HomeMy Public PortalAboutMEDDIN DR_29 (3).pdfCity of Tybee Island • Community Development Dept.
Inspection Report
403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 31328
Phone 912.472 -5032 • Fax 912.786.9539
INTERNATIONAL
CODE COUNCIL
MEMBER
Permit No. / ' . 1 Date Requested ;• Z6. w=•
Owner's Name Date Needed *‘.y//.3
Gen. Contractor Subcontractor
Contact Information
Project Address
Scope of Work
Inspector .1) "1 Date of Inspection'/p " /?
Inspection f {) ; % ! Pass Fail ® Fee
QPSS
Inspection Pass ❑ Fail ^ Fee
L
Inspection Pass ❑ Fail 11-11 Fee
Inspection Pass �� Fal 1---1 Fee
DATE ISSUED: 07 -8 -2013
WORK DESCRIPTION
WORK LOCATION
OWNER NAME
ADDRESS
CITY, ST, ZIP
PHONE NUMBER
CONTRACTOR NAME
ADDRESS
CITY STATE ZIP
FLOOD ZONE
BUILDING VALUATION
SQUARE FOOTAGE
OCCUPANCY TYPE
TOTAL FEES CHARGED
PROPERTY IDENTIFICATION #
PROJECT VALUATION
CITY OF TYBEE ISLAND
BUILDING PERMIT
REROOF - SHINGLES
29 MEDDIN DR
PAUL GATTI
131 PARKS RIDGE
DUBLIN GA 31021
478 - 275 -9669
ROOF CRAFTERS * **
PO BOX 61055
SAVANNAH GA 31420
P
$ 205.00
PIN #4- 0002 -10 -001
$20,000.00
PERMIT #: 130431
TOTAL BALANCE DUE: $ 0.00
It is understood that if this permit is granted the builder will at all times comply with the zoning, subdivision, flood control, building, fire, soil
and sedimentation, wetlands, marshlands protection and shore protection ordinances and codes whether local, state or federal, including all
environmental laws and regulations when applicable, subsequent owners should be informed that any alterations to the property must be
approved by the issuance of another building permit. Permit holder agrees to hold the City of Tybee Island harmless on any construction
covered by this permit.
This permit must be posted in a conspicuous location in the front of building and protected from the weather. If this permit is not posted work
will be stopped. The building contractor will replace curb paving and gutter broken during construction. This permit will be voided unless
work has begun within six months of the date of issuance.
Signature of Building Inspector or Authorized Agent:
P. O. Box 2749 - 403 Butler Avenue, Tybee Island, Georgia 31328
(912) 786 -4573 - FAX (912) 786 -9539
www.cityoftybee.org
Property Address:
13-0431
X79
City of Tybee Island, Georgia
912 - 472 -5033 or 912 - 472 -5031 - Fax 912 - 786 -9539
APPLICATION FOR BUILDING PERMIT
4--00 02- lo - oo�
Ingle Family
Duplex
❑ Multi - Family units
❑ Commercial units
(Check all that apply)
❑ Discovery/Tearout
❑ Footprint Changes —
new _ square feet
heated /cooled
Details of Project: iQ-O D f %.e ,J cevkle 177
41‘4426_ 7h a. l
Ti Demolition of Structure
❑ Other
Estimated Cost of Construction: $ Z 0, 0 0 0 07) (materials + labor + profit/overhead)
If applicable, attach a copy of the certified elevation certificate and /or survey of the property. Depending upon
the scope of the work, two sets of construction drawings and /or a site plan may be required.
Year Built: Listed on National Historic Register or located within a National Historic District? Y / N
* Buildings older than 50 years may be eligible to be listed on the State / National Register. With this designation, you
may be eligible to take advantage of various tax incentive programs while preserving the heritage of Tybee Island.
* Also see the Tybee Island Land Development Code Article 14: Historic Preservation
During construction:
On -site restroom facilities will be provided through . Construction debris will be disposed
by by means of . I understand that I must comply with zoning, flood
damage control, building, fire, shore protection and wetland ordinances, FEMA regulations and all applicable codes and
regulations. I realize that I must ensure the adequacy of drainage of this property so that surrounding property is in no way
adversely affected as required by Article 16, Stormwater Management. I accept responsibility for any corrective action that
may be necessary to restore drainage impaired by thi pper itted construction.
Date: (i-7- �O' ( 3 Signature of Applicant:
Printed Name [k r' y S
Note: A permit normally takes 7 to 10 days to process
v^ -d 4.4
Approvals: a ure Date
Planning & Zoning Manager `�_8�l
Building Official
Water /Sewer
Storm /Drainage
City Manager
FEES
Permit
Inspections
Cap Cost Rec
Water Tap
Sewer Stub
Eng. Fees
Aid to Const.
TOTAL
Name
Mailing Address
Telephone
Owner
G 77 ;
2 4
'p4-
Home:
Cell: '-f 7F- ,2/'9- 902
Architect or
Engineer
/ea pin/
Contractor
/200 f 60-4 (71-.c. yLs
Office:
Cell: /2 - 27 2- li/
Ingle Family
Duplex
❑ Multi - Family units
❑ Commercial units
(Check all that apply)
❑ Discovery/Tearout
❑ Footprint Changes —
new _ square feet
heated /cooled
Details of Project: iQ-O D f %.e ,J cevkle 177
41‘4426_ 7h a. l
Ti Demolition of Structure
❑ Other
Estimated Cost of Construction: $ Z 0, 0 0 0 07) (materials + labor + profit/overhead)
If applicable, attach a copy of the certified elevation certificate and /or survey of the property. Depending upon
the scope of the work, two sets of construction drawings and /or a site plan may be required.
Year Built: Listed on National Historic Register or located within a National Historic District? Y / N
* Buildings older than 50 years may be eligible to be listed on the State / National Register. With this designation, you
may be eligible to take advantage of various tax incentive programs while preserving the heritage of Tybee Island.
* Also see the Tybee Island Land Development Code Article 14: Historic Preservation
During construction:
On -site restroom facilities will be provided through . Construction debris will be disposed
by by means of . I understand that I must comply with zoning, flood
damage control, building, fire, shore protection and wetland ordinances, FEMA regulations and all applicable codes and
regulations. I realize that I must ensure the adequacy of drainage of this property so that surrounding property is in no way
adversely affected as required by Article 16, Stormwater Management. I accept responsibility for any corrective action that
may be necessary to restore drainage impaired by thi pper itted construction.
Date: (i-7- �O' ( 3 Signature of Applicant:
Printed Name [k r' y S
Note: A permit normally takes 7 to 10 days to process
v^ -d 4.4
Approvals: a ure Date
Planning & Zoning Manager `�_8�l
Building Official
Water /Sewer
Storm /Drainage
City Manager
FEES
Permit
Inspections
Cap Cost Rec
Water Tap
Sewer Stub
Eng. Fees
Aid to Const.
TOTAL
LEAD -BASED PAINT RRP RULES
Ordinary renovation and maintenance activities can create dust that contains lead. Contractors who perform
renovation, repairs, and painting jobs in pre -1978 housing and child- occupied facilities must, before beginning
work, provide owners, tenants, and child -care facilities with a copy of EPA's lead hazard information pamphlet
Renovate Right: Important Lead Hazard information for Families, Child Care Providers, and Schools.
Contractors must document compliance with this requirement. After April 22, 2010, federal law will require you
to be certified and to use lead -safe work practices. Georgia Environmental Protection Division Lead -Based
Paint and Asbestos Program (404) 363 -7026.
Projects must be done by a Certified Lead Renovation Firm AND a Certified Renovator
When disturbing lead -based painted or coated surfaces or components more than 6 ft2 per interior
room or 20 ft2 of exterior surfaces AND all window replacements and partial demolitions of any size.
* * * * * * * * * * * * * * * * * * * **
Asbestos /Environmental Notification to Georgia EPD for
Projects Involving Demolition, Wrecking, or Renovation
The undersigned hereby acknowledges that the issuance of this permit does not in any way grant permission
to the owner, owner's representative, or permit holder to proceed with demolition, wrecking, or renovation of a
structure prior to the filing of any required ten (10) day "Project Notification for Asbestos Renovation
Encapsulation or Demolition" form in accordance with the Georgia Asbestos Rules. The Georgia
Environmental Protection Division administers the rules. In most cases, the rules require both the owner and
the involved contractors to assure the portion of the building involved in the project is thoroughly inspected by
an Accredited Asbestos Inspector for materials that contain asbestos; and the removal of the asbestos before
renovation, wrecking, or demolition begins almost without exemption. Georgia EPD requires a completed
demolition notification from be submitted 10 workings days in advance even if no asbestos is present in the
building. Further guidance for regulatory compliance and contact telephone numbers are provided by the
brochures entitled Asbestos & Renovation and Asbestos and Demolition. Other environmental issues such
as asbestos removal techniques, lead abatement, ground contamination, or unusual site conditions may have
EPD regulations that could affect the project.
