HomeMy WebLinkAbout76204D - Conner� CAMA / DREDGE & FILL No. 76204 A B C CB�
GENERAL PERMIT Previous permit #
Ievv ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attached.
Applicant Name j �� VCATH/-1okq\O
A.. c O N h e r Project Location: County �Qy Nsw'�C
Addre//s��s \I A�� EJ Strreet Address/ State Road/ Lot #(s) L(�
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Phone # y 0� r{�� E-Mail SAGE 53 Q ALIL_COM Subdivision pa /h �`. 0 ✓ e-
Authorized Agent �Nc-\GS c.,IJ City 0A S E 1 �E'-Nr-)A ZIP
Affected ❑ cW ❑ EW ❑ PTA 7kES ❑ PTS
AEC(s): ❑ OEA ❑ HHF QQIH UBA ❑ N/A
❑ PWS: I
ORW: yes /< no PNA yes /
Phone # ( )
River Basin
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A building permit may be required by: T[W N e F S'J Jv SE Z 66tyCA ❑ See note on back regarding River Basin rules
( Note Local Planning jurisdiction) UAAJ-tv%oRl At.
Notes/Special Conditions( ALA AQ1QRAC' MvSt fit: 2EWOJIrQ Z(Z`A 1-6 S^NDW10 k"r.1h«AT16d ®IN ARIAS
%#4"C F f OLNIAL "%%a 4MiEQ SJktJ4F1, aOAt tAWp- AA%N t�,,C OF SAAJbM1L> (AN/0117 C-aGt.%b 1b FFE't FOUL
I L N %J4 Vi I LOJ U) U T
Agent or Applicant Printed Name
Signature *tpleasereadc mpliance statement on back of permit"
Application Fee(s) Check #
7�
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PermitO
ted ame
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Signature
2 1
rk d
3
Issuing D e
pirat n Date
2/12/2020
Mail - Brock, Brendan O - Outlook
Doa Sign Envelope ID. 8W M8D-7846-4248-BFA9-EC I EO1338591'
CERTIFIED MAIL •RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN
%PROPERTY OWNER NOTIFICATIOMWAIVER FORM
Name of Property Owner 0A/AJ 1! a -bD Al A,1 A \AJ
Address of Property: "A- -1 (--o tl-i— 'Ra-� 24/81
A of n Clrowf • f�`1nw nr A+w++1 �yw. s I`n..+v�
Agents Namer1f Tim Jackson
Agents phone rt 1 951 S. McPherson Ch RD 10
Fayetteville NC 28303
FI
I hereby certify that I own property ad)aoant to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
1 have no objections to this proposal. I have objections to this proposal.
a/ you love o4%cdom eo whet Is being Prod you must no�tf j� dN DMWon ofCa=W Mwwgwnarrt
(UCH) in wrftbig wMA. 10 c*s o/ r>rceipt o/ OWS rlingk (:W1j i itniN, lig on for UCU offkes is
arlNabi%at hCp1/www nccoastalmanaoementnet/wetycm/stafti* listngarbycoM g 14UN11- RCOAST.
Ab response is oonslldlared On sa►rw as no objft-don H you hav+a bon rx*kW by Corti m d .tail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If
you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement
(P rty Owner Information)
Signmw+e
Gwielz boAtAIA 1,t,(
FlrW or Type Nar►re
32--19 aa-4, Al
A�bng Address
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cdy'�Staw
Telephone Number/ mail Address
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Mailb>'g Add►m
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Telephone Raba r/ IWUsaat �ld
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near
(Revised Aug. 2014)
hftps://outlook.office365.com/mail/search/id/AAQkADVjMzg3NTMyLTIIMTMtNGM5Yyl hNzQ4LThiOW M2N WZhNjc5YwAQADfsTF4RthIPjOHHrG9%2F... 1 /2
DMSION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFiICATIONlWAIVER FORM
Name of Property Owner. (
Address of Property: J—� —1 13� w` de> Vr► 34/ 91
p.ot or Street Ifs Street tx � Cfiv b Camty)
r
Agent's Name I Tim Jackson t si nature aroo�rties Qom z!
