HomeMy Public PortalAboutSecond Av_5FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1- 7.
O.M.B. No. 3067 -0077
Expires December 31, 2005
SECTION A - PROPERTY OWNER INFORMATION
BUILDING OWNERS NAME
INDIA KING
BUILDING STREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
5 SECOND AVENUE
For Insurance Company Use:
Policy Number
Company NAIC Number
CITY STATE
TYBEE ISLAND, GA
PROPERTY DESCRIPTION (Lot and Biotic Numbers, Tax Parcel Number, Legal Description, etc.)
EAST HALF OF LOT 49, WARD NO. 1
ZIP CODE
31328
BUILDING USE (e.g., Residential, Non - residential, Addition, Accessory, etc. Use a Comments area, if necessary.)
RES
LATITUDE/LONGITUDE (OPTIONAL)
( ##° ##'- ##.##/' or ##.##f##°)
HORIZONTAL DATUM:
❑ NAD 1927 ❑ NAD 1983
SOURCE: ❑ GPS (Type):
❑ USGS Quad Map ❑ Other.
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP COMMUNITY NAIVE & COMMUNITY NUMBER
TYBEE ISLAND 135164
B2. COUNTY NAME
CHATHAM
83. STATE
GA
B4. MAP AND PANEL
NUMBER
135164 0001
65. SUFFIX
C
86. FIRM INDEX DATE
611786
67. FIRM PANEL
EFFECTNEtREVISED DATE
6/17/86
B8. FLOOD ZONE(S)
A8
B9. BASE FLOOD ELEVATION(S)
(Zone AO, use depth of ibodirg)
13
810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe):—
B11. tndcate the elevation datum used for the BFE in B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe):
B12. Is the building located in a Coastal Ranier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date
SECTION C • BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
01. 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. Building Diagram Number 1(Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram
accurately represents the building, provide a sketch or photograph.)
C3. Elevations - Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (mirth BFE), AR, ARIA, AR/AE, AR/A1-A30, AR/AH, AR/AO
Complete Items C3. -a-i below according to the building diagram specified in Item C2 State the datum used. If the datum is different from the datum used for the BFE in
Section B, convert the datum to that used for the BFE Show field measurements and datum conversion calculation. Use the space provided or the Comments area of
Section D or Section G, as appropriate, to document the datum conversion.
Datum NGVD 29 Conversion/Comments
Elevation reference mark used Does the elevation reference mark used appear on the FIRM? 0 Yes ® No
o a) Top of bottom floor (including basement or enclosure) 9. 4 ft.(m) 1
o b) Top of next higher floor NA . ft.(m) -0
o c) Bottom of lowest horizontal structural member (V zones only) NA . ft.(m) o 0
o d) Attached garage (top of slab) NA. __ft(m) w
o e) Lowest elevation of machinery andlor equipment
servicing the building (Describe in a Comments area) 9.5 ft.(m) R
o fj Lowest adjacent (finished) grade (LAG) 7.7 ft.(m) z' N
o g) Highest adjacent (finished) grade (HAG) 8. 0 ft.(m)
o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 0
o i) Total area of all permanent openings (flood vents) in C3.h sq. in. (sq. cm)
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.
1 certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available.
1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIERS NAME J. Whitley Reynolds LICENSE NUMBER 2249
TITLE Land Surveyor
ADDRESS
636 STEPH
SIGNAT
COMPANY NAME
CITY STATE ZIP CODE
SAVANNAH GA 31405
DATE TFI FPHONE
11/1/04 912 - 352-0464
MA Fo 8 ,131, Janua •03 See reverse side for continuation. Replaces all previous editions