* * * * * * * * * * * * * * * * * * * **
BMPs
While BMP deficiencies are not necessarily the fault of the owner or his agent, BMPs are their responsibility.
Two areas of deficiencies are in the most basic and common BMPs; Co — Construction Exit and Sd1 —
Sediment Barrier. Correct installation information can be found in the Field Manual for Erosion and Sediment
Control in Georgia, Fourth Edition 2002, Georgia Soil and Water Conservation Commission;
http:// www. gaswcc .org /docs /field_manual_4ed.pdf.
Problems with the Co is not limited to the installation, but to material. The stone will be a representation of
1.5 " -3.5" stone or larger.
Type A sediment barriers have been installed where Type C is required and shown on the permit drawings.
Where two rows are called for they will be installed with a separation that allows for the first one to fail (fall
over) without impacting the second one. The complete assembly and installation must be compliant; steel or
wood posts, post spacing, Type C or A.
Signatyre or receipt of Lead Paint, Asbestos, and BMP notices.
Printed Name
7 _ , /3
Date
Chatham County Board of Assessors: 2P13 Property Record Card 4- 0002 -10 -001
2013 Chatham County Board of Assessors
Property Record Card
APPRAISER LESTEPH
LAST INSP 11/24/2010
APPR ZONE 000008
LOT 1 BLOCK 17 FORT SCREVEN WARD TYBEE ISLAND SAVANNAH BEA CH
SALES BOOK / INS VI QU RSN PRICE
PAGE
23 Nov 356Z 306 WD I Q 475,000
2009
GRANTOR:PAIGE JULIANA C
GRANTEE :PTG LLC
27 Aug 257W 0129 NA I U UG
2003
GRANTOR:PAIGE JOHN W
GRANTEE:PAIGE JOHN W & JULIANNA C
PERMITS TYPE DATE
10 -017 GM 24 Nov 2010 Comp
100303 PO 24 Nov 2010 Comp
100311 GM 24 Nov 2010 Comp
10 -0401 24 Nov 2010 Comp
10 -00361 HT 24 Nov 2010 Comp
070013 28 Jan 2008 Comp
040336 WO 10 Aug 2004 Issued
AMOUNT
5,600
22,000
900
4,000
7,000
1,500
15,000
COMMENTS:
12 Mar 2010
26 Jul 2005
TY10 B2S REM PER 356Z/306
ADD CHG PER FORM 07/26/05
JLM
13 Jul 2005 JOHN W PAIGE COD 04/20/05
NM CHG PER SURVS 07/13/05
JLM
08 Dec 2003 * TY04 SURVS
Page 1 of 2
4- 0002 -10 -001
29 MEDDIN DR TYBEE ISLAND
PTG LLC
131 PARKS RIDGE
DUBLIN GA 31021
CAMA ASMT
157,700 157,700 LAND 2
196,900 196,900 BLDG 1
OBXF 0
354,600 354,600 Cost - MS
[Click for larger picture]
,.z. `i; Chatham County
Tax Commissioner
-0r � 1': ip21A TB, _nt =ricrtt
CODES
PROPERTY 0006 RESIDENTIAL
USE
UTA 0004 Tybee Island
NBHD 020270.00 T270 TYBEE
SCREVEN
EXEMPTIONS
HISTORY LAND IMPR TOTAL
2012 177,700 198,100 375,800 Cama
2011 233,600 136,600 370,200 Cama
2010 331,100 104,200 435,300 Cama
2009 331,000 226,500 557,500 Over
2008 331,000 226,500 557,500 Cama
2007 331,000 226,500 557,500 Cama
2006 377,000 153,000 530,000 Cama
2005 142,500 226,500 369,000 Cama
2004 169,000 186,000 355,000 Cama
2003 120,500 186,000 306,500 Cama
2002 124,000 186,000 310,000 Cama
2001 123,500 105,000 228,500 Cama
2000 113,500 105,000 218,500 Cama
1999 39,500 105,000 144,500 Cama
1998 39,500 105,000 144,500 Cama
1997 39,500 99,500 139,000 Cama
1996 18,000 99,750 117,750 Cama
1995 18,000 115,870 133,870 Cama
1994 18,000 102,300 120,300 Cama
1993 18,000 83,200 101,200 Over
1992 18,000 83,200 101,200 Over
LAND
ID# USE DESC
