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Oak Island —UJ( V 01 17-10
Local Government Permit Number
CAMA
MINOR DEVELOPMENT i
�*.
S P 'MI '
If r�Z r ' 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 Patricia Donnelly, authorizing development in the Inlet Hazard (AEC) at 6949 Kings Lynn Dr., in Oak Island, as
requested in the permittee's application, received 2/15/2017. This permit, issued on 2/28/2017, 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 2/15/2017.
(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)
This permit action may be appealed by the permiltee 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, 2020
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.
RECEIVED
DCM WILMINGTON, NC
APR 0 3 2017
ArwljVX-4—
Q"I�
Donna F. Coleman
CAMA LOCAL PERMIT OFFICIAL
4601 E. Oak Island Dr.
Oak Island, INC
,28465
PERMITTEE
(Signature required if conditions above apply to permit)

Name: Donnelly
Minor Permit # 01 17.10
Date: 2/28/2017
Page 2
(5) The structure must set back a minimum of 60 feet from the first line of stable natural vegetation, 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
sided square; and the first floor level of the sills and joists must meet the 100-year flood level elevation.
(9) All pilings shall have a tip penetration greater than eight feet below the lowest ground elevation under the structure.
(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)AII unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Disturbed areas shall be vegetatatively stabilized (planted and
mulched) within 14 days of construction completion.
(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 CRC rules.
(13) State SW permit restricts BUA to 5500 sq. ft.
SIGNATURE: DATE:
PERMITTF

Locality o(� _S I AAJ Permit Number UZ I q - I rc �"
Ocean Hazard %/ Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other T L_L_
(For official use only)
GENERAL INFORMATION
LAND OWNER - MAILING ADDRESS
Patricia Donnelly
Address 3 017 Goff Rd
City Corning State NY Zip 14830 Phone
Email [e-mail]
AUTHORIZED AGENT
Name Custom Island Homes by Ken Kiser LLC
Address 137 NE 37th St
607-974-9000
City Oak Island State NC Zip 28465 Phone [phone]
Email [e-mail]
LOCATION OF PROJECT: (Address, street name and/or directions to site; name of the adjacent waterbody.)
6949 Kings Lynn Dr, Oak Island, NC 28465
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.)
Single family residential dwelling
SIZE OF LOT/PARCEL: 2 0 4 2 7 square feet 0 .4 7
acres
PROPOSED USE: Residential [n (Single-family [] Multi -family ❑ ) Commercial/Industrial ❑ Other ❑
COMPLETE EITHER (1) OR (2) BELOW (Contact your Local Permit Officer if you are not sure which AEC applies
to your property):
(1) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: 2360 square feet (includes
air conditioned living space, parking elevated above ground level, non -conditioned space elevated above ground level but
excluding non -load -bearing att:c 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 roject drawing.)
REpCEIVED
STATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area sup6M W&MEVGTON, NC
Stormwater Management Permit issued by the NC Division of Energy, Mineral and Land Resource— I $,117
YES IC NO [[00
If yes, list the total built upon area/impervious surface allowed for your lot or parcel: 5500 square feet.

OTHER PERMITS MAY BE REQUIRED_ The activity you are 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, FIA
Certification, Sand Dune, Sediment Control, Subdivision Approval, Mobile liomc Park Approval, Highway Connection, and
others. Check with your Local Permit Officer for more information.
STATEMENT OF OWNERSHIP:
1, the undersigncd an applicant fora LAMA 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 LAMA minor development permit, certify that the person
listed as landowner on this application has a sigrtificant interest in tree real property describedtherein- This interest can be
described as: (check one)
X an owner or record title, Ti tic is vested in name of Patricia Dannelly
see Decd Book 3339 page 531 in the Brunswick County Registry of Deeds.
van owner by virkuc of inheritance. Applicant is an heir to the estate of
; probare was in
County.
if other interest, such as written contract or lease, explain below or use aseparate shxt & attach to this application.
NOTIFICATION OF ADJACENT RIPARIAN PROPERTY OWNERS:
I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that l have given
ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a LAMA permit.
(Name) (Address)
Robert Farrar 9006 North Ocean Blvd, Myrtle Beach, SC 29572
(2) Kevin Shoemaker 1667 Rack Creek Rd Charleston SC 29412
(3)
(4)
Town o- Oak island
ACKNOWLEDGEMENT&
1, the undersigned, acknowledge that the land awner is aware that the proposed development is planned for an area which
may be susceptible to erosion andfor @loading. 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 tloodpwofing 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.
Thisthe loth day of Feb 2017
M
person authorized to act as hisfieragent for purpose of filing a LAMA permit application
This application includes: general fnformmadon fddy farm), a site dram ing as deseribai on the back of this application, the
ownership statement, the Ocean Hazard AEC .Votice whew necessary, a check fvr$100.01 n,ade payabic to the locality; and
an.v information as craw be provided orally by the applicant The details of the application as described by these sources are
incorporated without reference in attr' permit which may be issuer!. Deviatfonfrom these details will constitute a violation nP
ari v wrtnit. ApYperson developing in an AEC withoutperni t is mated to civil, criminal and administrative action.

I, Joseph R. Brcehwe, PL5 - /759, Certify that this plat --_
was drawn under my superurslon from an actual survey Island
made under my svpernsion from Inforrnaton shown in fp/pl C,
deed books rdercnced on map and map books rdercnce N OR1Ve ALLOdAll®&/OLL4/A� 5rveyor-5, Inc.
on map; That ary Lnes not achulysurveyed appear as G(, KING5 LYN noramA: GRttROGD.
broken Grlez and were plotted fi'orn mfonruhon as noted a xxreRornuuL-175s
onthepGh fiat the ratio ofprecolonas vlculatedls - > WTNi9A064YODFAN 127 wo-waR
bettertJunl:ID.LYV.'. Hut the area rs computed by E� '^GIOIGG/A@aQ OE 1�. NC 20a
i roord�vte memod.vatncss my ongnul slgruture, regutrahon ✓ IACO'a.9RlA1D. PM0.4[9W42 192
number and seal Nn the 10MH yof FED.. A.D. 0017. 31o5z3blzz
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