OI_16-28_Ballard

Oak Island
Local Government
0116-28
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 General Statutes,'ronment concern pursuant "Co "Coastal Area Management" to Section 113A-118 of the 1'"�'��"Y,
Issued to Wallace Ballard, authorizing development in the Ocean Hazard (AEC) at 3216 E. Beach Dr., in Oak Island, as
requested in the permittee's application, dated 3/31/2016. This permit, issued on 4/15/2016, 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 construction of a single family residence with associated development.
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s) dated received on 3/31/2016.
(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 [phone] for a final inspection at
completion of work.
(Additional Permit Conditions on Page 2)
RECEIVED
DCM WILMINGTON, NC
This permit action may be appealed by the permittee or other qualified persons
within twenty (20) days of the issuing date. This permit must be on the project
site and accessible to the permit officer when the project is inspected for
compliance. Any maintenance work or project modification not covered under
this permit, require further written permit approval. All work must cease when this
permit expires on:
DECEMBER 31, 2019
In issuing this permit it is agreed that this project is consistent with the local Land
Use Plan and all applicable ordinances. This permit may not be transferred to
another party without the written approval of the Division of Coastal
Management.
Donna F. Coleman
CAMA LOCAL PERMIT OFFICIAL
4601 E. Oak Island Dr.
Oak Island, NC 28465
PERMITTEE
(Signature required if conditions above apply to permit)

AEC HAZARD NOTICE
Project Is In An: V Ocean Erodible Area High Hazard Flood Area Inlet Hazard Area
Property Owner: _(, 1) C 0 CkC3 _bcd I (al l
Property Address: �J I P I c C I^— l ILS
Date Lot Was Platted: �O� Z 0n v
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 perrr''
issued.
The Commission's rules on buildi
setbacks and dune alterations are des, ++ \\ -- 11I
eliminate, property loss from hazards W l /`-
Coastal Resources Commission does i
the development and assumes no liab Vr,^^� , 1 _SiA
the development. Permits issued in d �
Environmental Concern include the cc
relocated or dismantled ifthey become:
changes in shoreline configuration. 7
relocated or dismantled within two
imminently threatened, and in any ca
subsidence.
The best available information, as ac
Resources Commission, indicates that e
average ocean erosion rate for the area where your property is
located is a` 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
I'X< feet landward in a major storm.
The flood waters in a major storm are predicted to be about
IV 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, groins, jetties
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.
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 of the
third year following the year in which the permit was issued.
ct ^�'•• `-" k begins on the project site, the Local Permit
atacted to determine the vegetation line and
,our site. If the property has seen little change
mit issuance, and the proposed development
sir back requirement, the LPO will inform you
work. Substantial progress on the project
160 days of this setback determination, or
emeasured. Also, the occurrence ofa major
re result ofa storm within the 60-day period
:asurement of the setback. It is important
e LPO before the permit expires for official
the work after the permit has expired.
rn pilings have been placed and substantial
;, permit renewal can be authorized. It is
cork after permit expiration.
r, contact.,
t )iq C
Local Permit Officer
0()O- col - W040
Phone Number
Revised

Name:BALLARD
Minor Permit # 0116-28 -
Date: 411512016
Page 2
(5) The structure must set back a minimum of 60 feet from the 1998 static vegetation line, as determined by the DCM,
the LPO, or other assigned agent of the DCM.
(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) All buildings 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 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 100year flood. level elevation.
(9) All,pilings'shali have a tip penetration greater than eight feet below the lowest ground elevation under thestructure.
(10)Dune disturbances will be allowed only to the extent necessary for development and if the dune's protective value is
not weakened or reduced. Disturbed dune areas will be immediately stabilized.
(11)All unconsolidated material resulting from associated grading and landscaping shall be retained, on site by effective
sedimentation and erosion control measures.: Disturbed, areasshall be •vegetatatively stabilized (planted and
mulched) within 14 days of. construction completion.. .
(12)Any structure authorized by this,peimit 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 vears of the time
When it'becomes imminenW threatened, -and in any case upon its. collapse or subsidence:; However;' if natural'
shoreline recovery or beach renourishment takes place within two years of ttie time the structure becomes
imrhirfently 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.

