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HomeMy Public PortalAboutVan Horn_18U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important Read the instructions on pages 1 -9. OMB No. 1660 -0008 Expires March 31, 2012 SECTION A - PROPERTY INFORMATION For Insurance Company Use: Al. Building Owner's Name Sa tz CC.� -r-r ©u t= C_ A2. Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. / g Vans 140 2/� L � Jr T'Iz rc T✓ City -�� State ZIP Code / / ?'13E ! 3 L.d►sv O o E. C72 fal e:s. A3. Property Description (}ot and Block Numbers, Tax Parcel Number, Legal Description, etc.) I c,-r /3 Y,ct..t totz E PLAc� Policy Number Company NAIC Number 3132 8 A4. Building Use (e.g., Residential, Non - Residential, Addition, Accessory, etc.) A5. Latitude/Longitude: Lath 324 045 X54 5 `Long V/ SC � 'o r A6. Attach at least 2 photographs of the building if the Certificate is being used A7. Building Diagram Number (j A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) / ✓`' 4® sq ft b) No. of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b / -'T 7 7 sq in d) Engineered flood openings? ❑ Yes is No .IS.L :+ 1 o. r+l- r,.atr. i Horizontal Datum: to obtain flood insurance . ❑ NAD 1927 it NAD 1983 A9. For a building with an attached garage: a) Square footage of attached garage sq ft b) No. of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 1 d c) Total net area of flood openings in A9.b ^ A. sq in d) Engineered flood openings? ❑ Yes _• No ' • SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP CommM Comm Name & Community Number C t 1Y 6C i Y 3E>3, t SLL.i D( 351 Ca 4 B2. County Name C J;- tnTilAM B3. State Co'Gr2C.0 /..9. B4. Map /Panel Number 13051C-0213 B5. Suffix F B6. FIRM Index Date O9- zc -OS B7. FIRM Panel Effective /Revised Date a4- Z , -og B8. Flood Zone(s) As.. el B9. Base Flood Elevation(s) (Zone AO, use base flood depth) ( l B10. indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 89. ❑ FIS Profile FIRM ❑ Community Determined ❑ Other (Describe) B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 NAVD 1988 ❑ Other (Describe) B12. is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes Designation Date ❑ CBRS ❑ OPA ig No SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* 52 Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations - Zones A1A30, 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 DISK BV025'H Vertical Datum /JC■Vb f If 'act Conversion /Comments O, 94/ gROat 4 oV o ,qzq a) b) c) d) e) f) 0) h) YALvE -t'O coarv-r -Tb /I4Vo f9g.,S Check the measurement used. Top of bottom floor (including basement, crawlspace, or enclosure floor) ) a .1- im feet g feet ❑ feet ❑ feet ® feet Top of the next higher floor Bottom of the lowest horizontal structural member (V Zones only) Attached garage (top of slab) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) Lowest adjacent (finished) grade next to building (LAG) Highest adjacent (finished) grade next to building (HAG) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support feet feet tia feet ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) 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./ 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 licensed land surveyor? Yes ❑ No Certifiers Name JAMES M. KEATON, RLS License Number GEORGIA #2743 Title LAND SURVEYOR Company Name CHATHAM SURVEYING SERVICES, INC. Address P. 0. BOX 61649 City SAVANNAH State GA ZIP Code 31420 Signature Date Telephone 912 - 303 -0302 /07'64445.A. t5 f tot i 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. City_. State , Code h-'63 66 sr�.�.�r� �� oszC,ps a . 3 I ? 2- SECTION For Insurance Company Use: Policy Number Company NAIC Number 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 1,T c Zc_ , 5 PAVE A PA.A.I< t of co STDi CDE tJ+ & O iz 714 E. /-(44 r 7:431- £ 'LOCIZ . [ N = I5. Cd,p5,ED `aTA.rIa W 4G. W ITi{ --77 5QLa..2..sr F<<s -1 CIS' £/1CCOS E, G26 1`7 714 4..Le-3t -ra.ea L.E s=c-0c2 . EA.% C-Z. . ss SKr, eiosz ,t-tv c- Ealt.r/ ►e rr O'er 4 wet, t7is ws Pc.a,TFon. Nt , I' ?EM C2k 15 6,R4-1,1 ar -rs{f_ t. SCT sloe. SAY0— Signet e Date ---4 % lZtS P-redw ,3 I Zoe ON E - B 1LDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) ❑ Check here if attachments For Zones AO and A (without BFE), 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 E1 -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 . ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ 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 Instruction e next hig floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or 0 below the HAG. E3, Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. ,A_( L�-- E4. Top of platform of machinery and /or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ be 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 ❑ 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 G8 and G9. G1. ❑ 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 G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. 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 G10. Community's design flood elevation ❑ feet ❑ meters (PR) Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑ Check here if attachments Building Photographs See Instructions for Item A6. For Insurance Company Use: Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 1S V4n1 � OFD -�•1 � �2Ea�"i Policy Number City—, State %% ZIP Code //� J r�ae 6'�JL.�./�117 LS��O /2� /.G` .3 %32 Company NAJC Number If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to the instructions for Item A6. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View: If submitting more photographs than will fit on this page, use the Continuation Page, following. pt -tern) es —1.76.1e::"..,( 71/077eM6. /S, Zb� / I -"20ns T IX E K.) se .5"ft2g Building Photographs Continuation Page For Insurance Company Use: Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. S Veld■-r 110.eXi E �'T7 r:t Policy Number Company NAIC Number City. State ZIP Code /-' S 154-6.01/4tc, CZV,e Go /,a 3/32 8 If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." /\ z. .2 V;'t .) RICPfT Vt