OI_16-11_Davenport

Oak Island 0116-11
Local Government Permit Number
CAMA
MINOR DEVELOPMENT --`
PERMIT
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 Michael & Valerie. Davenport, authorizing development in the Estuarine Shoreline (AEC) at.5130 W. Dolphin
Dr., in Oak Island, NC, as requested in the permittee's application, received 1/27/2016, This permit, issued on
2/12/2016, is subject to compliance with the application and site drawing (where consistent with the permit), all
applicable regulations and special conditions and notes set forth below. Any violation of these terms may subject
permittee to a fine, imprisonment or civil action, or may cause the permit to be null and void.
This permit authorizes; the expansion of the house footprint by 521.5 feet and interior remodeling with associated development.
(1) All proposed development and associated construction must be done in. accordance withthepermitted work plat
-
drawings(s) dated received on 1/27/2016:
(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, 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 910-278-5024 for a final inspection at
completion of work.:.,
(Additional Permit Conditions on Page 2)
This permit action may be appealed by the permittee or other qualified persons l{/
within twenty (20) days of the issuing date. This permit must bon the project .. .
site and accessible to the permit officer when the protect Is inspected for i
site I
compliance. Any maintenance work or project modification not covered under
this permit, require further written permit approval. All work must cease when this Donna F. Coleman co
permit expires on: CAMA LOCAL PERMIT OFFICIAL F—. �.
DECEMBER 31, 2019 Oak island Dr. Z
Oak Islan 65 U
,
In issuing this permit it is agreed that this project is consistent with the local Land z .
5
Use Plan and all applicable ordinances. This permit may not be transferred to
another party without the written approval of the Division of Coastal
Management. PERMITTEE
(Signature reliuired if conditions above apply to permit)

Name: Davenport
Minor Permit # 0116.11
Date: 2112/2016
Page 2
(5) The amount of impervious surface shall not exceed 30% of the lot area within 75 feet of the normal high water
(Estuarine Shoreline Area of Environmental Concern), in this case, 521.5 square feet is authorized.
(6) Unless specifically allowed in 15A NCAC 07H. 0209(d)(10), and shown on the permitted plan drawing, all
development/construction shall be located a distance of 30 feet landward of the normal high water. No portion of the
roof overhang shall encroach into the 30 ft. buffer.
(7) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Prior to any land -disturbing activittes, a barrier line of filter cloth must
be installed between the land disturbing activity and the adjacent marsh or water areas, unfit such time as the area
has been property stabilized with a vegetative cover.
(8) Any proposed for grading within the 30' buffer from the normal high water must be contoured to prevent additional
stormwater runoff to the adjacent marsh. This area shall be immediately vegetatively stabilized, and must remain in
a vegetated state.. .
(9) All other disturbed areas shall be vegetatively stabilized (planted and mulched) within 14 days of construction
completion.
DATE: 02�� SI(b
RECEIVED
DCM WILMINGTON, NC
APR 2 8 2016

1�`Locality
Ocean Hazard v1 Estuarine Shoreline ORW Shoreline Public Trust ShorelineOtherj�ff
(For official use only)
Oak- Ts (and Permit Number QZ 1 Lo-
GENERAL INFORMATION
._.ZI t I A% UI
Name:
s
Address: -71 D 5 ik3 G-i� I -
City: 5CeAf'a70k- State: Zip:9,733(0 Phone: q1'7
AUTHORIZED AGENT
Name:
Address: ?n mc-�- ' 1 0 City: Q11k- 1-5;k l Ci— State: /y Q Zip: Z C Phone: _ c(10 -�Frg -lzuo —
LOCATION OF PROJECT: (Address, street name
adjacent waterbody.) 51 30 W
to site. If not oceanfront, what is the name of the
DESCRIPTION OF PROJECT: JList all proposed construction and land disturbance.)
fv"'7. 5-
SIZE OF LOT/PARCEL: 4XQ0 square feet acres
-V2V10JC,�+q'l
PROPOSED USE: Residential (Single-family VrMulti-family ❑) Commerical/Industrial ❑ Other ❑
TOTAL ENCLOSED FLOOR AREA OF A BUH.DING IN THE OCEAN HAZARD AREA OF
ENVIRONMENTAL CONCERN (AEC): (�1 square feet (includes air conditioned living space, parking elevated
above ground level, non -conditioned space elevated above ground level but excluding non -load -bearing attic space)
COASTAL SHORELINE AREA OF ENVIRONMENTAL CONCERN AECs :SIZE OF BUILDING FOOTPRINT
AND OTHER IMPERVIOUS OR BUILT -UPON SURFACES: S"ti l rsquare feet (includes the area of the roof/drip line
of all buildings, driveways, covered decks, concrete or masonry patios, etcthat are within the applicable AEC. Attach
your calculations with the project drawing .)
Chr2)w1ithin
a AEC area that applies to your property:
lin 75 feet of Normal High Water for the Estuarine Shoreline AEC
575 feet of Normal High Water for the Estuarine Shoreline AEC, adjacent to Outstanding Resource Waters
(3)within 30 feet of the Public Trust Shoreline AEC
(Contact your Local Permit Officer if you are not sure which AEC applies to your property.)
STATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area sublecW a State Stormwater
Management Permit issued by the NC Division of Water Quality? YES ❑ NO fff
If yes, list the total built upon area/impervious surface allowed for your lot or parcel. square feet.E C E I V E D
DCM WILMINGTON, NC
JAN282016

OTHER PERMITS MAY BE REQUIRED: The activity you are planning may require permits other than the CAMA minor development permit.
As a service we have compiled a listing of the kinds of permits that might be required. We suggest you check over the list with your LPO to
determine if any of these apply to your project. Zoning, Drinking Water Well, Septic Tank (or other sanitary waste treatment system), Building,
Electrical, Plumbing, Heating and Air Conditioning, Insulation and Energy Conservation, FIA Certification, Sand Dune, Sediment Control,
Subdivision Approval, Mobile Home Park Approval, Highway Connection, and others.
STATEMENT OF OWNERSHIP:
I, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in an AEC or
a person authorized to act as an agent for purposes of applying for a CAMA minor development permit, certify that the
person listed as landowner on this application has a significant interest in the real property described therein. This interest
can be described as: (check one)
owner or record title, Title is vested in see Deed Book ZS 2 9
page S09 in the `&udStutCIG 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 and attach to this application.
NOTIFICATION OF ADJACENT PROPERTY OWNERS:
I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that I have given
ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
(1)
(2)
(3)
(4)
FOR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE HAZARD AREAS:
I 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 particular
hazard problems associated with this lot. This explanation was accompanied by recommendations concerning stabilization
and floodproofing techniques.
PERMISSION TO ENTER ON LAND:
I furthermore certify that I am authorized to grant and do in fact grant permission to the local permit officer and his agents
to enter on the aforementioned lands in connection with evaluating information related to this permit application.
This application includes: general information (this form), a site drawing as described on the back of this application, the
ownership statement, the AEC hazard notice where necessary, a check for $100.00 made payable to the locality, and any
information as may be provided orally by the applicant. The details of the application as described by these sources are
incorporated without reference in 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.
This $t�-�r a of M,4uc w , 20 IC
owner or person authorized to act as his agent
purpose of filing a CAMAATr Lt pp do
DCM WILMINGTON, NC
JAN 2 8 2016