Locality
Permit Number 01 (_28
Ocean Hazard Estuarine Shoreline
GENERAL INFORMATION
LAND OWNER
_ORW Shoreline Public Trust Shoreline Other Cf 14
(For official use only)
Name: W Qf I Q e'Q
Address: uSC7 SCcYY1 jPppl2 1
City: 1 CJL" 1 ar 5 V 1 �� State: rc Zip: a 00 61 Phone: '99 'U%— CF79a
AUTHORIZED AGENT
Name:
Uk
Address: rL:� a�aL S ( O
City: r, I( _ asicyA State: �� Zip: 2LO'C�_ Phone: R)U",;r%9--IN7
LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is the name of the
adjacent waterbody.) _MP-3a 1 tU E -S? CI %/ t'
d1'e'..j 0 CY14'
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) —s% TZ
SIZE OF LOTIPARCEL: �75OO square feet acres
PROPOSED USE: Residential (Single-family Multi -family ❑) Commerical/Industrial ❑ Other ❑
TOTAL ENCLOSED FLOOR AREA OF A BUILDING IN THE OCEAN HAZARD AREA OF
ENVIRONMENTAL CONCERN (AEC): 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,, square feet (includes the area of the roof/drip line
of all buildings, driveways, covered decks, concrete or masonry patios, etc. that are within the applicable AEC. Attach
your calculations with the project drawing.)
Choose the AEC area that applies to your property:
wwithin 75 feet of Normal High Water for the Estuarine Shoreline AEC
ithin 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 subjec to a State Stormwater
Management Permit issued by the NC Division of Water Quality? YES ❑ NO Ln
If yes, list the total built upon area/impervious surface allowed for Vlot or parcel.
DCM WILMINGTON, NO
APR 0 7 2016
square feet.
E�EiIIrFa`7>

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)
Eran owner or record title, Title is vested in 2LPsee Deed Book
page S2 in the `Bnxvte�&w +t ICC 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.
(Name) (Address)
(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 floodproofmg 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.
day of c,.6 — 20 Imp
Landowner or person authorized to act as his agent
for purpose of filing a CAMA permit application

VICINITY ^ MAP
I I
I I
I I
I I
I I
(I CD
I
I I
1: SEED STRAW ALL
ED DISTURBAREAS
TREES. FOR EACH 2025
S.F. OF LOT AREA MUST - I
BE PLANTED OR REMA
IN
AIN i
AFTER CONSTRUCTION.9'X1
3: ONE 9' 8' CAR
PARKING AREA MUST BE
PROVIDED ON THIS I
PROPERTY PER BEDROOM
COMPLETELY OFF OF THE
STREW RIGHT-OF-WAY. I
I I
I �
I I
I
LOT AREA = 7500.0 SF
EAST DOLPHIN DRIVE
60' PUBLIC RIGHT—OF—WAY
I
I
I
I 0
I
I
I
I
HOUSE AREA ='1516.0 SF
COVERED PORCHAREA = 272.0 SF
CONCRETE DRIVEWAY AREA - 76B.0 SF
TOTAL IMPERVIOUS AREA - 2556.0 SF 3216
RETAINAGE CALCULATIONS PER TOWN OF
OAK ISLAND STORMWATER REGULATIONS
((2556.0 / 7500.0)•100)) - 34.1%
VOLUME REQUIRED = ((162.0 • 34.1))/30J= 184.1 C.F.
VOLUME OF HOUSE DRAINAGE PITS-(((4.O'"4.O''2.O')•4)= 120A CIF
VOLUME OF DRIVE DRAINAGE PITS=((4.O'•4.O'-2.0')•2)= 64.0 CF
TOTAL VOLUME PROVIDED = 192.0 CIF
USED)
2 STORY
5 BEDROOM
RESIDENCE
ON PILINGS
za b b +zo t
MY
5' MB y..
NE p o
R+tl-,o.
nN¢
IRF
6.8't 50.00 m OTwn �]A'3
N 76'25'00" WIP
EAST BEACH DRIVE
60' PUBLIC RIGHT—OF—WAY
2 FOUND
ISLAND
LINE
ZONING
ZONING
GRAPHIC SCALE
NT FOUND
15 0 ]5 "15 30
OK-1-7
SETBACKS
I INCH - 30 FEET
FRONT- 25'
SIDE- 8'
REAR= 20'
STREET REAR= 25'
RAGEMENT AGENCY
MANHOLE
:t NOUT
ENCY MANAGEMENT
TAX PARCEL # 235NB006
:NTRATE MAP
M
1. THIS PROPERLY LIES WITHIN F.E.MA SPECIAL FLOOD HAZARD AREAVE-17
& VE-16 AS SHOWN ON F.LR.M. 3720206600,1, DATED 6/02/2006.
GENERAL NOTES:
I. MEASUREMENTS ON THIS MAP ARE IN FEET AND DECIMALS THEREOF.
2. ALL SET CORNERS ARE 1/2' IRON REBAR LINES OTHERWISE NOTED.
3. THIS PROPERTY MAY BE SUWECT TO ADORIONAL EASEMENTS. RIGHTS OF
WAYS AND RESTRICTIONS NOT DISCERNIBLE BY OBSERVATION AT THE
TIME OF SURVEY OR THAT MAY BE OF RECORD. NO TIRE SEARCH BY
THOMAS D.'VON CANON.
REFERENCES-
1. PLAT OF LONG BEACH, RECORDED IN MAP CABINET 1, PAGES 96-99
ON 12/13/1938 IN THE BRUNSWICKTY. . COUNNORM CAROLINA
REGISTER OF DEEDS.
2. DEED BOOK 3149. PACE 582. RECORDED IN THE BRUNSWICK CCOTf,
NORM CAROLINA REGISTER OF DEEDS.
PRELIMINARY SITE PLAN
FOR: MOFFITT BUILDERS, INC.
LOT 8
BLOCK 25
LONG BEACH
OAK ISLAND, SMITHVILLE TOWNSHIP
BRUNSWICK COUNT, NORTH CAROLINA
VCS & -CO., INC. C-2160
1 YAUPON WAY
V�P
OAK ISLAND, NC
TELE. [phone]
EMAIL [e-mail]

