit:10as.
. •
The applicant must 'IteknoWledge this information and
•
requirements by signing this notice in the;sPaCe below;Without
the proper signature,t " :';..;i'catkin willoot.be•complete.
—.111111r •D .. .
-obert - • '
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.-rope: imyner Sig .- ore Date 1
-ReAsetMey MO
•RECEIVED
.......
•

Receipts for
Certified Mail
(Staple Here)
A jacent Property Own r
51i " c ec gcaa2
Mailing Addre s
C.,ingr3� �S P A
City, State,Zip Code
Dear Adjacent Property: kr9d1
This letter is to inform you that I,(4 � ��\ have applied for a CAMA Minor
Property Owner
Permit on my property at kD GO cL ( I`1UC ,in Topsail Beach,
Property Address
Pender 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//y�questions or comments about my proposed project,please
contact me at q i 9 -3kc) �'moo ,or by mall at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the CAMA Minor Permit Program,you may submit them to:
Jason Dail,DCM Field Representative
LPO,Town of Topsail Beach
NC DEC)/DCM
127 Cardinal Drive Ext.
Wilmington,NC 28405
(--Ociktc,h
Property Owner
1 bt- .c�i�n ()DAC c`e
Mailing Address
CA_ y, 16 9151g
City,State,Zip Code
RECEIVED
FEB 2 8 2019

I. . -os a ervice
CERTIFIED MAIL' RECEIPT
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For delivery information,visit our website at www.usps.com'.
COT S.77 PA
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Total P,�tage and Foes 02/14/2019 U
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] Street and Apt.No.,or PO Sox Pro.
-Ltiity,State,ZIP+4e '

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213 HOLLY ST
HOLLY RIDGE
NC
28445-7879
3637040445
02/14/2019 [phone] 2:09 PM
Product Sale Final
Description Qty Price
First-Class 1 $1.15
Mail
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(CORAOPOLIS, PA 15108)
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Credi t Card Recin1VE) $7.45
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(Transaction 494')
(AID:A0000000041010 C p)
MNsterCard N,
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(PIN N
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(2USPS) to get the latest status.
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-1LI-I�
Ad acent Property Owner
\\gO1 Sqc \IGNe. P
City,State,Zip Code
Dear Adjacent Property:
This letter is to inform you that I, AGO\A\Cak-c) have applied for a CAMA Minor
Property Owner
Permit on my property at_ b b (36A(4 i(A6 Q, ,in Topsail Beach,
Property Address
Pender 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 q / -3()a-0 306 ,or by mail at the address listed below. If you wish to
Applicants Telephone
file written comments or objections with the CAMA Minor Permit Program,you may submit them to:
Jason Dall,DCM Field Representative
LPO,Town of Topsail Beach
NC DEQ/DCM
127 Cardinal Drive Ext.
Wilmington,NC 28405
(*c (‘\ 6\1.\(RV
Property Owner
[DO CAW GoLke `A\a-
Mailing Address
City,State,Zip Code
RECEIVED
FEB 282019

1. . •os a - v -
CERTIFIED MAIL® RECEIPT
1 Domestic Mail Only
1
For delivery information,visit our website at www.usps.comn.
AC CAEFfit, tit) pojS0 7
1 Certified Mail Fee ..., ...... Z
0445
n7 z
' Extra Services&Fees(check box,add fee. .,.pr,,.ate) 0 ,, _ - 0
0 ReturnReceipt(hardcopy) $
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Return Receipt(electronic) $ $0.00 %. Postmark 0
3 ['Caddied Mail Restricted Delivery $ $0. 44 Z
i 0 Adult Signature Required $ so.00 1.11 - —
0 Adult Signature Restricted Delivery$ 0 2
) Postage W —I
1 i: $1.15
$
S14/2019 .,Total Postage and Fees
$7.45
$
3 Sent To
1
3 -gtreet and Apt.No.,or PO Box No.
City,State,ZIP+44
•
. .