AEC HAZARD NOTICE
Protect Is In An: — Ocean Erodible Area gh Hazard Flood Area —Inlet Hazard Area
Property Owner: 021 r�
Property Address: S)S 0 UJ • t✓d� hill7 0r=
Date Lot Was Platted: 60/7- %2ooco
This notice is intended to make you, the applicant, aware of the
special risks and conditions associated with development in this
area, which is subject to natural hazards such as storms, erosion
and currents. The rules of the Coastal Resources Commission
require that you receive an AEC Hazard Notice and acknowledge
that notice in writing before a permit for development can be
issued.
The Commission's rules on building standards, oceanfront
setbacks and dune alterations are designed to minimize, but not
eliminate, property loss from hazards. By granting permits. the
Coastal ResourcesCommission does not guarantee the safety of
the development and assumes no liability for future damage to
the development. Permits issued in the Ocean Hazard Area of
Environmental Concern include the condition that structures be
relocated or dismantled if they become imminently threatened by
changes in shoreline configuration. The structure(s) must be
relocated or dismantled within two (2) years of becoming
imminently threatened, and in any case upon its collapse or
subsidence.
The best available information, as accepted by the Coastal
Resources Commission, indicates that the annual long-term
average ocean erosion rate for the area where your property is
located ism_ feet per year,
The 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 move as much as
ram` Meet landward in a major storm.
The flood waters in a major storm are predicted to be about
feet deep in this area.
Preferred oceanfront protection measures are beach nourishment
and relocation of threatened structures. Hard erosion control
structures such as bulkheads, seawalls, revetments, groirk%jetties
and breakwaters are prohibited. Temporary sand bags may be
authorized undercertain 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.
Applicant Slgneture Data
SPECIAL NOTE: This hazard notice is required for development
in areas subject to sudden and massive storms and erosion. Permits
issued for development in this area expire on December 31 ofthe
third year following the year in which the permit was issued.
Shortly before work begins on the project site, the Local Permit
Officer must be contacted to determine the vegetation line and
setback distance at your site.lrthe property has seen little change
since the tire, ofpennit issuance, and the proposed development
can still meet the setback requirement, the LPO wil l inform you
that you may begin work Substantial progress on the project
must be made within 60 days of this setback determination, or
the setback must be remeasured. Also, the occurrence of a major
shorelinc change as the result ofa storm within the 60-day period
will necessitate remreasurement of the setback. It is important
that you check with the LPO before the permit expires for official
approval to continue the work after the permit has expired.
Generally, if foundation pilings have beenplaced and substantial
progress is continuing, permit renewal can be authorized. It is
unlawful to continue work afterpermit expiration.
For more information, contact
7pbril"ICA (2A NA G ✓1
Local Permit officer
y IQc3I � . o � r{s1G,t✓7ri li7r
Address
a I&M cl r tN zFr f o r
Locality
[210) -ar- 5;6q
Phone Number
RECEIVED
DCM WILMINGTON, NC
JAN 2 S 2016
Revised

VICINITY MAP
MW m0
NOTE THE CANA AREA OF ENVIRONMENTAL CONCERN LIES BETWEEN THE MEAN HIGH
WATER LINE AND THE 75' ESTUARINE SHORELINE - 5649.4 SF. THE PERMRTABLE
IMPERVIOUS .AREA BETWEEN THE 30' PUBLIC TRUST SHORELINE AND THE 75' ESTUARINE
SHORELINE IS 30R OF THE CANA AREA OF ENVIRONMENTAL CONCERN - 1694.8 S.F.
THE EXISTING IMPERVIOUS AREA IS 2MOO SF.
DAVIS CREEK 8
8
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5130 WEST
DOLPHIN DRIVE
60' PUBLIC RIGHT—OF—WAY
NOTE: THIS PROPERTY LIES WITHIN THE CANA
OCEAN ERODIBLE AREA OF ENVIRONMENTAL CONCERN.
/QPpFESSI,Z
SEAL
r L-3S86
O N... 'et
LEGEND (IF USED)
IRF-IRON ROD OR REBAR TO
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MBL-MINIMUM BUILDING LINE
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AGENCY
EMERGENCY MANAGEMENT
INSURANCE RATE MM
WATER LINE
FLOOD CERRFICATIIXI
I, THIS PROPERTY US WITHIN REMA SPECAL FLOOD HAZARD ABFA VE-16
AS SHOWN ON F.I.R.M. 3720203100.1. DATED 6/02/2006.
GENERAL NOTES:
1. LS MEASUREMENTS ON THIS MM ARE IN FEET MD DECIMATHEREOF.
LL 2. ASET CORNERS ME 1/2' IRON REBM UNLESS OTHERWISE NOTED.
3. THIS PROPERTY MAY BE SUBJECT TO ADDITIONAL EASEMENTS, RIGHTS OF
WAYS MD RESTRICTIONS NOT DISCERNIBLE BY OBSERJATTON AT THE
TIME OF SURVEY OR THAT MAY BE OF RECORD. NO TITLE SEARCH BY
THOMAS D. VON CANON.
REFEREHCm.
1. PLAT OF LONG BEACH, SECTION 4, RECORDED IN MM CABINET 2.5,
PAGES IK-189 IN 1947 IN THE BRUNSWICK COUNTY, NORM CAROLINA
REGISTER OF DEEDS.
2 DEED BOOK 2529. PAGE 809. RECORDED IN THE BRUNSWICK COUNTY.
NORTH CMOLIM REGISTER OF DEEDS.
THIS IS TO CERTIFY MAT ON NOVEMBER 12M, WIS. I SURVEYm ME
PROPERiI• SHOWN ON ME PUT, AND TWAT ME TITLE UNES AND ME
WAIi9 O ME BUILDINGS, C ANY HBY CO DI AREA OF
W PROPERTY IS 0.ING ACRES BY ON. ME AM
SIGNED RD HOD MO CLOSURE Is 1:1 D.ao0.
—Jr////,�,L `,•`\/THOMAS D. VON C41ON L-3686
N BT45 00 W
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NOW OR FORMERLY
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MICHAEL G. MASIRONARDY
DEED BOOK 2217, PAGE 790
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PHYSICAL SURVEY
FOR: MOFFITT BUILDERS, INC.
LOTS 15 & 1/2 OF 14
BLOCK 117, SECTION 4
WEST LONG BEACH
OAK ISLAND, SMITHVILLE TOWNSHIP
BRUNSWICK COUNTY, NORTH CAROLINA
VCS & CO., INC. C-2160
1 YAUPON WAY
OAK ISLAND, NC �
TELE. (704) 3s1—i ss}'72�-''�E E l V E D
EMAIL vcsbrunsco a .rt.01 i INGTON, NC
REST w,4
JAN282016

