SCEX03-23 COOK

ROY COOPER
ELIZABETH S. BISER
Secretary
BRAXTON DAVIS
Director
Russell and Linda Cook
20472 Hunter Lane
Huntington Beach, CA 92646
NORTH CAROLINA
Environmental Quality
RE: EXEMPTED PROJECT (MINOR) EXEMPTION
MAINTENANCE AND REPAIR - (15A NCAC 7K .0209) — Exemption# SCEX03-23
810 N Topsail Drive, Surf City, NC
AREA OF ENVIRONMENTAL CONCERN — Ocean Hazard AEC
Dear Mr and Mrs. Cook:
I have reviewed the information submitted to this office in your inquiry concerning the necessary filing of an
application for a minor development permit under the Coastal Area Management Act. Based on the information
provided, I have determined that the activity you propose is exempt from needing a minor development permit if
it remains consistent with the information received by our office on February 13, 2023, and meets the conditions
specified below. If your plans should change and your project will no longer meet these conditions, please
contact me before -proceeding.
_
Maintenance & Repair _
1. The work authorized under this exemption specifically includes substantial improvement of the existing
dwelling to include the installation of those items referenced in the application for determination of
substantial development dated 2/9/23 and received by DCM on 2/13/2023. No additions, expansions,
including roof overhangs, deck cantilevers, expansions, retaining walls, enclosures, walkways or
stair extensions are authorized under this exemption.
2. The development must not involve removal, damage, or destruction of threatened or endangered an
or plant species, nor shall the development alter the profile/contour of the existing dune or dry sand
beach.
3. The development must not alter naturally or artificially created surface drainage channels.
4. The development must be consistent with all applicable use standards and local land use plans in effect at
the time the exemption is granted.
5. This permit does not authorize expansion of any existing structure(s). All work shall be confined to the
footprint of the existing dwelling.
6. No new pilings may be set outside of the footprint of the existing dwelling.
This exemption to CAMA permit requirements does not alleviate the necessity of your obtaining any other State,
Federal or Local authorization. This exemption expires 90 days from the date of the letter.
S' rely, Iton D , LP
CC: Shelia Cox, Town of Surf City
D_EQ��
�uoarr. cnacur�
oepvte�enl d F renmenbl 0.4.1
North Carolina Department of Environmental Quality I Division of Coastal Management
Wilmington Office 1 127 Cardinal Drive Extension I Wilmington, North Carolina 28405
910.796.7215

S�,o3J�
North Carolina Division of Coastal Management
SUBSTANTIAL IMPROVEMENT AND SUBSTANTIAL DAMAGE FIELD GUIDE
INTRODUCTION
The purpose of this document is to assist the Local Permit Officer (LPO) in determining if a proposed project constitutes
"repair or replacement° of structures within Areas of Environmental Concern (AECs). The Coastal. Resource Commission's
(CRC) rules pertaining to repair and/or replacement of existing structures are found in:15A NCAC 07J .0210 Replacement of
Existing Structures; 7K 0103 Maintenance and Repair, and NCGS 113A 103(5)(b)(5).
15A NCAC 7J .0210 - establishes the criteria to determine whether proposed work is considered repair or
replacement. Proposed worts is considered replacement if the cost to do the work exceeds 50 percent of the market value of
an existing structure immediately prior to the time of damage or the time of request- of structures damaged or
destroyed by natural elements, fire. or normal deterioration is considered development and requires CAMA permits.
Replacement of structures shall be permitted if the !replacement is consistent with current CRC rules.
For the purpose of managing repair andlor replacement of structures in AECs, two terms will be used: "Substantial
Improvement" and "Substantial Damage.' This document will cover substantial improvements to structures and how to
- manaae:maror arditions arrd°ether- a riff:hilin,�-ma�� � rn�rom• �„ �—.M�c��+ ��—ate = - --
to structures thathave been severely damaged. . -
SUBSTANTIAL IMPROVEMENT
For the purpose of this document, "Substantial Improvement" means any reconstruction, rehabilitation, addition crother
improvement to a structure, the total cost of which exceeds 50 percent of the market value of the structure prior to the start of
construction of the improvement.
All building' improvement projects that constitute "Substantial Improvement" will`require a CAMA permit. These include:
• Remodeling projects RECEIVED
• Rehabilitation projects
• Building additions FEB 13 2023
• Repair and reconstruction projects
The CRC rules and/or North Carolina General Statutes NCGS exempt some Vf projects ®N N
(NCGS) p types of projects rom theYefinition of
development and such projects are not subject to the CAMA permit requirements, for example, customary maintenance or
repairs [NCGS 113A=103 (5)(b)(5)], such as, re -roofing a house. However, if there is a larger project that includes re -roofing,
structural repairs, alterations, etc,, then it must include the entire cost of the project.
PERMITTING NOTE: If the project consists of the enlargement of a structure, DCM considers this development and requires
a CAMA permit, regardless of the cost to repair [NCGS 113A-103(5) (a)j. For example, by increasing the pitch on a roof, if the
new roof creates habitable area or has the effect of enlarging the attic area that can reasonably accommodate habitable
space, then it is development and requires a CAMA permit, and is not exempt. Use discretion to determine if maintenance
and repair projects, such as putting a pitched roof over an existing fiat roof, are enlargement of a structure. DCM does not
consider work or any other type of construction taking place within the confines of the space created by the modified design
to be "development" [as defined in the NCGS] in matting a permit determination. However, the cost to repair, improve,,or
rehabilitate is considered in the total "cost to repair when determining substantial improvement. LPOs should consult with
the District Field Representative and/or the District Manager when there is potential for enlarging a structure or changing the
use of a structure in an AEC.
' In this document, the term °buitding" is the same as the tefm "structure."