A receipt(this portion of the Certified Mail labe. for an electronic return receipt,see a retail
A unique Identifier for your mailpiece. associate for assistance.To receive a duplicate
Electronic verification of delivery or attempted return receipt for no additional fee,present this
delivery. USPS®-postmarked Certified Mail receipt to tin
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. delveryto the addressee specified by name,or
to the addressee's authorized agent
nportant Reminders: -Adult signature service,which requires the
You may purchase Certified Mail service with signee to be at least 21 years of age(not
First-Class Mail°,First-Class Package Service®, available at retail).
or Priority Mail°service. -Adult signature restricted delivery service,whit'
Certified Mail service is notavailable for requires the signee to be at least 21 years of at
international mall. and provides delivery to the addressee specifier
Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agen
with Certified Mail service.However,the purchase (not available at retail). "
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
certain Priority Mail items. USPS postmark.If you w,uld 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 punier
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 mailplece; IMPORTANT:Save this receipt for your records.
S Form 3800.April 2015(Reverse)PSN 7530-02-000-9047

HOLLY RIDGE
NC
28445-7879
3637040445
02/14/2019 [phone] 2:11 PM
Product Sale Final
Description Qty Price
First-Class 1 $1.15
Mail
Large Envelope
(Domestic)
(ACCOKEEK, MD 20607)
(Weight:0 Lb 1.30 0z)
(Estimated Delivery Date)
(Tuesday 02/19/2019)
Certified 1 $3.50
(®®USPS Certified Mail #)
(70181130000084649633)
Return 1 $2.80
Receipt
(®®USE'S Return Receipt #)
(9590940232037166415079)
Total $7.45
Credit Card Remitd $7.45
(Card Name:Master . )
(Accoun pE n X9283)
(Approv #l?7i9P)
(Transaction #:495)
(AID:A000p!j 0q4 0119 Chip)
(AL:MasteN "d
(PIN:Not Required));
Text yoyh,010001 er to 2ON,8 77
(2USPS) 'Co get the latest status.

Receipts for
Certified Mail
(Staple Here)
ate en,$ VDvn LX1kmi 0\um
jacg�tx Prd.X rtt g_ner
l' of
Mess
asl c-ke arty NC a BUGS
City,State,Zip Code
Dear Adjacent Property:This letter is to inform you that I, '��b\ A ` 1 \ \ have applied for a CAMA Minor
(�� Property Owner
Permit on my property at \bb Llu a v4) AN)koue_ ,in Topsail Beach,
Property Address
Pender 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 "I,I q-3o 60c ,or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the CAMA Minor Permit Program,you may submit them to:
Jason Dail,DCM Field Representative
LPO,Town of Topsail Beach
NC DEQ!DCM
127 Cardinal Drive Ext.
Wilmington,NC 28405
12k( CAI4)4
Property Owner
Cfq(1in
Mailing Address
CPS
City,State,Zip Code
RECEIVED
ER 2 8 2019

I. . •os a ervtce
CERTIFIED MAIL® RECEIPT
i• Domestic Mail Only
• For delivery information,visit our website at www.usps.com
HO 7, ' 1G 844t`' . Z
] Certified Mall Fee Z
$ $3.50 14,45 O
Extra Services&Fees(check box,add fee a$e2rypreef{te) CI E U7 1�._
❑Return Receipt(hardcopy) $ S!•00 Ui C J V
3 ❑Return Receipt(electronic) $ $0.00 >POstminp z
3 0 Certified Mail Restricted Delivery $ t O.00 ui Herd
3 0 Adult Signature ReQuired $ 7 V�7 y z
❑Adult Signature Restricted Delivery$ $0•00 C co J
Postage ,, Li— 3
$ $1.15 ``
i Total Postage and Fees 02/14/2019
$ $7.45 C
3 Sent To
i
3 Street and Apt.No.,or PO box IVo.
City,State,ZIP+4s ��

