HomeMy Public PortalAbout11-0675 Kohn_1of2,
Permit No. Date Requested
Owner's Name Lb t■ Date Needed „-
Gen. Contractor 1)r-A Subcontractor
City of .ee Island • Community Develop ..tnt Dept.
Inspection Report
403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 31328
Phone 912.786.4573 ext. 114 • Fax 912.786.9539
Contact Information
I
Project Address - . r t .• .....-
• , ,
Scope of Work 1 , ) , ti La _.-
Inspector
Inspection
WM\
Milk*
EL•1=Zia
INTERNATIONAL
CODECOUNCt
MEMBER
Date of Inspection
Pass ID,Fail El Fee
\
Inspection Pass Fail Fee
Inspection Pass Fail Fee
Inspection Pass 0 Fail Fee
U.S. DEPARTMENT OF HOMELAND SECUR
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICA'.
Important: Read the instructions on pages 1 -9.
OMB No. 1660 -0008
Expires March 31, 2012
SECTION A - PROPERTY INFORMATION
Al. Building Owner's Name Jerry Bunton
For Insurance Company Use:
Policy Number
A2. Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No.
12 Teresa Lane
Company NAIC Number
City TYbee Island State GA ZIP Code 31328
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
lot 12, Northwave Subdivision
A4. Building Use (e.g., Residential, Non - Residential, Addition, Accessory, etc.) Residential
A5. Latitude /Longitude: Lat. N 32 deq 01.200 min Long. W 80 deq 51.680 min Horizontal Datum
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 6
A8. For a building with a crawlspace or enclosure(s):
Square footage of crawlspace or enclosure(s) 313
No. of permanent flood openings in the crawlspace or
enclosure(s) within 1.0 foot above adjacent grade 7
Total net area of flood openings in A8.b 1635
Engineered flood openings? ❑ Yes ® No
a)
b)
c)
d)
sq ft
sq in
❑ NAD 1927 ® NAD 1983
A9. For a building with an attached garage:
a) Square footage of attached garage n/a sq ft
b) No. of permanent flood openings in the attached garage
within 1.0 foot above adjacent grade n/a
c) Total net area of flood openings in A9.b n/a sq in
d) Engineered flood openings? ❑ Yes ® No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
Tybee Island 135164
B2. County Name
Chatham
B3. State
GA
B4. Map /Panel Number
13051CO213F
B5. Suffix
F
B6. FIRM Index
Date
9/26/08
B7. FIRM Panel
Effective /Revised Date
9/26/08
B8. Flood
Zone(s)
VE
B9. Base Flood Elevation(s) (Zone
AO, use base flood depth)
13
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
❑ 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)?
Designation Date ❑ CBRS ❑ OPA
❑ Yes ® No
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1
C2
Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction*
*A new Elevation Certificate will be required when construction of the building is complete.
Elevations - Zones A1-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO
below according to the building diagram specified in Item A7. Use the same datum as the BFE.
Benchmark Utilized localVertical Datum NAVD 1988
Conversion /Comments
Finished Construction
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 7.2
b) Top of the next higher floor 16.1
c) Bottom of the lowest horizontal structural member (V Zones only) 14.1
d) Attached garage (top of slab) n /a.
e) Lowest elevation of machinery or equipment servicing the building 15.0
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 6.3
g) Highest adjacent (finished) grade next to building (HAG) 6.7
h) Lowest adjacent grade at lowest elevation of deck or stairs, including n /a.
structural support
Check the measurement used.
® feet
® feet
® feet
® feet
Z feet
® feet
® feet
® feet
Complete Items C2.a -h
❑ 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
Certifier's Name J. Whitley Reynolds License Number 2249
Title Company Name J. Whitley Reynolds, Land Surveyor
Address 636 Stephenson Aven e, Suite - C avannah,
Signature
State GA ZIP Code 31405
Date 3/17/11 Telephone 912 - 352 -0464
FEMA Form 81 -31, M- 09 See reverse side for continuation.
Replaces all previous edition
IMPORTANT: In these spaces, copy th rresponding information from Section A.
Building Street Address (including Apt., Unit, Sui«, and /or Bldg. No.) or P.O. Route and Box No.
12 Teresa Lane
For Insurance Company Use:
Policy Number
City Tybee IslandState GA ZIP Code 31328
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 C2 e) = A/C pad-)
Signature
Date 3/17/11
❑ Check here if attachments
SECTION'S - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
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 Instructions), the next higher floor
(elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E3. 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
❑ Check here if attachmen
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 attachmer
FEMA Form 81 -31, Mar 09
Replaces all previous editio
--�— V -ZONE CERTIFICATE
c _
Building Address « t� ��'s �` ovo -1 Pre- construction
Owner's Name 0 H � r.,.ri-H A 14' 1 -1
Contractor's Name 3 tLSwtSo1.1 cA Z.52" C. Ad
As -built K
SECTION I: Flood Insurance Rate Map (FIRM) Information
Community Panel Date of Firm
Number Number L taZt Suffix F FIRM Index Zone VC
13-rl e f
SECTION II: Elevation Information
NOTE: This V -Zone Certificate does not substitute for an Elevation Certificate
1. Elevation of the Bottom of Lowest Horizontal Structural Member / 4. 1 feet (NGVD)
2. Base Flood Elevation (BFE) / 3 feet (NGVD)
3. Elevation of Lowest Adjacent Grade 6 . feet (NGVD)
4. Approximate Depth of Anticipated Scour /Erosion used for Foundation Design tJ (i4 feet (NGVD)
5. Embedment Depth of Pilings or Foundation Below Lowest Adjacent Grade N /4 feet (NGVD)
SECTION III: V -Zone Certification Statement
NOTE: This section must be certified by a registered engineer or architect
I certify that I have developed or reviewed the structural design, plans, and specifications for construction and that the design and
methods of construction to be used are in accordance with accepted standards of practice for meeting the following provisions:
• The bottom of the lowest horizontal structural member of the lowest floor (excluding piles and columns) is elevated to or above
the BFE; and,
• The pile and column foundation and structure attached thereto is anchored to resist flotation, collapse, and lateral movement due
to the effects of the wind and water loads acting simultaneously on all building components. Water loading values used are those
associated with the base flood. Wind loading values used are those required by the applicable State or local building code,
whichever is more restrictive. The potential for scour and erosion at the foundation has been anticipated for conditions associated
with the base flood, including wave action.
SECTION IV: Breakaway Wall Certification Statement
NOTE: This section must be certified by a registered engineer or architect when
breakaway walls exceed a design safe loading resistance of 20 pounds per square foot
I certify that I have developed or reviewed the structural design, plans, and specifications for construction and that the design and
methods of construction to be used for the breakaway walls are in accordance with accepted standards of practice for meeting the
following provisions:
• Breakaway wall collapse shall result from a water load less than that which would occur during the base flood; and,
• The elevated portion of the building and supporting foundation system shall not be subject to collapse, displacement, or other
structural damage due to the effects of wind and water loads acting simultaneously on all building components (wind and water
loading values to be used are defined in Section III).
SECTION V: Certification
Signature below certifies: X Section 1; X Section 11; ,{ Section III; A Section ,1":,.1s',:,.,,,,, �f; �M (`4 r
n t.J. ,.fir
Certifier's Name Kitytp ;a )(. So' uu Company Name a1+• Y.r A t t%i fi.c,� I i Int. ,'^ t� '
Title Pc 4e.1 License Number fi 211 4 1,
Street Address a \y Ca 1.0.001,34.1 AtIt, City, State, Zip 5 -loi.e.g•(o t ‘or 304a
Signature PDate a,• 11 - II, Telephone gtti ' `gi • 8431
o c k4 1399554
FILED RECORD
NONCONVERSION AGREEMENT' 01:S6prtl
FOR STRUCTURES IN THE FL tYi��J�A`1�_ .
`,/ 60;.r Y' y I'1r�-
\L9,w.'% '-iii 1 1._ Court i1 h tlw I.r9..-t;',
i - _ �Ct� if _t 1•.. 11.'..11 1
Building Permit Number 11 0 6 / -) Address of Prope y='.+h tl W'-rti e°'" ° Y 7 'J3 e k i,4 )
PIN — 0022 -O/ - 031
FIRM Zone urc
BFE 3 feet (NAVD)
Property Owner(s)—J O /Ctr,..)7-pti A 4-1,J
Panel Number C 0 3..1.3 F , effective date
Contractor
ri-oPsoA) BL06- DE -,g 1L -,�
In accordance with the Flood Damage Prevention Ordinance of the City of Tybee Island, Georgia, the Property Owner agrees to the
following:
1. That the enclosed area below the Base Flood Elevation shall be used solely for parking of vehicles, limited storage, or access to the
building, and will never be used for human habitation without first becoming fully compliant with the Flood Damage Prevention
Ordinance in effect at the time of conversion.
2. That all interior walls, ceilings, and floors below the Base Flood Elevation shall be unfinished or constructed of flood - resistant
materials.
3. That mechanical, electrical, or plumbing devices shall not be installed below the Base Flood Elevation.
4. That the walls of the enclosed area below the Base Flood Elevation shall be equipped with at least two vents which permit the
automatic entry and exit of floodwater with total openings of at least one square inch for every square foot of enclosed area below
flood level. The vents shall be on at least two different walls, and the bottoms of the vents shall be no more than one foot above
grade. If located in a V -zone, breakaway walls are required.