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13

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit: IBC �7A4) DCAVe t 7PCL-L
Mailing address: -71 0 S,4-,3 a✓1I2I
Phone Number: GI Cl - ' 7S- q-)y I
certify that I have authorized 116b-Jr;u-' b'ji(CUAs T✓ln..
Agent / Contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of VIVICAC4-k2n S
at my property located at
in �County.
This certification is valid through t 1'iS" 1 111
Date
(Property Owner Information)
signature f
i C%1 aj L-) GuI2yll�a�
Print or Type Name
Title
i�ZS � I Lo
Date
71T - 9'7g 1
Phone Number
Emeii Addreea
RECEIVED
DCM WILMINGTON, NC
JAN 2 8 2016

Receipts for
Certified Mail
(Staple Here)
t I75-hLp
Date
MiCV7CAf
Adjacent Property Owner
I >s `. e,G Z c ,
�a�ngAdglress�iU[( f NY 6iS7s�
City, State, Zip Code
Dear Adjacent Property: /��
This letter is to inform you that I, I Y (v(,ctU f JO�e�?have applied for a CAMA Minor
Property Owner
Permit on my property at 57K66 UD • TDd ( ph t n Di-7 in Brunswick
Property Address
County. As required by CAMA regulations, I have enclosed a copy of my permit application and project
drawing(s) as notification of my proposed project. No action is required from you or you may sign and return
the enclosed no objection form. If you have any questions or comments about my proposed project, please
contact me at G IQ - 17 S • 9141 or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the Town of Oak Island CAMA Minor Permit Program, you may submit
them to:
Donna F. Coleman
Local Permit Officer for the Town of Oak Island
4601 E. Oak Island Dr.
Oak Island, NC 28465
Sincerely,
`Acts) —pCN-,npa 4
Property Owner
—7I d c5ks)Q l Gi -
Mailing Address
�_ , V--) &,m rA r 1�T C 21 3 3
City, State, Zip Code
RECEIVED
DCM WILMINGTON, NC
JAN 2 8 2016

lksIju
ate
�iCViCrrc�l c, 1JVQyr G��r'LQ
AdMlProperN 0 ner
Mailingg Address
�GtJC.`t's( nd, NOL 7814(Dl:z—
City, State, Zip Code
Dear Adjacent Property:
W
This letter is to inform you that I, W MA E110 ��19.iyo have applied for a CAMA Minor
Property Owner �—
Permit on my property at 5 13 6 uu - fbd f p faj/o #01 . in Brunswick
Property Address
County. As required by CAMA regulations, I have enclosed a copy of my permit application and project
drawing(s) as notification of my proposed project. No action is required from you or you may sign and return
the enclosed no objection form. If you have any questions or comments about my proposed project, please
contact me at Q 1g - 7'7 S , c",41 or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the Town of Oak Island CAMA Minor Permit Program, you may submit
them to:
Donna F. Coleman
Local Permit Officer for the Town of Oak Island
4601 E. Oak Island Dr.
Oak Island, NC 28465
Sincerely,
mtey,aj
Property Owner
'1(0 SA C f-A-
Mailing Address
5r14a 4 1N ;" 3CD
City, State, Zip Code
RECEIVED
DCM WILMINGTON, NC
JAN282016