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 thin
delivery. USPS®-postmarked Certified Mail receipt to th
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. delivery to the addressee specified by name,o
to the addressee's authorized agent.
mportant Reminders: -Adult signature service,which requires the
I You may purchase Certified Mail service with signee to be at least 21 years of age(not
First-Class Mail®,First-Class Package Service®, available at retail).
or Priority Mail®service. -Adult signature restricted delivery service,whic
I Certified Mail service Is notavallable for requires the signee to be at least 21 years of a,
International mall. and provides delivery to the addressee specifie
l Insurance coverage is not available for purchase by name,or to the addressee's authorized ager
with Certified Mail service.However,the purchase (not available at retie).
of Certified Mail service does not change the s To ensure that your Certified Mail receipt is
Insurance coverage automatically included with accepted as legal proof of mailing,it should bear
certain Priority Mail items. USPS postmark.If you would like a postmark on
For an additional fee,and with a proper this Certified Mall receipt,please present your
endorsement on the mailpiece,you may request Certified Mall item at a Post Office-for
the following services: postmarking.It you don't need a postmark on this
-Return receipt service,which provides a record Certified Mall receipt,detach the barcoded portico
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.
S Form 3800,April 2015(Reverse)PSN 7530-02-000-9047

HOLLY RIDGE
213 HOLLY ST
HOLLY RIDGE
NC
28445-7879
3637040445
02/14/2019 [phone] 2:08 PM
Product Sale Final
Description Oty Price
First-Class 1 $1.15
Mail
Large Envelope
(Domestic)
(HOLLY RIDGE, NC 28445)
(Weight:0 Lb 1.30 Oz)
(Estimated Delivery Date)
(Saturday 02/16/2019)
Certified 1 $3.50
(NUSPS Certified Mail #)
(70181130000084649619)
Return 1 $2.80
Receipt
(NUSPS Return Receipt #)
(9590940232037166415055)
Total $7.45
Credit Card F VED $7.45
(Card Na erCard)
(Account #:XXXX XXXX2XX))L9283)
(Approval #;r4;,ol01�) o
t
(Transacts 4 445533)
(AID:A0000000041010 Chip)
(AL:Ma(PINtiS tWIdtM7-- NC
,
Text your tracking number to 28777
(2USPS) to get the latest status.
. .. . --4 n +, r +oc may

SENDER: COMPLETE THIS SECTION
COMPLETE THIS SECTION ON DELIVERY
A Signature Agent
X
■ Complete items 1,2,and 3.
• Print your name and address on the reverse r Addressee
so that we can return the card to you. ���"'Date of Delivery
■ Attach this card to the back of the mailpiece,
B. Received by(Printed Nam-
or on the front if space permits. I.
-
1. Article Addressed to: D. Is delivery a.dress differe t from item 1? ❑Yes
/ If YES,enter delivery address below: No
r t t ,Pd rri f(00o 466,di
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3. Service Type ❑Priority Mail Express®
1111lll1 I'llll III\I\II\\II\II III\III II III ❑Adult Signature ❑ Mail
❑Adult Signature Restricted Delivery ❑RegisteredRegistered Mail Restricted
Certified MailO Delivery
9590 9402 3203 7166 4150 55 CI Certified
Mail Restricted Delivery 0 Return Receipt for
❑Collect on Delivery
Merchandise
0 Signature Confirmation,"
Collect on Delivery Restricted Deliveryg
ail El Signature Confirmation
2. Article Number(Transfer from service label) Restricted Delivery Restricted Delivery
7 018 113 0 0 0 0 0 8 4 6 4 9 619 all
Domestic Return Receipt
PS Form 3811,July 2015 PSN 7530-02-000-9053
RECEIVED
FEB 2 8 2019