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit: 1.�CCl �hCj I r^ A
Mailing address: (o SO Sr^ wl `Poo IL Lo
Phone Number: Sj? 8 — t,Q t P `I -7 2.;X
I certify that I have authorized nCCca In/tamt+ / YV69 9 BrIlco S
Agent / Contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of
.51 ✓ c-4-
at my-roproperty located at � Z i lP
in t A6yiswi ac. County.
This certification is valid through 12 /31 I L4
Date
(Property Owner Information)
r Signature
l >Jctl I ac k CJ 1 orct
Print or Type Name
Title
31�1►i�
Date
4:?2 �;- - U 19 4-7 9 7-
Phone Number -
Email Address
SC

U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No.1660-0008
National Flood Insurance Program Important: Read the instructions on pages 1-9. Expiration Date: July 31, 2015
SECTION A- PROPERTY INFORMATION FDRINSUJRANCf=G9MPpti}YtiSE r
Al. Building Owners Name MOFFITT BUILDERS, INC. - Poifgr9•tumGer
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. omOlu,Iy NAtC Nor ber
3216 EAST BEACH DRIVE =+
City OAK ISLAND- State NO ZIP Code 28465
A3. Property Description (Lot and Block Numbers, Tau Parcel Number, Legal Description, etc.)'
LOT 8, BLOCK 25, LONG BEACH, M.C. 1, PG. 96-99, TAX PARCEL # 235N2006
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Let 33.91209 Long..-78.12899 Horizontal Datum: ❑ MAD 1927 Z 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. Fora building with an attached garage:
a) Square footage of crawispace cr enciosum(s) 116 sq ft a) Square footage of attached garage N/A sq ft
b) Number of permanent flood openings in the crawispace b) Number of permanent flood openings in the attached garage
or enclosure(s) within 1.0 foot above adjacent grade 2 within 1.0 foot above adjacent grade NIA
c) Total net area of Flood openings in A8.b 187 sq in c) Total net area of flood openings in A9.b N/A sq in
d) Engineered flood openings? ❑ Yes Z No d) Engineered flood openings? ❑ Yes Z No
SECTION B-FLOOD INSURANCE RATE MAP (FIRM):INFORMATION
Bt. NFIP Community Name & Community Number B2. County Name B3. State
OAK ISLAND/370523 1 BRUNSWICK NO
B4. Map/Panel Number
B5. Suffix
66. FIRM Index Date
B7. FIRM Panel
68- Flood
B9. Base Flood Elevation(s) (Zone
372020660012066
J
10/16/2008
1
Effective/Revised Date
Zone(s)
AO, use base flood depth)
1
6/0212006
VE
16-17
1310. 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: _
Ell. Indicate elevation datum.used for BFE in Item 69 ❑ NGVD 1929 Z NAVD 1988 ❑ Other/Soume:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area.(OPA)? ❑ Yes- Z No
DesignationDate:_ ❑ CBRS ❑ OPA _
SECTION C- BUILDING .ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations am based on: N Construction Drawings' ❑ Building Under Construction* ❑ Finished Construction
'A new Elevation Certificate will berequired when construction of the building is complete.
C2. Elevations -Zones Ai-A3%AE, AH, A (with ERE), VIE, VI-V30, V (with BFE), AR, ARIA, AR/AE, AR/A1-A30, ARiAH, ARIAO.. Complete Items C2.a-h
below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters:
Benchmark Utilized: NCVRS Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in hems a) through h) below. ❑ NGVD 1929 ® 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, crawispace, or enclosure floor)
b) Top of the next higher floor
c) Bottom of the lowest horizontal structural member (V Zones only)
d) Attached garage (top of slab)
a) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments) -
1) Lowest adjacent (finished) grade next to building (LAG)
g) Highest adjacent (finished) grade next to building (HAG)
h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support
6.3 '
Z feet
❑ meters
20.2
Z feet
❑ meters
18.0 �
N feet
❑ meters
NIA_
❑ feet
❑ meters
18,0
Z feet
❑ meters
fil
N feet
❑ meters
6.0 1
Z feet
❑ meters
5.7
Z 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 car' that the infomratien on this Certificate represents my best efforts to interpret the data avarilable-
1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a
❑ Check here if attachments. licensed land surveyor? N Yes ❑ No
Certifiers Name THOMAS D. VON CANON License Number L-3586
Title PRESIDENT Company Name VCS & CO., INC., C-2160
Address 1 YAUPON WAY City OAK ISLAND State NO ZIP Code 28465
Date 3/2912016
[phone]
086-0-33 (7/12) See reverse side for continuation. Replaces all previous editions.