North Carolina Division of Coastal Management
{MULTIPLE PROJECTS
One problem LPOs may face is a property owner or builder trying to sneak through a loophole by applying for a permit for
only part of the job and then later applying for another permit to finish the work. If both applications together are worth more
than 50% of the market value of the building (and the second permit is applied for within 12 months after the first permit), the
combined project should be considered a substantial improvement and subject to the rules. It is DCM`s determination that
the entire improvement project be considered as one. NOTE., If part of a structure is in an AEC, the anVre structure is
subject to this prmdsion.
In order to help local governments to enforce this, LPOs may count all applications submitted over a 12-month period as one
project. Local Permit Officers should check with their legal counsel on whether their ordinance clearly gives them the
authority to do this. This should also be clearly spelled out in the permit papers given to the applicant.
A project is a substantial improvement if:
Cost of improvement project y 5fl'�a
Market value of the structure
For example, if a proposed improvement project will cost $30,000 and the value of the structure is $50,000:
In this example, the cost of the project exceeds 50% of the market value of the structure, so it is a substantial improvement.
The CRC rules for the project apply and the structure must meet the current CRC rules. The formula is based on thecost of
the project and the value oftthe market value of the structure. Market value of the structure does not include the value of the
land, value resulting from the location of the property, value of accessory structures, or value of other improvements located
on the property.
PROJECT COST OF SUBSTANTIAL. IMPROVEMENT
The cost of the project means all structural costs, including: RECEIVED
• All materials
• Built-in appliances
• Overhead
FEB 13 2023
• Profit
• Repairs made to the damaged part of the structure worked on at the s KWILMINGTON. NC
• Labor
Labor is the "true" cost of hiring someone to do the job, and include the cost of qualified Tabor and materials obtained at
market prices. If the owner does ,it himfherself or has free help, the true" cost of the labor must still be included. To
determine if a proposed project constitutes substantial improvement, the LPO will need a detailed cost estimate for the
project. jNCAC 15A 7J .0210(1)(b)j states that the cost shall be determined bythe Division utilizing any orall ofthe following:
(i) an estimate provided by a North Carolina licensed contractor qualified by license to provide an estimate. or
bid with respect to the proposed work;
(ii) . an insurance company's report itemizing the cost, excluding contents and accessory structures, or
(Iii) an estimate provided by the local building inspections office.
The LPO must review the estimate submitted by the permit applicant. To verify it, LPOs can use their professional judgment
and knowledge of local and regional construction costs, or can use building code valuation tables published by the major
Page 2
Updew on 07/1,W006

North Carolina Division of Coastal Management
building code groups. These tables can be used for determining estimates for particular replacement items if the type of
structure in question is listed in the tables.
It is strongly suggested to use the forms provided as attachments to this document to substantiate the estimated cost of the
project. All forms must be signed, completed in full; and notarized where applicable on the affidavits: Forms that are
incomplete, not signed or notarized should not be accepted.
FicuRE !.
ITEMS TO BE INCLUDED IN THE COST ESTIMATE
ALL STRUCTURAL ELEMENTS, INCLUDING:
a Spread or continuous foundation footings and pilings
ci Structure jacking, elevating, moving, relocating, and the associated costs & materials
a Monolithic or other types of concrete slabs
.a Bearing walls, lie beams, and trusses
o Floors, walls, and ceilings
a Attached decks and porches
o Interior partition walls
❑ . Exterior wail finishes (brick, stucco, siding) including painting, trim, and moldings
o Windows and doors
-==shingling=or-ril'inq a roof _ _ - . _. - - _ _ _ _ _ _ _ _ _
a Hardware - -
ALL INTERIOR FINISHING ELEMENTS, INCLUDING:
o Tiling, linoleum, stone, or carpet over subflooring
o� Bathroom tiling and fixtures
a Wall finishes (drywall, painting, -stucco, plaster, paneling, marble, etc.)
o Kitchen, utility and bathroom cabinets
o Built-in bookcases, cabinets, and furniture
o Hardware
• ALL UTILITY AND SERVICE EQUIPMENT, INCLUDING:
a HVAC equipment
❑ Plumbing (down to the sewer drain). and electrical services (to the service entrance conductors)
o Light fixtures and ceiling fans
o Security systems
o Built-in kitchen appliances
a Central vacuum systems
a Water filtration, conditioning, or recirculation systems
• COST TO DEMOLISH AND HAUL -OFF STORM DAMAGED BUILDING COMPONENTS
• LABOR AND OTHER COSTS ASSOCIATED WITH MOVING OR ALTERING UNDAMAGED BUILDING COMPONENTS TO ACCOMMODATE
IMPROVEMENTS OR ADDITIONS
• OVERHEAD AND PROFITS
ITEMS TO BE EXCLUDE'i
• SEPTIC SYSTEMS (SEPTIC SYSTEMS ARE EVALUATED SEPARATELY)
• PLANS AND' SPECIFICATIONS FEB g_ 3 2023
• ENGINEERING OR ARCHITECTURAL FEES
• SURVEY COSTS DCM WII~I1A1NGTO14e Jq0
• PERMIT FEES
• POST -STORM DEBRIS REMOVAL AND CLEAN UP
Page 3
Updated on 07/1WON

North Carolina Division of Coastal Management
• OUTSIDE IMPROVEMENTS, INCLUDING:
❑ LANDSCAPING
❑ SIDEWALKS
❑ FENCES
❑ YARD.LIGHTS
❑ SWIMMING POOLS (UNLESS THE POOL IS THE STRUCTURE IN QUESTION)
❑ SCREENED POOL ENCLOSURES
❑ DETACHED OR ACCESSORY STRUCTURES (INCLUDING GARAGES, SHEDS, GAZEBOS UNLESS THESE ARE THE STRUCTURES
IN QUESTrON)
❑ LANDSCAPE IRRIGATION SYSTEMS .
MARKET VALUE
The term "market value' reflects the structure's subsequent improvements, physical age of building components and current
condition and original quality. For the purposes of determining substantial improvement, the market value pertains only to the
structure in question. It does not pertain to the land, landscaping; or detached accessory structures on the property (unless
the detached structures are the structures in question). Any value resulting from the location of the property should be
attributed to the value of the land, not the building. . .
15A NCAC 7J .0210(1)(A) - Market value of the structure shall be determined by the Division based upon information
provided by the applicant using any of the following methods-
(iil) 'replacerrrenf cost witt;' deprebiatidn forage of ttie structure and quality
(iii) tax assessed value.
• An independent appraisal by a certified professional appraiser. The appraisal must exclude the value of the land
and not use the 'income capitalization approach" which bases the value on the property, not the structure.
• Detailed estimates of the structure's actual cash value - the replacement cost for a structure, minus depreciation
percentage based on age and condition. For most situations, the structure's actual cash value should approximate
its market value. One may prefer to use actual cash value as a substitute for market value, especially where there is
not sufficient data or enough comparable sales.
• Property appraisals used for tax assessment purposes with an adjustment recommended by the tax appraiser to
reflect the adjusted assessed'value.
SUBSTANTIAL DAMAGE
For the purpose of this document, "Substantial Damage" means damage of any origin sustained by a structure whereby
the cost of restoring the structure to it before damaged condition would exceed 50 percent of the market value of the structure
before the damage occurred.
Two key points:
1. The damage can be from any cause —flood, fire, hurricane, wind, rain, natural deterioration caused by the elements,
or other natural or human -induced hazard.
2. The substantial damage definition and CRC rules applies to all structures in AEC's unless otherwise exempted from
the' CRC rules.
The formula is essentially the same as for substantial improvements-.���'��®
Cost to repair the structure > 50% IEB 13 2023
Market value of the structure
DCjW WILMINGTO�v�
Market value is calculated in the same way as for substantial improvements. Use the pre -damage ma-rKelue.
Page 4
Updated an M r2008