` v�� Healt�p PENDER COUNTY HEALTH DEPARTMENT
c1./ \� ENVIRONMENTAL HEALTH DIVISION
•
(n �_I 3 803 Walker Street,P.O. Box 1209
�';J-L
Burgaw,NC 28425
Phone [phone] FAX [phone]
.www.pendereountyne.gov
North Carolina Public Health
Everywhe,e,Evetyd.y.Evetyixxly •
IMPROVEMENT PERMIT
Parcel PIN: 4202-70-6907 Permit#: IP 15-136H
Application Date:
Applicant: Robert Goldbach Owner: George Stehenson
Address: 104 Canon Gate Address: 2102 Bloomsburg Road
Cary,NC Greenville,NC
Phone: Phone:
Property Desc.: New Topsail Beach Block 2 Lot 3 Lot Size(Acres):
Property Address: 105 Godwin Ave Facility Type: Single Family Dwelling
Permit Type: Residential New Water Supply: Public
JNTIAL SYSTEM REPAIR SYSTEM
Design Flow: 480 GPD System Type: Other Trench(25%) System Type: EXEMPT
No.of Bedrooms: 4 System Class: IIIg System Class:
Site Classification:PS Useable Soil Depth:42" Useable Soil Depth:
LTAR: 1.0 LTAR:
Conditions:
Property recorded in 1977--Repair exempt.
-INSTALL DRAIN LINES ON CONTOUR.
-IF GRAVITY FLOW CANNOT BE MAINTAINED A PUMP TANK WILL BE REQUIRED.
-THE DRAINFIELD MUST BE SEEDED PRIOR TO SYSTEM APPROVAL.
Refer to the attached site plan for specific information regarding location of the designated area. Soil and site descriptions are
located on file at Pender County Environmental Health. There may be other types of systems which are applicable to this site.
The permit and evaluation are valid only for the site as designated on the attached site plan. A Construction Authorization must
be issued prior to the issuance of the Building Permit and before any construction or system installation can commence.
This permit is subject to revocation if the site plan,plat, or intended use changes or if the site is altered.Do not drive on or
otherwise disturb the designated soil area or this permit may be revoked.
CI
s .
l��-
ISSUED:26 May 15 Z EXPIRES: 26 May 20 ```
W 71
Registered Environmental Health Specialist U
W

?ENDER COUNTY HEALTH DEPT
ENVIRONMENTAL HEALTH SECTION
P.O.BOX 682
HAMPSTEAD,NC 28443
PERMIT# ! /36 /T
PAGE OF .
/ ( 3 x3o
ui3R
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RECEIVED
FEB 2 8 2019

