SW8921019_Annual Certification Summary (2024)_20240117

Section A-Project Information
Permit Number: SW8921019 Project Town/City: Shallotte
Project Name: Brunswick Electric Membership Corporation Corporate Facility Project County: Brunswick
Permit issued: 10/17/2019 Project Status: completed
Section B-Permittee Information
Name: Brunswick Electric Membership Corporation Street Address: Mailing Address:
Signing Official: Joshua Winslow 795 Ocean Hwy West PO Box 826
Title: CEO
Phone Number: 910-754-4391 Ext. Supply,NC 28462 Shallotte,NC 28459
Email Address: [e-mail]
Section C-Property Owner Information
Name: Brunswick Electric Membership Corporation Street Address: Mailing Address:
Signing Official: Justin Pruitt 795 Ocean Hwy West P.O.Box 826
Title: MGR.Facilitites
Phone Number: 910-540-8204 Supply,NC 28462 Shallotte,NC 28459
Email Address: [e-mail]
Section D-Site Conformance with Permitting Conditions
Max BUA not exceeded? Yes Veg.setbacks per plans? Yes Site is as shown on plans? Yes
SCM BUA not exceeded? Yes Easements recorded? Yes Designer Cart.submitted? Yes
Lot BUA not exceeded? NA O&M Agreemt recorded? Yes O&M being performed? Yes
BUA as shown on plans? Yes O&M Agreemt on plats? Yes No maintenance issues? Yes
SCM/LD area per plans? Yes Deed Restrict.recorded? Yes Maint.records being kept? Yes
SCM/LD area accessible? Yes O&M done per E&SC? NA Permit is active? Yes
Stormwater outlets stable? Yes SCMs fixed when done? Yes Other conditions met? Yes
See Attachment A for a list of all N/A explanations to the above items.
Section E-Plan to Bring the Project info Conformance
Project is in conformance with all permit conditions.
Section F-Project Certifier Information
Certifier Signing: Joshua Winslow Street Address: Mailing Address:
Title: CEO 795 Ocean Hwy West PO Box 826
Phone Number: 910-754-4391 Ext.
Email Address: [e-mail] Supply,NC 28462 Shallotte,NC 28459
Section G-Certification
The information in this form is true,accurate,and complete? Yes
The project is in conformance with all permit conditions? Yes
Electronically signed by Joshua Winslow on January 17,2024.

ATTACHMENT A
Explanation about why"N/A"items above are not applicable to this project.
Max BUA not exceeded N/a:
SCM BUA not exceeded N/a:
Lot BUA not exceeded N/a: We are a commercial facility/public business
BUA as shown on plans N/a:
SCM/LD area per plans Nla:
SCM/LD area accessible N/a:
Stormwater outlets stable N/a:
Veg.setbacks per plans N/a:
Easements recorded N/a:
O&M Agreemt recorded Nla:
O&M Agreemt on plats N/a:
Deed Restrict.recorded N/a:
O&M done per E&SC N/a: Construction is complete
SCMs fixed when done N/a:
Site is as shown on plans N/a:
Designer Cert.submitted N/a:
O&M being performed N/a:
No maintenance issues N/a:
Maint.records being kept N/a:
Permit is active N/a:
Other conditions met N/a: