HomeMy WebLinkAboutNTB_15-34_TaylorIssued by WiRO
North Topsail Beach
NTB15-34
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 David Taylor authorizing development in the Estuarine Shoreline (ORW) Areas of Environmental. Concern
(AECs) at 3627 Island Drive, in North Topsail Beach, Onslow County as requested in the permittee's application
package, dated December 10; 2015 and received by DCM on December 17, 2015. This permit, issued on December
31, 2015, 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: Construction of a single family residence.
(1) All _proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s) dated received by the Division of Coastal_ Management on December 17, 2015.
(2) This Permit DOES NOT authorize the "proposed wood walk and proposed dock" referenced on the Charles F. Riggs and
Associates Survey map dated December 5, 2014.
(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) 766-7221 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
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, 2018
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.
r.
Jason Dail
CAMA LOCAL PERMIT OFFICIAL
127 Cardinal Drive Extension
Wilmington, NC 28405-3845
ECEIVED
L WILMINGMINGTON, N(
CPERMITUEED JAN 19 2016
Signs uetequitedifGq�diions' a5ove ppilto.p mire
Name: David Taylor
Minor Permit # NTB 15-34
Date: December 31, 2015
Page 2
(5) All buildings 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.
(6) 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 vegetate and stabilized (planted and
mulched) within 14 days of construction completion.
(7) The amount of impervious surface/coverage on this property shall not exceed 25% within 575 feet of the Normal
High Water line.
(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 100-year flood level elevation.
(9) All pilings shall have a tip penetration greater than eight (8) feet below the lowest ground elevation under the
structure. The deck shall be constructed independently from the residence and shall be structurally detached.
(10) This permit does not authorize the excavation or filling of any wetlands or open water areas.
(11) The permittee is required to contact the Local Permit Officer (910) 796-7221, shortly before he plans to begin
construction to arrange a setback measurement that will be effective for sixty (60) days baring a major shoreline
change. Construction must begin within sixty (60) days of the determination or the measurement is void and must
be redone.
(12) Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold or otherwise
disposed of to a third -party.
(13) 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.
SIGNATURE: DATE:
PERMIT EE
RECEIVED
DCM `1dILMINGTON. NC
JAN 19 Z516
Dail, Jason
From: Dail, Jason
Sent: Wednesday, June 08, 2016 1:19 PM
To: 'khiroman@aol.com'
Cc: 'Deb Hill'; Terrie Woodle (terriew@ntbnc.org)
Subject: RE: Fax received 6/6/16 - driveway and 4x4's
Good afternoon David. After reviewing the information you provided, including the type of material to be used for the
driveway as well as the installation of a 4'x4' "border", it is our position that you may use whatever type of material you
wish for the driveway provided you do not exceed 25% built upon area (impervious coverage) within 575' of the
normal/mean high water line. In addition, our Rules do not prohibit you from laying down the 4"x4" post, so I would
check with Deb Hill (NTB Zoning) to make sure there are not local regulations that would limit you from doing this.
Also, I should point out that if you decide to place Grade 57 stone down for your driveway, it WILL NOT count as
impervious provided you lay 4-6" of Grade 57 stone on top of a layer of filter fabric.
Hope this helps.:. if not, feel free to give me a call.
Thank you,
Jason
Jason Dail
Field Representative
NC Department of Environmental Quality
NC Division of Coastal Management
127 Cardinal Drive Ext.
Wilmington, NC28405
Phone: (910)796-7221, Fax: (910)395-3964
Jason. Dail wncdennaov
Kl--C�-
NothingCompares_..
E-mail correspondence to and from this address
may be subject to the North Carolina Public
Records Law and may be disclosed to third parties.
un. 0.2C16 11:52AM Jvi le Chiro And Wellless
Jacksonville
Vo.IIH P. 112
choropi°acic & Wellness
1201 Gum Branch Road
Jacksonville, North Carolina 28540
910-455-6696 Phone
910-455-6696 Fax
-Dr. David Taylor
DATE
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PHONE:
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Total
FAX TRANSMISSION
umber of Pages Including Cover Sheet:
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This facsimile contains Individually identifia3le patient health informauon. The use and disclosure of information
contained in this fax is restricted bytha health insurance portability and accountability, act of 199E and is protected
under the prlvacy act of 1974. It is intended.for the use of the addressee(s) identiFed below. This faxed material must
ba destroyed appropriately when its use Is no longer required. If the reader of this message is not the intended
reciplent(s) or the employee or agent responsible for delivering the attached information to the intended recipiant(s)
please note that any dissemination, distribution of copying of this communication is strictly prohibited. Anyone who
receives this communication in error should notify name of practice Immediately and return the original message to the
address on this cover shae, via U.S. Melt.
an, 6.2C16 11:52RM Jvi'le Chiro And Welliess No. 1130 P. 2/2
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i OV17 71
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to Dau i d T u jw - -a
(Name of Property Owner) 1
property located at 3&27-rala-d 10/ AI. T9tatI NC �>i'3I ,
Address, Lot, Block, Road, etc.) ,/f
on YCIy in 00- 70A4;12/ MAY J940 IN.C.