ALPHA OBJECTID PIN NAME ADDR CITY STATE ZIP PROPERTY ADDRESS PROPERIY_DESCRiPTON
4202-70-2648-0000 153857 4202-70-2648-0000 SERENITY POINT CONDOMINIUM ASS PO BOX 3297 SURF CITY NC 2R445-INNlt 2173 INLET AVE COMMON AREA PB 37 68 SERENITY POINT
COND
4 -7 - 942-0000 142857 4202-70-6942-0000 HOFF RICHARD C et al 2511 BEAVER GRADE RD CORAOPOLIS PA 15108 103 GODWIN AVE LT 2 PB 12/51 NEW TOPSAIL BEACH BLK 2
4202-71-5060-0000 142900 4202-71-5060-0000 BULCAVAGE RICHARD P TRUSTEE et al 1801 SPRINGVALE CT ACCOKEEK MD 20607 107 GODWIN AVE LT 4 PB 15/62 NEW TOPSAIL BEACH BLK 2 PB 12/E
0 IT
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DATE LAST_SALE_DATE SALE_PRICE PLAT ACCOUNT TOWNSHIP TNSH_DESC ACRES LAND_VALUE BUILDING_VALUE TOTAL_VALUE DEFERRED- - _
VALUE SUBDIVISION TAX CODES EXEMPT USE AL1
12/11/1995 12/12/1995 370068 42624 102 TOPSAIL 280000 I4770 29 „�
12/31/19b9 12051 9643 102 TOPSAIL 0.13 176330 3498 9 8 SE NEW
TOPSAIL POINT GO1 C54 R40
BEACH GO1 C54 R40
10/10/2013 10/11/2013 110000 150062 961382 102 TOPSAIL 0.13 176330 233008 409338 NEW TOPSAIL BEACH G01 C54 R40
0 cll.)W 0
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Shape.area Shape.len SHAPE.fid PTPAGE PLATBOOK indx
R121051 004 0:00 2073
3080;00:00 2073 R 7 708269.0004 12319.12802 75599
R 638 84 5789.325021 319.4009274 64599 37 68
4333 218 5702.823735 316.5358513 64642 1
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CLIENT:BOB GOLDBACH BEACH RESORT HOMES PLAN: CUSTOM /
105GODVHNAVE. J.NATHAN KING SQUARE FEET: 1440 111 SHEET OF
TOPSAIL BEACH,NC 28445 GENERAL CONTRACTOR DRAWN 08001/15
DRAWN BY:C.NATHAN KING REVISED:2/052019 /
COPYRIGHTS ALL RIGHTS RESERVED / /
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National Flood Insurance Program
V-Zone Certification
Property Information For insurance Company Use
Name Policy Number
Robert Goldbach
Address
105 Godwin Avenue
City State Zip Code
Topsail Beach NC 28445
Section I: Flood Insurance Rate Map (FIRM) Information
Note:to be obtained from appropriate FIRMS
1: Community Number 2: Panel Number 3:Suffix 4: Date of FIRM Index 5: FIRM Zone
370187 4202 J 2/16/07 VE 12.0
Section II: Elevation Information
Note:This form is not a substitute for an Elevation Certificate.Elevations should be rounded to the nearest tenth of a foot.
1. Elevation of the Bottom of The Lowest Horizontal Structure Member 15.1 feet(NGVD)
2. Base Flood Elevation 12 feet(NGVD)
3. Elevation of Lowest Adjacent Grade 5.2 feet(NGVD)
4. Approximate Depth of Anticipated Scour/Erosion Used for Foundation Design... 1.0 feet
5. Embedment Depth of Pilings or Foundation Below Lowest Adjacent Grade 8 feet(Minimum)
Section III: Zone Certification Information
Note:This section must be certified by a registered engineer or architect
I certify that I have developed or reviewed the structural design, plans and specifications for construction
and that the methods of construction are in accordance with the accepted standards of practice for meeting the
following provisions:
a)The bottom of the lowest horizontal structure member of the lowest floor(excluding the pilings or
columns) is elevated to or above the BFE.
b)The pile or column foundation and structure attached thereto is anchored to resist flotation collapse and
lateral movement due to the effects of the wind and water loads acting simultaneously on all building
components. Water loading values used are those associated with the base flood including wave action.
Wind loading values used are those required by the applicable State or local building code.The potential
for scour and erosion at the foundation has been anticipated for conditions associated with the base
flood.
Section IV: Breakaway Wall Certification Statement
Note:This section must be certified by a registered engineer or architect when breakaway
walls exceed a design safe loading resistance of 20 pounds per square foot.
I certify that I have developed or reviewed the structural design,plans and specifications for construction
and the design and methods of construction of the breakawaywalls are in accordance with accepted
standards of practice for meeting the following provisions:
a) Breakaway collapse shall result from a water load less than that which would occur during the base
flood.
b)The elevated portion of the building and supporting foundation system shall not be subject to collapse,
displacement,or other structural damage due to the effects of wind and water loads acting
simultaneously on all building components(wind and water loading values defined under Section III).
Section V: Certification
(Check: Section III X and/or Section IV X )
Name of Certifier
Weston Lyall
Title License Number
Engineer 27885
Street Address a,1`��►•����'��
``� �� Cq �1#• Phone Number
214 Highway 17 N. Suite�:©Q• •...... A() �. [phone]
City ••QpfES4/0••,. to Zip Code
Holly Ridge Q s�� ,'t 28445
Signature) ( _ Date
= 27$85 •
2/22/1 9
•
.tiQnyf�+••: RECEIVED
%01•"*.::.

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
GOLDBACH ROBERT
A2. Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and
Box No. Company NAIC Number:
105 GODWIN AVE
City State ZIP Code
Topsail Beach North Carolina 28445
A3. Property Description(Lot and Block Numbers. Tax Parcel Number, Legal Description,etc.)
PIN#4202-70-6907-0000
A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory,etc.) Residential
A5. Latitude/Longitude: Lat.34-20-58.14 Long.-77-38-58.69 Horizontal Datum: ❑ NAD 1927 ❑x 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):
a) Square footage of crawlspace or enclosures) 250 sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b 0 sq in
d) Engineered flood openings? ❑Yes El 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 0
c) Total net area of flood openings in A9.b 0 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 83. State
Town Of Topsail Beach 370187 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)
3720420200 J 02/16/2007 02/16/2007 VE 12
810. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 89:
❑FIS Profile 0 FIRM ❑Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item 89: ❑ NGVD 1929 j NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes ❑x No
Designation Date: ❑ CBRS ❑ OPA RECEIVED
FFR 2 8 2019
FEMA Form 086-0-33(7/15) Raninrac.emu