ELEVATION CERTIFICATE
U.S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
National Flood fnaurance Program
Important: Read the instructions on pages 1-9.
A - PROPERTY INFORMATION
OMB No. 1650-0008
Expiration Date: July 31, 2015
A2. Building Street Address [including Apt, Unit Suite, and/or Bldg. No.) or P.O. Route and Box No. I company NAIL NUmmeC
5130 WEST DOLPHIN DRIVE
City OAK ISLAND State NC ZIP Code 28465
LOT 15 & 12 OF LOT 14, BLOCK 117, SECTION 4, LONG BEACH, M.C. 2.5, PG. 182, TAX PARCEL # 233MBOOI
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, eta) RESIDENTIAL
A5, Latitude/Longdude: Lat. 33.91490 Long.-78.21102 Horizontal Datum: ❑ NAD 1927 ® NAD 1983
A6. Attach at least 2 photographs of the building 9 the Certificate is being used to obtain flood insurance.
AT 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) 321 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 7 within 1.0 foot above adjacent grade NIA
c) Total net area of flood openings in A8.b 363 sq in c) Total net area of flood openings in A9.b NIA sq in
d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes ® No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
St. NFIP Community Name & Community Number B2. County Name B3. State
OAK ISLAND / 370523 1 BRUNSWICK INC
B4. Map/Panel Number B5. SuBb( B8. FIRM Index Date B7. FIRM Panel B8. Flood 69. Base Flood Elevatlon(s) (Zone
37202036002036 J 10/182008 Eflective/2e� Date 20 s) AO, use ba 6flood depth)
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 89.
❑ FlS Profile ® FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: ❑ 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)
Ct. Building elevations are based on: ❑ Construction Drawings• ❑ Building Under Construction* ® Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations - Zones Al-A30, AE, AH, A (with BFE), VE, Vt-V30, V (with BFE), AR, ARIA, AR/AE, AR/A1-A30, ARIAH, AR/AO. Complete Items C2.a-h
below according to the building diagram specified in Item AT In Puerto Rico only, enter meters.
Benchmark Utilized: NCVRS Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 ® NAVO 1988 ❑ Other/Soume:
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)
5.7
® feet
❑ meters
b) Top of the next higher floor
16.8
® feet
❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only)
A6
® feet
❑ meters
d) Attached garage (top of slab)
NIA._
❑ feet
❑ meters
e) Lowest elevation of machinery or equipment servicing the building
15.3
® feet
❑ meters
(Describe type of equipment and location in Comments)
0 Lowest adjacent (finished) grade next to building (LAG)
5.4
® feet
❑ meters
g) Highest adjacent (finished) grade next to building (HAG)
5.4
® feet
❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support
5.3
® 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
information. I certify that the information on this Certificate represents my best efforts to interpret the data available. d
v
1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. "R
® Check here it comments are provided on back of forth. Were latitude and longitude in Section A provided by a S,pjO
❑ Check here if attachments. licensed land surveyor? ® Yes ❑ No Q F�.� Z -
Certifiers Name THOMAS D. VON CANON License Number L-3586
Title PRESIDENT - Canpany Name VCS & CO., INC. C-2160
Address 1 YAUPO .WAY ty OAK ISLAND State NC ZIP Code 28465
Sionature / Date 1/192Telephone [phone]
,... L r
,L'!$j6
(7/12) See reverse side for continuation.