(Waterbody) (North Topsail Beach,Onslow County) +;
He has described to me as shown in the attached application and project drawing(s), the development he is
proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)]
q�—r�(/�Slil'^C` C-0titb� ✓bVt�fj�
Sign
Print or Type Name
Telephone Number
Date
DCM RECEIVED
OIU, NC
JAN i 4 2016
Coastal Management
ENVIRONMENTAL QUALITY
January 4, 2015
Mr. David Taylor
505 Adler Lane
Goldsboro, NC 27530
Dear Mr. Taylor:
PAT MCCRORY
G,,wnor
DONALD R. VAN DER VAART
$PtMIUn
BRAXTON DAVIS
Uirtnur
Attached is CAMA Minor Development Permit NTB 15-34 for work to be done 3627 Island Drive,
in North Topsail Beach. A copy has been sent to the town building inspections department and
to your agent, Marc Oljaca.
In order to validate this permit, please sign both copies of the permit as indicated for our
records. Retain the orange copy for your files and sign both pages of the white copy and return
to us within 20 days of receipt, in the enclosed, self-addressed envelope.
This is not a valid permit until it is signed and returned to our office.
Thank you for your prompt attention to this matter.
Enclosures
cc: WiRO files
NTB Inspections Dept.
Sincerely,
S�
Shaun K. Simpson
Permit Support Technician
State ofNmfh Carolina I Environmental Quality I Coastal Managemem
127 Cardinal Ihive Ext., Wilmington, NC 28405
919 796 7215
L
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f-7 1
locality f=/f/ �D/S91L PEi4 Perrnittvumber A
Ocean Hazard iSmarine Shoreline- ORW Shoreline Pubiic Trust Shoreline Othcr
//oI ME
mmonywanl 1 1
LAND OWNER
flowid-
Address 6-0s- 144-Nr- 4tJ
City coa/Jt.t 4wb State A" —
Email xRl(t'tD .nay t, 0-61, c e"%
AUTHORIZED AGENT
Name
Addre
Zip PnO Phone 9'/1 - 7.34E
City -S46aAs State W L Zip 2p16n Phone %Q Qzo F 7 7 1
Email /Y) e) I', tt- CC-- Q_ n C- , r r, C 0'..;
LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is the name of the
adjacentwaterbody.) 3r4.27 rs /g,•c( oi- AJ, I ofscg/ wc--r_ororroo a
DnE"S,CRIPTION OF PROJECT: (List all proposed construction and land disturbance.) yrnXe , ems. Scrod,
SIZE OF LOT/PARCEL: 94 " 0 square feet 1,2911 /acres
PROPOSED USE: Residential Rell� (Single-family M/MMUlti-family 0 ) 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 FLOORAREA OF PROPOSED STRUCTURE: 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 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.)
STATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area subject to a State Stormwater
Management Permit issued by the NC Division of Water Quality?
YES NO
If yes, list the total built upon area/impervious surface allowed for your lot or pa a square feet.
RECEIVED
DEC 17 2015
DEC 1 7 "",
DCM WILMINGTON, NC
DCm
OTHER PERMITS MAYBE 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 Home Park Approval, Highway Connection, and
others. Check with your Local Permit Officer for more information.
STATEMENT OF OWNERSHIP:
I, the undersigned, an applicant for a CAMA minor development permit, being either the owner of property in an AEC or a
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)
/an owner or record title, Title is vested in . see Deed Book 1485,
page 6y6) in the el. c to n-. J 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 OFADJACENT 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)
ACKNOWLEDGEMENTS:
Ak— VY&
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.
This the 10 day of 17+ , 20 k15'
Landowner or person anthdrihd,(o act as his/her agent for purpose of filing a CAMApermit application
This application includes: general information (this form), a site drawing as described on the back of this application, the
ownership statement, the Ocean Hazard AEC Notice where necessary, a checkfor $100.00 made payable to the locality, and
any information as may beprovided 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.