IMPORTANT: In these spaces, copy the corresponding information from Section A. 'FOR INSURANCE cOMaANr wr r,
Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. `PolicytJumber.
3216 EAST BEACH DRIVE ,
City OAK ISLAND State NC ZIP Code 28465 Company NAIL Nurifber'
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenttcompany, and (3) building owner.
Comments
Signature _// Date 3/29/2016
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 Et-E5. If the Certificate is intended to support LOMAor LOMR-F request, complete Sections A. B,
and C. For Items E1-E4, use natural grade, if available. Check 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, cmwlspace, 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 8-9 of Instructions), the next higher floor
(elevation C2:b in the diagrams) of the building is _._ ❑ feet ❑meters ❑ above or ❑ below the HAG..
E3. Attached garage (top of slab) is — ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is __ ❑ feet ❑ meters ❑ above or❑ below the HAG.
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management
ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G.
SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owners 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 Owners or Owners Authorized Representative's Name
Address - City State zir coae
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 oommunhys 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 G8­Gt0. In Puerto Rico only; enter meters.
Gt. ❑ 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 fora building located in Zone A (without a FEMA-issued or community -issued BFE) or Zone AO.
G3. ❑ The following information (Items G4-G10) is provided for community floodplain management purposes. -
G4. Permit Number _ G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued -
G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) of the building: __ ❑ feet ❑ meters Datum
G9. BFE or (in Zone AO) depth of flooding at the building site: .. __ ❑ feet ❑ meters Datum
G10. Community's design flood elevation: _ _ ❑ feet ❑ meters Datum
Local Officials Name Title
Community Name Telephone
Signature Date
Comments
❑ Check here if attachments.
FEMA Form 086-033 (7112) Replaces all previous editions.

4601 E. Oak Island Drive
Oak Island, NC 28465
Phone [phone]
Fax[phone]
PermitNo.: ELEC2016=00051
Permit Type:Electrical'
_ - WorkClas"sification: Trade(Non-Residential)'
Permit5tatus: Issued
Issue Date: 04/04/2016 Expiration: 10/03/2016
Project Address Parcel Number Applicant
5901 E. OAK ISLAND DR 250A0007 Food Lion LLC
Oak Island, NC 28465
Owner Information Address Phone Cell
Food Lion LLC P O Box 294 910-278-7291
Salisbury, NC 28145
Contractor(s)
Phone Email
Contractor Type
License#
Sylvester & Cockrum, Inc
3367663430
Electrical. Contractor
30329 U -
Description: Replace 13 20ft pole lights
Comments:
Valuation: $60,477.00
TotalSq Feet:
Fees Due Amount
Trade Electrical (Commercial) $125.00
TOTAL $125.00
Total Amt Paid Amt Due
$ 125.00 $125.00
Payment Type: Check # 33856
$0.00
Conditions:
1. The Owner/Contractor/Developer is advised that it is their responsibility to assure compliance with all local, state, and federal
codes and regulations. That errors or deficiencies not discovered during plan review does not relieve the
Owner/Contractor/Developer from corrections.
2. Sub contractor cards must be submitted prior to trade contractor beginning work .
3. All construction must meet 130 MPH windzonerequirements.
4. All zoning codes and setbacks must be met.
Call Development Services for inspection request by 4:30pm day prior of request at [phone] or fax [phone]..
Any damage to public properties within a 100' of your construction site must be reported by written statements and photo
documentation prior to commencing of the project; failure to submit any notice will be presumed that there is no damage to public
properties and the contractor assumes all responsibilities if damage is reported.
April 05, 2016
Authorized Signature Date
Tuesday, April 5, 2016

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