tLtvAI IVN t tKl lr'IL A l t, page L
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:
5130 WEST DOLPHIN DRIVE
City OAK ISLAND State NC ZIP Code 28465 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/oompany, and (3) building owner.
Comments LOWEST MECHANICAL EQUIPMENT IS THE OUTSIDE HVAC UNIT.
Signature Date 1/192016
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 E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B,
and C. For Items E1-E4, use natural grade, if available. Cheek the measurement used. In Puerto Rico only, enter meters.
Et. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade (HAG) and the lowest adjacent grade (LAG).
a) Top of bottom floor (including basement, crawlspace, or enclosure) is —_ ❑ feet ❑ meters ❑ above or ❑ below the HAG.
b) Top of bottom floor (including basement, crawlspace, or enclosure) is —_ ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 6--9 of Instructions), the next higher floor
(elevation C2.b in the diagrams) of the building is _ _ ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is — _ ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management
ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this infornation 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 community4ssued BFE)
or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge.
Property Owners or Owners Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
Check here if attachments.
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G
of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G6-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 floodplam management purposes.
Number
Issued
G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement
G6. Elevation of as -built lowest floor (including basement) of the building: _ _ ❑ feet ❑ meters Datum
G9. BFE or (in Zone AO) depth of flooding at the building site: _ _ ❑ feet ❑ meters Datum
G10. Community's design flood elevation: _ _ ❑ feet ❑ meters Datum _
Local Offrcdars Name Title
Community Name Telephone
Signature Date
Comments
❑ Check here if attachments.
JAN 2 8 2016
FEMA Form 086-0-33 (7/12) Replaces all previous editions.

ELEVATION CERTIFICATE, page 3 Building Photographs
See Instructions for Item A6.
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
5130 WEST DOLPHIN DRIVE
City OAK ISLAND State NC ZIP Code 28465 Company NAIC Number.
If using the Elevation Certificate to obtain NAP 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 AS. If submitting more photographs than will fit on this page, use the Continuation Page.
iECEiVED
DCM WILMINGTON, r
JAN 2 8 2016
FEMA Form 086-0-33 (7112) Replaces all previous editions.

ELEVATION CERTIFICATE, page 4 Building Photographs
Continuation Page
IMPORTANT: In these spaces, copy the corresponding Information from Section A. FOR INSURANCE COMPANY USE
Building Street Address (including Apt, Una, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number.
5130 WEST DOLPHIN DRNE
City OAK ISLAND
State NC ZIP Code 28465
Company NAIC Number,
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.
RECEIVED
DCM WILMINGTON,
!A,l2S2016
Form 086-0-33 (7/12) Replaces all previous editions.

National Flood Insurance Program V-Zone Certificate
For Registered Engineers and Architects
Name 1 `r l U t-i 11 1- nUl dtAt.4V,3t j t it Policy Number (Insurance Co. Use) p
Building, Address or Other Description 5 310 W 6 ST b Q LP14 I W 1,
City Q i r— I S L lA N. © State MC, ZIP Code 2
3_1052
S CTION 1: Rood Insurance Rate Map (FIRM) Information
3'1202031000 203ta 1011e0108 VE
Community Number Panel Number SufforyL Date of FIRM Index FIRM Zone _
SECTION It: Elevation Information
1. Elevation of the Bottom of Lowest Horizontal Structural Member..............a.......................... 1q-6feet (NGVD)
2. Base Flood Elevation(BFE)........................................................................................_ I t♦Zfeet (NGVD)
3. Elevation of Lowest Adjacent Grade........................................................................_... 53 feet (NGVD)
4. Approximate Depth of Anticipated Scour/Erosion used for Foundation Design ........................ I. feet (NGVD)
5. Embedment Depth of Pilings or Foundation Below Lowest Adjacent Grade.........................feet (NGVD)
SECTION 111: V-Zone Certification Statement
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 design and methods of construction to be used are in accordance with accepted standards of practice for meeting
the following provisions:
• The bottom of the lowest horizontal structural member of the lowest floor (excluding piles and columns) Is
elevated to or above the BFE; and
• The pile and 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. 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, including wave action.
SECTION N: Breakaway Wail 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 that
the design and methods of construction to be used for the breakaway walls are in accordance with accepted
standards of practice for meeting the following provisions:
• Breakaway wall collapse shall result from a water load less than that which would occur during the base flood;
and \\11111/!/f
• The elevated portion of the building and supporting foundation system shall not be tc
displacement, or other structural damage due to the effects of wind and water loads actin `sires ne�t'i�
building components (wind and water loading values to be used are defined in Section I . O E E 7,O'•. �f
SECTION IV: Certification = : a SEAL �.
_ 037385 =
Signature below cerfffies: _"Section Ill-, fiction IV � � =• �; ,? n
Certifiers Name
Title ',�+rXA C"}tAj�-()1A E log ncon —License Number
Street Address Cytp"1
City V i State 1 Zip Code 2 8..,451
Signature Date 25 Uffrelephone Number%&2�0-EN
DCM WILMINGTON, NC
JAN 2 8 2016