RECEIVED
DCM WILMINGTON, NC
DEC 17 2015
OCEAN HAZARD AEC NOTICE
Project is in an:
Property Owner:
Property Address
Ocean Erodible Area High Hazard Flood Area Inlet Hazard Area
Date Lot Was Platted: / 51
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 Commissiods 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 Resources Commission 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 is _ 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
feet 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, 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
PmpertyOwner Sig 1a r Date
SPECIAL NOTE: This hazard notice is required for
development in areas subject to sudden and massive stoma and
erosion. Permits issued for development in this area expire on
December 31 of the thud 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. If the property
has seen little change since the tune of permit issuance, and the
proposed development can still meet the setback requirement,
the LPO will 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 re -measured. Also,
the occurrence of a major shoreline change as the result of a
storm within the 60-day period will necessitate ro-measurement
of the setback. It is important that you check with die LPO
before the permit expires for official approval to continue die
work after the permit has expired. Generally, if foundation
pilings have been placed and substantial progress is continuing,
permit renewal can be authorized. It is unlawful to continue
work after permit expiration.
For more Injornroliou, coulact:
JNO,
Local Permit Officer
NC DENR
Div. of Coastal Management
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
i9/a) H6
Phone Number
RECWe�traygo
DCM WILMIN T N, NC
DEC 17 2015
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to l�>Ctydd' T u /6 r— S
(Name of Property Owner)
property located at 3(o,T 7 .%60,4 0 f A 'to 'pkn I NC. Lo y
Address, Lot, Block, Road, etc.) /�
on YCty in [WSJ• fOO.(a / 1.CsWY d/0-0 N.C.
(Waterbody) (North Topsail Eleach, Onslow County)
He has described to me as shown in the attached application and project drawing(s), the development he Is
proposing at that location, and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
Signature
Print or Type Name
Telephone Number
Date
RECEIVED
DCM WILMINGTON, NC
0EC 1 7 2015
W
Dear Adjacent Property:
This letter is to inform you that I, D�tU/q( a cy lAhave applied for a CAMA Minor
Property Owner
Permit on my property at a 7 _.�l I&e, X 1] r in ONSLOW
Property Address
County. As required by CAMA regulations, I have enclosed a copy of my permit application and project
drawing(s) as nolification of my proposed project. No action is required from you oryou 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 7 .?,P /2/y ,or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the NC DENR CAMA Minor Permit Program, you may submit them to:
Jason Dail
Local Permit Officer for North Topsail Beach
NCDENR/DCM
127 Cardinal Drive Extension
Wilmington, NC 28405
Sincerely,
_ 7av r} cQ (cec-S �02
Property Owner
S—d S
Mailing Address //
�166 i /o WLC- -',7S-36
City, State, Zip Code
REGENED
DCM WILMINGTON, NC
DEC 17 2015
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This letter is to inform you that I, Dew id, /a N & — have applied for a CAMA Minor
Property.Owner
Permit on my property at 3 G 2 7 -11 ,, X D C in ONSLOW
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 71 c/ -??Oa /2/c% ,or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the NC DENR CAMA Minor Permit Program, you may submit them to:
Jason Dail
Local Permit Officer for North Topsail Beach
NCDENRIDCM
127 Cardinal Drive Extension
Wilmington, NC 28405
Sincerely,
_Dpyr'd2 7 CAC.ac-slot
Property Owner '' nn
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Mailing Address
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City, State, Zip Code
RECEIVED
DCM WILMINGTON, NC
0EC 1 7 2015
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I.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE
'EDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008
lar:onal Flood Insurance Program Important: Read the instructions on pages 1-9. Expiration Date: July 31, 2015
SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE
At. Building Owners Name DAVID J. TAYLOR & WIFE, NANCY M. TAYLOR Policy Number:
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number
3627 ISLAND DRIVE
City NORTH TOPSAIL BEACH State NC ZIP Code 28460
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
NEW LOT 4, TREASURE COVE
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory. etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 34d28'27"N Long. 77d27'43'W Horizontal Datum: ❑ NAD 1927 0 NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
AT Building Diagram Number Q
AS. 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) 1080 sq ft a) Square footage of attached garage NIA sq R
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 5 within 1.0 foot above adjacent grade Q
c) Total net area of flood openings in A8.b 1080 sq in c) Total net area of flood openings in A9.b Q sq in
d) Engineered flood. openings? ❑ Yes 0 No d) Engineered flood openings? ❑ Yes 0 No
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Bl. NFIP Community Name & Community Number I B2. County Name I B3. State