Agent's phone 951 S. McPherson Ch RD 101
910-309-2983
Fayetteville NC 28303 _ _ ■
i hereby certify that I own property adjacent to the above referenced property. The individuai
applying for this permit has described th me as shown on the attached drawing the development
they are proposing,
I have no objections to this proposal. I have objections to this proposal.
l► YOU bavVokacfloosto0Wisberngpropm4you mustna fyffieDlvlalono/CosadlAhrwgamant
(DCM & m*h3e w>Ign 10 days of iecalpt of a& noflo& CWOW Nbrnaffon for DCH offices is
W890dleat - orbyc tNAv 14MO-RCOAST.
WAIM SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If
you wish to waive the setback, you Must InWal the appropriate blank below.)
t do wish to waive the 1 S' setback requirement.
I do not wish to waive the I & setback requirement
(Property Owner Infornumon)
Signature
00"fialq1Z
Piiht or Type Nome
% 11ra 20 i SS
20r g�g�
TafaAw* Number/EmetAftess
(Riparian Property Owner Information)
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Pratt or Type Name
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Tft*houte Number/ Address
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(Revised Aug. 2014)
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Conner Donna W.
Mailing Address: 13279 Catharpin Valley
Gainesville, VA 20155
Phone Number:
Email Address:
Tim Jacksonia
I certify that I have authorized
Agent t Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Install sand bags alone
Fact hAain St_ Pr�('nye i'ihriivicnn
at my property located at Lot 7 Palm Cove Plat 84/81
in Brunswick County.
I furthermore certify that 1 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, evatuafing information related to this
permit application.
Property Owner Information:
' l
Signature
Donna W. Conner
Print or Type Name
Owner
Tate
Date
This certification is valid through 2/ I 31/ I 2020
NC DIVISION OF COASTAL MANAGEMENT
SANDBAG REMOVAL NOTICE
I,
Donna W, Conner understand that sandbags are temporary erosion control
structures that tnaY retrain in place for up to eight years aftor the date of approval if it is protecting a
building and an associated sepdc system, a bridge or a road. The property owner shall be responsible for
rotnoval of any portion of the temporary erosion control s� exposed above grade within 30 days of
the and of the allowable limo period• Any portion of the temporary erosion control structure that becomes
exposed above grade after the expiration of the permitted time period shall be removed by the property
owner within 30 days of official notification from the Divisioa of Coastal Management.
AIN
In this case the sandbag alignment may remain in place up to: � Permit No. V
Address of the Structure Being Protected:
Lot 7 Palm Cove Plat 84/81
Sunset Beach 28468
Property Owner: Donna W. Conner
(Preen, Corporation or ludividwil)
If the property is owned by a Firm or Corporation give
the name of the officer or authorized representative:
Donna W ('.)nnPr 2/6/2020
Print Name Date
If an agent is obtaining the permit, on your behalf the following section must be completed in full:
Donna W. Conner give permission to, Tim Jackson
Plat ownwor officarNome Print Agent Name
to aaas my/ouragent in obtaining a CAMA General Permit to place sandbags on the property noted
above.
Tim Jackson
jAa&e�= , — — --
owner ff sign=" Print Agent
(5)-
LIMITED LIABILITY COMPANY ANNUAL REPORT
I0/2017
NAME OF LIMITED LIABILITY COMPANY: Finley Efard, LLC
SECRETARY OF STATE ID NUMBER: 1403678 STATE OF FORMATION: NC
REPORT FOR THE CALENDAR YEAR: gn9n
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: Triplett, Neal Finley
2. SIGNATURE OF THE NEW REGISTERED AGENT:
Filing Office Use Only
E - Filed Annual Report
1403678
CA202004101177
2/10/2020 02:00
Changes
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
2808 Chelsea Circle
Durham, NC 27707-5133 Durham County
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: hnmp rantalc
2808 Chelsea Circle
Durham, NC 27707-5133
2. PRINCIPAL OFFICE PHONE NUMBER: (919) 383-6165 3. PRINCIPAL OFFICE EMAIL: privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS
2808 Chelsea Circle
Durham, NC 27707-5133
5. PRINCIPAL OFFICE MAILING ADDRESS
2808 Chelsea Circle
Durham, NC 27707-5133
6. Select one of the following if applicable. (Optional see instructions)
❑ The company is a veteran -owned small business
❑ The company is a service -disabled veteran -owned small business
SECTION C: COMPANY OFFICIALS (Enter additional company officials in Section E.)