North Carolina Division of Coastal Management
COST To REPAIR SUBSTANTIAL DAMArjE
Notice the formula uses °cost to repair," not "cost of repairs." The cost to repair the structure must be calculated for full repair
to the structure's before -damage condition, even if the owner elects to do less. It must also include the cost of any
improvements that the owner has opted to include during the repair project. The total cost to repair includes the same items
listed in Figure 1.
Properly repairing storm -damaged buildings can be more expensive than people realize. The owner -may opt not to pay for
all the items needed. The owner may:
• Do some work, such as removing and discarding construction debris
• Obtain some materials free.
• Have a volunteer organization do some of the work.
• Decide not to do some repairs, such as choosing to nail down warped flooring rather than replace it.
However, the basic rule still applies. Substantial damage is determined regardless of the actual cast to the owner. One
must figure the true cost of bringing the structure back to its pre -damage condition using qualified labor and materials
obtained at market prices.
15A NCAC 07J .0210(1)(b) - The cost to do the work is the cost to return the structure to its pre -damaged condition, using
labor and materials obtained at market prices, regardless of the actual cost incurred by the owner to restore the structure. It
shall include the costs of construction necessary to comply_ with local and state building codes and any improvements that
(i) an estimate provided by a North Carolina licensed contractor qualified by license to provide an
estimate or bid with respect to the proposed work;
(it) an insurance company's report itemizing the cost, excluding contents and accessory structures;
or
(M) an estimate provided by the local building inspections office.
The permit office and the owner may have serious disagreements over the total 16t of needed repairs and their cost, as the
owner has a great incentive to show less damage than actually occurred in order to avoid the cost of bringing the building
into compliance.
P9,14 WILMINOTON, NO
Page 5
Updated on 07/152088

North Carolina Division of Coastal Management
PROPERTY OWNER AFFIDAVIT
Permit No.: Tax Map: 9lock: Parcel
D
P �t�. r: $04 C.� Subdivision Name:
roperty Address: � IO AL. I aP
Contracl&.sName: clan It ALY16- �'�- License Number:
Owner's Name: Q&gbak 'Nl.. �Ak Phone Number:
UnAa.
(Check on or" as applicable)
Attachment OW-4
Lot:
i5bt Z'
ziy 93(0 —�R'74
7 f(f 9:a. V 0'8$9
f 1 t hereby attest 1p' the fact that the information submitted is true and accurate; the repaira/reconsbuction,
rehabfitation, and for remoWmg list submitted for review by my contra*r area]] the damages sustakled by this
sWelureand that all other additions and improvements, or repairs proposed on the sub*tpmpwwam included in
this estimate. No other person, firm, or corporation, or no other contractor had made repairs, reconatnrdion,
additions, or remodeling not Included on the attached list.
-
- _ . _.►�irue-and-acxurate�ide�repa��s�addEl�r+s,-rejt-.: '. ins; - - _
reconstructions and/or remodeling list submitted for review by my contractor are all of the improverents drat will be
done to the existing structure and that all other additions, improvements, or repairs on the subject property are
included in this estimate. No other person, firm, or corporation, or no other contractor had made repairs,
reconst action, additions, or remodeling not included on the attached fist.
I understand that I am subjectto enforcement actions, restoration, andforcivil penalties if inspection of the property
reveals OW the infomnation submitted is not true and accurate, or that l have performed or authorized work on the
structure not included on the attached list of repairstmodifications to this st ucture, or that I have included or
authorized non-confonning or illegal.structums or additions to the existing structure without having presented any
plans forsuch additions. I understand that any permit issued by this jurisdiction pursuant to this affidavit does not
authorise reconstruction, rehabilitation, repair, or maintenance of any illegal additions, fences, sheds$ or non.
conforming uses of structures of the subject property.
State of-Ve�, County of Q�A�clt=
Before me this day'personailyappeared (ink \hrlirr, S ,k1rJ>#"GPk "� M.6k,who, WngdrlySwam
deposes and says that he or she has re , un rs a s, and agrees to Comply VAth all the a orementioned conditions.
Signature of Owner:
k
Sworn to and suhsaibed before me thi ay of �-'e6"aawj_A.D., 20 Z3
(Seal)
Notary Public State aRECE�VEO
My Commission expires:L5 q f r.�.�t�
i 1 FEB 13 2023
Page 9
DCM WILNINGNT060N, PVC