NORTH TOPSAIL BEACH 370466 ONSLOW NORTH CAROLINA
zone
37 0426600 mbar 85. Suffix I BB. FIRM 18 67 Date Effective/ evil d Date RM Panel B8. one(s) B9. Base Flood
AD, se bass flood depth)
Ito. 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:
Ill. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 0 NAVD 1988 ❑ Other/Source:
112. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes 0 No
Designation Date: _ ❑ CBRS ❑ OPA
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
:1. Building elevations are based on: 0 Construction Drawings' ❑ Building Under Construction* ❑ Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
:2. Elevations —Zones Al—A30, AE, AH, A (with BFE), VE, V1—V30, V (with BFE), AR, ARIA, AR/AE, AR/Al—A30, ARIAH, ARIAD. Complete Items C2.a—h
below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: NC CORS Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below. ❑ 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)
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)
0 Lowest adjacent (finished) grade next to building (LAG)
g) Highest adjacent (finished) grade next to budding (HAG)
h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support
5.5 0 feet
❑ meters
16.1 eet
❑ meters
141RECEIV zneet
❑meters
NAM WILMINGT(INfe@IC
❑meters
14.1 feet
DEC 1 7 2d
1.2 0 feet
❑ meters
❑ meters
5.5 0 feet
❑ meters
N.A ❑ feet
❑ meters
SECTION D—SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation u
information. I cattily, that the information on this Certificate represents my best efforts to interpret the date available. ��144
1 understand that any false statement may be punishable by line or imprisonment under 18 U.S. Code, Section 1001. qi�►
0 Check here if comments are provided on Were latitude and longitude in Section A provided by a ,�n+P O �✓
❑ Check here if attachments. censed land surveyor? 0 Yes ❑ No �C: {g r,
Certifiers Name JAMES A LEWIS. P ; • Or License Number L-4562
Title PROJECT MANAGER I I Cortletanni qHAPtES F. RIGGS & ASSOCIATES, INC.
Address 502 NEW BRIDGE STREE I CitA.,J,NVILI_E State NC ZIP Code 28540
Signatur Telephone (910)455-0877
EMA Form 086-0.33 (7/12) ,,,,v` ee reverse side for continuation.
L L 1
v.)T'r �tl
Replaces all previous editions.
I'll..w,. V11... .V^.• r tray. a
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Budding Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number:
3627 ISLAND DRIVE
City NORTH TOPSAIL BEACH State INC ZIP Code 28460 Company NAIC Number
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments DWELLING IS PROPOSED TWO STORY ON PILINGS, ENCLOSED BELOW. SURVEYOR HAS NOT REVIEWED FINAL CONSTRUCTION
PLANS. THE TOWN OF NORTH TOPSAIL BEACH HAS ADOPTED V-ZONE CONSTRUCTION STANDARDS THROUGHOUT AND REQUIRES A 2'
FREEBOARD DURING CONSTRUCTION THEREFORE THE BOTTOM OF THE LOWEST HORIZONTAL STRUCTURAL MEMBER MUST HAVE AN
ELEVATION,OF AT LEAST 12.0' + 2.0' = 14.0' (PROPOSED ELEVATION = 14.1') ,
SECTION E - BUILDING ELEVATION INFORIFATL611(SURVEY AbnEtUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AO and A (without BFE), complete Items Ell 5.1 th,,gggg cLt interfded support a LOMA or LOMR-F request, complete Sections A, B,
and C. For Items E1-E4, use natural grade, if available. e teasurem ed. Puerto Rico only, enter meters.
El. Provide elevation. information for the following and 7 dDi show whether the elevation is above or below the highest adjacent
grade (HAG) and the lowest adjacent grade (LAG). 7 •..
a) Top of bottom floor (including basement, crawlspace, 1�6sygp) �� `' ❑, feet [I meters ❑ above or ❑ below the HAG.
b) Top of bottom floor (including basement, crawlspace, or eiklosurey R`'�!— ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E-2. - 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 (topof 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
fhe 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)
)r Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge.
>roperty Owner's. or Owner's Authorized Representative's Name
4ddress City State ZIP Code
signature
Date
Telephone
Check here if attachments.
SECTION G -COMMUNITY INFORMATION (OPTIONAL)
1e local offidal 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
this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8-G20. In Puerto Rico only, enter meters.
1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who
is authorized by law to certify elevation information. (indicate the source and date of the elevation data in the Comments area below.)
2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued or community -issued BFE) or Zone AO.
3. ❑ The following information (Items G4-G10) is provided for community floodplain management purposes.
34. Permit Number
G5. Date
Ali
r. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement
1. Elevation of as -built lowest floor (including basement) of the building _ _ ❑ feet ❑ meters
). BFE or (in Zone AO) depth of flooding at the building site:
10. Community's design flood elevation:
El feet ❑ meters
❑ feet ❑ meters
Datum
Datum
Datum
Issued
.oval Official's Name Title n e e- G f\ 1 F n
:ommunityName Telephone ()CM WILMINGTON, NU
signature Date DEC 17 2015
,omments
Check here if attachments.
:MA Form 086-0-33 (7/12)
Replaces all previous editions.
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