108348 SINGLE FAMILY RES
108349 SINGLE FAMILY RES
FRONT DEPTH UNITS / TYPE PRICE ZONING LCTN TOPO OTHER ADJ1 ADJ2 ADJ3 ADJ4 MKT VALUE
0 0 7,000.00 -SF 19.00 R1 133000
0 0 5,197.00 -SF 19.00 R1 SZ -75 24700
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Page 2 of 2
4- 0002 -10 -001
29 MEDDIN DR TYBEE ISLAND
CONSTRUCTION TYPE RCN AYB EYB DEP TYPE PHYS ECON FUNC OBSV / % TOTAL DEP % RCNLD U.FACTOR MKT VAL
Residential 259,455 1975 1985 MS 31.00 0.00 0.00 0.00 31.00 179,024 .00 196,900
Chatham County Board of Assessors: "l3 Property Record Card 4- 0002 -10 -00
2013 Chatham County Board of Assessors
Property Record Card
BUILDING SECTION
84304 -1 -2013
16'
•
I], 22
32'
e'
[Click for larger picture]
SECTION TYPE 1 - Main
AREA 2568
TYPE 1 - Single- family Residence
FRAME 1 - Stud Frame
STYLE 2 - Two Story
QUALITY 4.00
CONDITION 3.00
# UNITS 0
#OF BEDS /BATHS 4/2.10
COMPONENTS
R1 108 Frame, Siding, Wood
R2 208 Composition Shingle
R3 352 Heat Pump
R4 402 Automatic Floor Cover Allowance
R6 601 Plumbing Fixtures ( #)
R6 621 Slab on Grade (% or SF)
R11 901 Open Slab Porch (SF)
R11 904 Slab Porch (SF) with Roof
R16 1626 Pool, Vinyl -lined (SF)
Units % QUAL
100.00
100.00
100.00
10.00
286.00
1196.00
536.00
100.00
http: //boa. chathamcounty . org /DesktopModules /ChathamCounty/B oardofAs se s sors /PropertyRecordCard. aspx... 7/8/2013
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
Al . Building Owner's Name PAUL GATTI
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1 -9,
SECTION A - PROPERTY INFORMATION
OMB No. 1860 -0008
Expires March 31, 2012
For Insurance Company Use:
IPolicy Number
A2. Building Street Address (including Apt., Unit, Suite, and /or Bldg, No.) or P.O. Route and Box No. I Company NAIC Number
29 MEDDIN DRIVE
City TYBEE ISLAND State GA ZIP Code 31328
A3. Property Uescnption (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 1, BLOCK 17 FORT SCREVEN WARD, TYBEE ISLAND, SAVANNAH, GA. TAX PARCEL NO. 4 -0002 -10 -001
A4. Building Use (e.g., Residential, Non - Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude /Longitude: Lat. 32 -01 -15 Long, 080 -50-42 Horizontal Datum: ❑ NAD 1927 E NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 1A
A8. 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) N/A sq ft a) Square footage of attached garage N/A sq ft
b) No. of permanent flood openings in the crawlspace or b) No. of permanent flood openings in the attached garage
enclosure(s) within 1.0 foot above adjacent grade N/A within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b N/A sq in
d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes El No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number B2. County Name
CITY OF TYBEE ISLAND 135164 CHATHAM
B4. Map/Panel Number 85.5. Suffix Bti. FIRM Index B7. FIRM Panel
13051C 0213 F Date Effective /Revised Date
09/26/2008 09/26/2008
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
❑ FIS Profile E FIRM ❑ Community Determined ❑ Other (Describe)
B11. Indicate elevation datum used for BFE in item 89: ❑ NOW 1929 ® NAVD 1988 ❑ Other (Describe)
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)?