A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate
Is attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of i raae
Subscribed and swom to (or affirmed) before me on this
day of _r-eb�u�ry , 20 23 , by Lv A,4 ��G`Pn Sc�6nJ� IC
ASAP E COk
proved to me on the basis of satisfactory evidence to be the
person(s) who appaared before me.
CAYM 6RAYALCKWTl
Cwwiw o r 231=5
ORANGECMMV
► y Conan Expiry SEP 2.20
W jeC'F
DCM Va _WjjNGr011- "C

North Carolina Division of Coastal Management
Attachment DCM4
APF. APPLICATION FOR DETERMINATION O
O SUBSTANTIAL IMPROVEMENT
❑ SUBSTANTIAL DAMAGE
Permit No, Tax Map Block Parcel Lot
Property Address: �'1 o Ill _ S'�e ► ( D4 l ('J b on Name:
FIRM Panel: Flood Zone: BFE: AEC:
Pre -damage Elevation: MSL Date Damage Sustained:
Property Owner co -Owner
Name:
- ---Mailinia=Addfess:-
City, State, Zip: '
Phone Number.
JZG
I am attaching a certified appraisal report of my structure, or
Initials:
❑ I am not submitting a certified appraisal report of my structure and,
l accept the Estimated Market Value from tax assessment.
,-, r' Initials:
U t accept the attached estimated cost of constniction as a fair
cost of repairhmprovement for my structure. Initats:
The following documents must accompany the application
The following document(s) islare attached:
❑ Detailed Construction Cost Estimate, Signed by a Licensed General Contractor R ;
❑ Contractor's Affidavit, signed, dated, and certified or notarized
❑ Copy of the General Contractor's License FEB 13 2023
❑ Owner's Affidavit, signed, dated, and certified or notarized
FEMA Elevation Certificate (if applicable or needed) DCM WILMINGTON. No
❑ Floor plan drawing (if available)
❑ Photos (or other evidence) of structure before and after damage event (if available)
Signatures: Owner: Date:
Co -Owner:
Date:
Contractor: Date: e? 2..�
_ Page 6
Updated on 071f W006

Permit No.:
North Carolina Division of Coastal Management
ESTIMATED COST OF RECONSTRUCTION
Tax Map: Block: Parcel
Pro er Address: �%�S�ta< Q� _ Subdivision Name:
Attachment DCM1rt-2
Lot:
Items
Labor Cost
Materials Cost
Total Cost
Total Relocation Costs (house jacking, moving, relocating, etc)
I
_
Foundations (pilings, piers, etc), Concrete, Forms, etc.
Carpentry material (rough) including decks & porches
-
Carpentry Labor (rough)
Roofing
Insulation and weather stripping
Z 37f � od
Exterior finish
- -
Doors, windows, and shutters
Lumber Finish
--
-=Ca-Wft WryLaba #iriish —
TEL
Ll
Hardware (rough)
2So
0
Hardware finish
31 (aa . of
,,Z - .0,
Cabinets
Floor covering (tile, carpet, etc.)
Plumbing
Shower, tub, toilets, and other plumbing fixtures
Electrical
Lighting fixtures
'
Built-in appliances
HVAC
i
Paint
KOoo
Overhead and Profit
TOTAL I 23{0 ._..._..--
S !, $g
NOTE: You must appI cull market value for all donated -labor and matarfals. Contractor attests this Information is true and accurate.
Contractor's Name: I +'7y kre,r u [Ll �'t' License plumber:
Address: Po eox leg-51y, o"T Y Phone Number: 2Sz" '7,V
JI
Signature of Contractor: Date:
C OV
Page 7
FEB 20ZJ9g 5 Updated on07/r5t2008
DCM WILMINGTON, NC

Attachment DCM-3
North. Carolina Division of Coastal Management
CONTRACTOR AFFIDAVIT
Permit No.: Tax Map: Block: Parcel _
u Gf .AA,
Property Address: a/La Ai , 1 a,(�s�� QA- Subdivision Name:
ticense
Contractor's Name: r`A Qk+Lulu �- Number:
JI
Lot:
Owner's Name: "Rrt4^ PW%'Q,. _ Phone Number:. 252 -531- 4 51 Y
I hereby attest to the fact that 1, or an employee of my company, personally inspected the above mentioned property and
produced the attached list of itemized repairs, additions, rehabilitations, reconstructions, andlor remodeling list which are
hereby submitted for review:
(Check on or both as applicable)
LI These damages are all the damages sustained by this structure, and all other additions and improvements or repairs
proposed on the 'subject property are included in this estimate.
l:.! These improvements are all of the improvements that will be done to the existing structure, and all other additions,
irnprovemefts refiabilitatrans,-orrepairs—o(Fth'e subject=property=are-incl[reied in ihisestirrrate- =T= =_ = _— _ - -
I understand that I am subject to enforcement actions, restoration, andior civil penalties if the information submitted
is not true and accurate, or if inspection of the property reveals that I have performed work on the structure not
included on the attached list of repairsimodifications to this structure, or that I have included: non-conforming'or
illegal structures or additions to the existing structure without having presented any plans for such additions. I
understand that any permit issued by this jurisdiction pursuantto this affidavit does not authorize reconstruction,
rehabilitation, repair, or maintenance of any illegal additions, fences, sheds, or non -conforming uses of structures of
the subject property,
Total Labor and Materials: $
Overhead and Profit:
Total Cost:
State of North Carolina, County of
$
$ c23 5S 3�
Q�'r
' •n
Before me this day personalty appeared L`)fi a' 1 n1n f a ck who, tieing duly sworn
depWo"d WSs that he or she has read, understands, and agrees to comply with all the aforementioned conditions.
�0TAR y• 2
� Sworp to and subs Vail
me.this l� day oZ V�f�GC� t _A.D., 2Ej
�Lr � I t" t
Notary Public State of No Carolina
F€B 13 2023
ON ILMINGTOa aPage 8
n 07l15?oQ8

North Carolina Division of Coastal Management
A"L"T r FW"TI0N of
5d SUBSTANTIAL IMPROVEMENT
© SUBSTANTIAL DAMAGE
Pod Na. Tuc Map Nock- l _ Pod 4 Z45ZD [070 Q_ Ld j
PrnpwtyAddmss: Be, Stt 641-C _ Subd'ndeionNxw.
FiRm Panel: xjZ04255WFlood Zane: V F, OFE: _!1_ AEC:
4jo—
F�edepraage Elevation: MSL D8b susta W:
.,.•'e U 1#�, tip .try 'jr"
v
lam abft g a certified a nNmitofmY shxtm, ar
lniirelsv
tam not suW ti V a certified apprisal rWort of my srnxdue and
l accept the EsthwW Market value from tax assessment.
I accW tie abched estimated cost of CWGW on as a fay
cost of rep kftmvement for my s Wwfe.
Initials:
The hdv#fng doarmft aurat m von* y Me appfkadort
The wk wbg docunetd(s) ware abdw:
f
DMIed Conat►oedon cost Estimatk speed by a L ansed t CorVa W
:Q cantradors Afrr. signed, dated and certified arnotarized -
Copy of me cenera. contractor's license . RECEIVED
9 Owner's~ "nod, dated, and 0060 or no Wtmd • 3
Ll FEMA Elevation Ce VxWe (4applirsb* o► needed) . 2023
❑ Aw plan drawing 0mM*) 0CM WILMINGTON,..��.
Rats (or other evidence) of structure bete and aAer damage event (d waWA)
Signatures: Owner.
t
Coah,rnerr � € -A ::101 .
Conhctorps
^_