NAME: Neal Finley Triplett
TITLE: General Manager
ADDRESS:
2808 Chelsea Circle
NAME: karen Williams triplett
TITLE: Managing Member
ADDRESS: 2808 Chelsea Circle
NAME:
TITLE:
ADDRESS:
Durham, NC 27707 Durham, NC 27707
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
karen williams triplett
SIGNATURE
Form must be signed by a Company Official listed under Section C of This form
2/10/2020
U7\111:1
karen Williams triplett Managing Member
Print or Type Name of Company Official Print or Type Title of Company Official
This Annual Report has been filed electronically.
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525
■
To whom It May Conc(Irr);
E.77_.-
1 hereby authorize Tim Jackson to sign on my behalf for any work pertaining to the Sunset.
Beach Palm Cove Sandbag project and associated projects of such.
Bob W Harrelson
Witness
Date Received
Deb ed
Check Fran Name
N.— or Permit Holder
Venda
Check Number
Check
amount
Parmh Number/Comments
R-1pt or RMunaReallocated
Columnf
Coumn3
C9umn3
Column/
Columns
ColumnC
Column7
Columnil
ColumnY
2/17/2020 Palm Cove Owners Association, Inc.
Palm Cove Holdings, LLC
First Citizens Bank
1014
$ 400.00
GP #762021)
BB rot. 8819
2/17/2020 Palm Cove Owners Association, Inc.
Benjamin & Cyndi Levine
First Citizens Bank
1015
$ 400.00
GP #762031)
BB rct. 8820
2/17/2020 Palm Cove Owners Association, Inc.
Longleaf Pines, LLC
First Citizens Bank
1016
$ 400.00
GP #762051)
BB rot. 8821
211712020 Palm Cove Owners Association, Inc.
Jill Marie Ronnion Rev. Trust
First Citizens Bank
1017
$ 400,00
GP #76206D
BB rct. 8822
2/17/2020' Palm Cove Owners Association, Inc.
Howard Beach House_ LLC
First Citizens Bank
1018
$ 400.00
GP #76207D _
BB rct. 8823
2/17/2020 Palm Cove Owners Association, Inc.
Donna Conner
First Citizens Bank
1019
$ 400.00
GP #76204D
BB rot. 8824
2/17/2020 'Palm Cove Owners Association, Inc.
Finley Efard, LLC
First Citizens Bank
1020
$ 400.00
GP #762081)
BB rct. 8825
2/17/2020 Palm Cove Owners Association, Inc.
David Tendler & Susan S_pratt
First Citizens Bank
1021
$ 400.00
GP #762091)
BB rct 11451
2/17/2020 Palm Cove Owners Association, Inc.
Tatiana McCuen
First Citizens Bank
1022
$ 400.00
GP #76210D
BB rct. 11452
2/17/2020 Palm Cove Owners Association, Inc.
Ann Morales
First Citizens_ Bank
1013
$ 400.00
GP #76201 D
BB rct. 8817
211712020 Charles Ducksworth Money Order
Christopher Miller
Wells Fargo Bank
19-04611211
$ 200.00
GP #74891 D
_BB rct. 11453
2/17/2020 H5 Construction, LLC
Thomas Holland Jr.
BUT
2473
$ 260.00
GP #74893D
_BB rot. 11455
2/17/2020 1 Jerry Ennett c/o Enned Marine Construc6
Deborah Kalner
Coastal Bank and Trust
2736
$_ 200.00
GP #74878D
JD rct 10965
2/17/2020' Charles & Christine Boise
Charlie Boise
The Fau uier Bank
2635
200.00
GP #762141)
JD rat. 10964