Designation Date 0 CBRS ❑ OPA
83. State
GEORGIA
88. Hood 89. Base Mood Elevation(s) (Zone
Zone(s) AO, use base flood depth)
AE 12.0'
❑ Yes E No
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based on: ❑ Construction Drawings" ❑ Building Under Construction' ® Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations -Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a -h
below according to the building diagram specified in Item A7. Use the same datum as the BFE.
Benchmark Utilized LOCAL BENCHMARK Vertical Datum 1988 NAVD
Conversion /Comments LOCAL BENCHMARK BASED ON 1988 NAVD DATUM
Check the measurement used.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 13.2 feet 0 meters (Puerto Rico only)
b) Top of the next higher floor 23.2 ❑ feet ❑ meters (Puerto Rico only)
c) Bottom of the lowest horizontal structural member (V Zones only) N /A.
0 feet 0 meters (Puerto Rico only)
d) Attached garage (top of slab) N/A. ❑ feet ❑ meters (Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building 12.8 ® feet 0 meters (Puerto Rico only)
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 12.5 ® feet
g) Highest adjacent (finished) ❑ meters (Puerto Rico only)
g ) ( d) grade next to building (HAG) 12.7 ®feet 0 meters (Puerto Rico only)
h) Lowest adjacent grade at lowest elevation of deck or stairs, including 12,6 E feet ❑ meters (Puerto Rico only)
structural support
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
information, /certify that the information on this Certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
® Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a
Certfier's Name MICHAEL JIM GARDNER
Title LAND SURVEYOR
licensed land surveyor? E Yes 0 No ✓
License Number GA. RLS # 2285
Company Name MICHAEL J. GARDNER, LAND SURVEYOR
Address 120 VARNEDOE AyEhliDE I City Gp.RDEN CITY State GA ZIP Code 31408
Signature l// / / J / Date 11/05/2009 Telephone 912- 661 -0479 CELL
FEMA Form 81 -31, Mar Q. / See reverse side for continuation.
Replaces all previous editions
IMPORTANT: In these spaces, copy the corresponding information from Section A.
Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No.
29 MEDDIN DRIVE
City TYBEE ISLAND State GA ZIP Code 31328
I For Insurance Company Use:
( Policy Number
( 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 L:2 (e) ELEVATION OF TOP OF AIR CONDITIONER PAD IS 12.8'. AIR CONDITIONER PAD AT RIGHT SIDE OF RESIDENCE.
NOTE: THIS PROPERTY AND RESIDENCE IS LOCATED IN ZONE AE WITH A BASE FLOOD ELEVATION OF 12.0'.
PROJECT NO. PGATTI, EC -11 -0
(01)
FB -A -09, GARDNER IMLER PG. 20.
Signature . f /f Date 11/05/2009
® Check here if attachments
SECTION E - BUILL(NGJLEVAI'IO I INFORMATION 7SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AO and A (without 13FE), complete Items E1 -E5. If the Certificate is intended to support a LOMA or LOMR -F request, complete Sections A, B,
and C. For Items El -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters.
El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade (HAG) and the lowest adjacent grade (LAG).
a) Top of bottom floor (including basement, crawlspace, or enclosure) is 0 feet ❑ meters ❑ above or ❑ below the HAG.
b) Top of bottom floor (including basement, crawlspace, or enclosure) is i ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. 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.
53. Attached garage (top of 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
The 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)
or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge.
Property Owner's or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
RI Check here if attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official 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 of this Elevation Certificate, Complete the applicable item(s) and sign below. Check the measurement used in Items 08 and G9.
G1. 0 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.)
G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA- issued or community - issued BFE) or Zone AO.
G3. ❑ The following information (Items G4 -G9) is provided for community floodplain management purposes.
G4. Permit Number G5. Date Permit Issued I G6. Date Certificate Of Compliance/Occupancy Issued
G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement
08. Elevation of as -built lowest floor (including basement) of the building: _ ❑ feet ❑ meters (PR) Datum
G9. BFE or (in Zone AO) depth of flooding at the building site: ❑feet ❑meters (PR) Datum
010. Community's design flood elevation ❑feet ❑ meters (PR) Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments
RI Check here if attachments
FEMA Form 81 -31, Mar 09 Replaces all previous editions