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
105 GODWIN AVE
City State ZIP Code Company NAIC Number
Topsail Beach North Carolina 28445
SECTION C—BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based on: 0 Construction Drawings* 0 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:Geoid 12A VRS RTK GPS
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) 6. 1 x❑ feet ❑ meters
b) Top of the next higher floor 17. 1 0 feet ❑ meters
c) Bottom of the lowest horizontal structural member(V Zones only) 15. 1 0 feet ❑meters
d) Attached garage(top of slab) N/A. 0 feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building N/A. Ej feet 0 meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent(finished)grade next to building(LAG) 5. 2 0 feet ❑ meters
g) Highest adjacent(finished)grade next to building(HAG) 6, 1 0 feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs,including N/A. 0 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.
1 certify that the information on this Certificate represents my best efforts to interpret the data available. 1 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? 0 Yes ❑No ❑Check here if attachments.
Certifier's Name License Number
Weston Lyall L-4438
Title ---
MNNp
Owner/PLS C�+�Company Nameff$414
, r ., . 0
Weston Lyall, PE, PLS, PLLC
al e 1
Address :Is
214HWY17N • att
City State ZIP Code :, . b....-
Holly Ridge North Carolina 28445 �4',,,� ,( Vim/
Signature - ��•Iri.N=t�Pa
Date Telephone
02/22/2019 [phone]
Copy all pages f this evation Certificate 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)
This elevation is preliminary only for a proposed residence. Elevations noted are per construction drawings.
Section A8: The estimated enclosure area is determined from preliminary construction drawings.All ground level walls shall be
constructed as break-away. Final calculations are determined with the finished construction elevation certificate.
Sections B8&89: Information noted is the effective flood zone.The flood zone shall change to AE 11 per preliminary FEMA flood map
RECEIVED
FEMA Form non-n-31 r7NF1 n_-'-_-- n 1---, zr 1.) -n-G

ELEVATION CERTIFICATE OMB No. 1660-0008
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
105 GODWIN AVE
City State ZIP Code Company NAIC Number
Topsail Beach 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, Band 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 0 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 0 below the HAG.
E4. Top of platform of machinery and/or equipment
servicing the building is []feet 0 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? Ej 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
RECEIVED
0 Check here if attachments.
FEMA Form 086-0-33(7/151

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:
105 GODWIN AVE
City State ZIP Code Company NAIC Number
Topsail Beach 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: ❑ 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: El 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)
RECEIVED
FEB 2 8 204,E Check here if attachments.
FEMA Form 086-0-33(7/15)

BUILDING PHOTOGRAPHS
ELEVATION CERTIFICATE See Instructions for Item A6. OMB No. 1660-0008
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:
105 GODWIN AVE
City State ZIP Code Company NAIC Number
Topsail Beach 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
Photo Two .,x..
Photo Two Caption
FEMA Form 086-0-33(7/15) Renlacac all nravini o�s,,,,e �., 0 0 ')^ 0 _ .. _ _

BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE Continuation Page 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:
105 GODWIN AVE
City State ZIP Code Company NAIC Number
Topsail Beach North Carolina 28445
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. 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.
Photo One
Photo one
Photo One Caption
Photo Two
RECEIVED
Phc o Two
Photo Two Caption 'FB 2 8 Z019
FEMA Form 086-0-33(7/151 - _ __

Date Date Check From Name of Vendor Check Check Permit Rct.
Received Deposited Permit Holder Number amount Number/Comments
3/1/2019 King Companies- Robert Goldbach Bank of 16408 $100.00 minor fee, 105 Godwin Ave, JD rct.7
Kinco Inc. America Topsail Beach PnCo