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Wilmington, NC
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CERTIFICATE OF INSURANCE' Certificate Number
Renswal of Number COMMON POLICY DECLARATIONS BWD743891
NEW 1-10.3 AUTHORITY REF NUMBER
This Declaration is attached to and foams part of certificate provisions (Form LPG1) B04299MIC0432
Insurance Is effective with cedaln UNDERWRITERS AT LLOYD'S, LONDON.
AGENT:
Bums 3 Wilcox, Ltd.
800 Arettdee Street, Suits 200
Morehead City, NC 28557
ADDRESS
12:01 AM Standard Time at the
Policy Term,,12 Months Elfective:05/24/2022 Explrstlon:05/24/2023 insured Location
COVERAGES
LIMIT OF LIABILITY
PREMIUM
SECTION 1 - A) DWELLING
B) OTHER STRUCTURES 3_ -• S� y. l; a 0
C) PERSONAL PROPERTY
D) LOSS OF USEIRENTS _.._
$ 486,000
$ 48.600
s 243,000
S 48,600
$ 7,105
Included
Included
Included
SECTION 2 - E) PREMISES LIABILITY
F) MEDICAL EXPENSE
$ 500,000
$ 5,000
Included
Included
AOOiTIONAL Replacement Cost Contents
COVERAGES Spedited Additional Arnount of Coverage
Water Backup
Included
25%
$ 25,000
Included
Included
Included
Excess Flood
Excluded
The Insurance company with which (his coverage has been
placed is not licensed by the State of North Carolina and is
not subject to its supervision. In the event of the insolvency of
the insuram-e company, losses under this policy will riot he
paid by any State insurance guaranty or solvency fund.
Bums &. Wilcox Ltd - 30833 Norti-meastem, Highway. 220
Premium:
$
7,105.00
Policy Fee: (Fully Earned)
$
165.00
Inspection Fee: (Fully Earned)
S
150.00
Stamping Fee
$
28.42
Su us Limes Tax:
$
355.25
Total Premium:
S
7,803.57
Kaufman Financial Center. Farm'sngtoo Hills MI 48334 -
License #1000006506
$
s
DEDUCT13LE (Section 1 only): All Otter Perks: $ 2,500 Each and Every Loss .
Named Storm: 2% of Dwelling Llmh
Earthquake: Excluded
Water Backup: S 250 Each and Every Loss
Insured Location:.810 Nf Topsall Dr, Surf City, NC 28445
Occupancy: Secondary Rental
FORMS AND ENDORSEMENTS
This policy Is made and accepted subject to the above statement together with the provisions, stipulations and
Agreements contained In the following forms) and endorsement(s). RECEIVE[)
See Schedule of Forms and Endorsements
MORTGAGEE(S): None
This policy shall not be valid unless
C,;j.ail f;7S 1.Ni 1) A
ourautnonzea
n� r. QAf
In order to evaluate your application(s)ar proczsac your c ar s a>=w any Of
your policies, we may cailect additional information about you. We are allowed by taw
to disclose this information to others without your authert=ation in certain speuyied
circumstances. you have the right to obtain access in certain items of information we
collets about you and to request correction of infonnadoo you feel to be Inactumte. If
you wish a more detailed description our Information practices, Please contact our
office for a mare detailed, or 'long term' notice.
LLOYDI ht0 (06109)

a•.
Linda Cook
Task
Exterior Windows and Doors
Exterior Shake Siding
Exterior deck hardware
Cabinets
Electrical
Plumbing
Shower door and Mirrors
Paint and Drywall
Demo and trash haul off
Flooring*-""
Permits
Cama
Open railing
With blinds in the doors Non Iml
New Shake on Exterior
Kitchen, Powder, Master bath
3rd floor only
3rd floor only
Going to all Tiled flooring
3rd Floor
Glass
Price
$42,957.88
42,375.00
$7,625
$64,240.00.
$8,337.50
$5,250.00
$5,000.00
$15,000.00
$6,250.00
$34,620.00
$1,000.00
53.929.00
FEB Z02�
IDCji W I LMI NG770N,