5. That the requested structure may be subject to increased premium rates for flood insurance available from the National Flood
Insurance P : _ due to its location in a Special Flood Hazard Area.
6. That an ation in ons ction beyond what is permitted shall constitute a violation and be abatable as such.
Si ature of Property Owner
oH�
Printe Name of Property Owner
gnature of Prop Owner I
Printed Name of Property Owner
STATE OF GEORGIA
COUNTY OF CHATHAM ( �
.�trt.WIi J
I hereby cer that on t}s c day�Qf , 20 ID„ , before me, a Notary Public of the State of Georgia,
personally appeared JQ !`0X ('( //✓1 Lt G( Ov
, known to me, or satisfactorily proven to be
the person whose name is subscribed to the foregding instrument, who acknowledged that he /she has executed it for the purposes
therein set forth, and that it is his act and deed.
In witness whereof, I have set my hand and Notarial Seal.
Date
,„0q//0
Date
NOTARY
My Commission expires on
WITNESS SIGNATURE M
Printed Name D lly
Address 1 CC) ) Yt VV
ANNA DAVIS
.NOTARY PUBLIC
Big! LOCH COUNTY
STATE OF GEORGIA
v_ Commission: Expires September 4. 2012
U 1•
(Seal)
Note: A Nonconversion Agreement must be used whenever an enclosed structure or portion of a structure is built or substantially improved within
the 100 year Floodplain below the Base Flood Elevation. A Nonconversion Agreement must satisfy all of the above conditions and requires proper
recordation in the land records of Chatham County, Georgia.
City of 1, -ee Island • Community Develop._ _. nt Dept. b `k
Inspection Report (.10,0r
403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 31328 �pe
Phone 912.786.4573 ext. 114 • Fax 912.786.9539 T
.wit
INTERNAP.ONP.L
CODECOUNa_
MEMBER
I _.--
Permit No. I - l.D (0 7 5 Date Requested 2- I - i 2
Owner's Name Id< -3 in r, Date Needed 2 -2 - 12
Gen. Contractor 'E Fan-5 o" Subcontractor
Contact Information "' 4 r r` k' 53(0-1(40D1
Project Address \ Z --1-1? r e a Lin
Scope of Work i h -)-aU bc'PGtk0 -Jo Lo Hs
Inspector / 1-') Date of In spection
Inspection pr JP C t , n (; I Pass--- Fail 0 Fee
W o ` iL. •L)
_ T)/ . vv
6s
Inspection Pass Fail Fee
V _'.
Inspection Pass ❑ Fail Fee
Inspection Pass ❑ Fail ❑ Fee
DATE ISSUED: 12 -16 -2011
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
BREAKAWAY WALLS
12 TERESA LN
JOHN /CYNTHIA KOHN
PO BOX 2561
TYBEE ISLAND GA 31328
BRINSON BUILDING & DESIGN
PO BOX 3029
STATESBORO GA 30459
P
$ 97.00
$6,500.00
PERMIT #: 110675
in G'D111/4/0 —S • o rl
A°3r- �►,..,z,.�-
V-20 ,r,.c,
TOTAL BALANCE DUE: $ 97.00
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. 0. Box 2749 - 403 Butler Avenue, Tybee Island, Georgia 31328
(912) 786 -4573 - FAX (912) 786 -9539
www.cityoftybee.org
CITY OF TYBEE ISLAND, GEORGIA
APPLICATION FOR BUILDING PERMIT
Vj
Location: 12 l fa_ r-- S O. Le„.
NAME
ADDRESS
PIN #
TELEPHONE
Owner --;OH
J-
� v1,i► -')
I I----C---- L±
17EeY 4
09410 I`iJi,
Architect
or Engineer
sir, Tu L c;�G
•?n ..n�2 ,q zct'rrzc
, Argds� c ao , G�
q
I'Z' �� i- z I .i
Building
Contractor
_
7-.9,,,z5 D 1'5
es-- floor-10,f -FLAT(
; ,1�sce.„:rte, 66 3cl /N
q1Z -S-5 C,-/ (o0j'
(Check all that apply)
❑ Repair
❑ Renovation
❑ Minor Addition
❑ Substantial Addition
❑ Other
❑ Residential
❑ Single Family
❑ Duplex
❑ Multi- Family
❑ Commercial
Details of Project: L I—L (7 J • k N e-- I
❑ Footprint Changes
❑ Discovery
❑ Demolition
Estimated Cost of Construction: $
ype
(1) Wood Frame
(2) Wood & Masonry
(3) Brick Veneer
Proposed use:
R- arks:
0 eN C3 hVac
-zo (1)--
(Enter appropriate number) S' Q-4i� r caul. ,
(4) Masonry (6) Other (please specify
(5) Steel & Masonry
ATTACH . • PY OF THE CERTIFIED ELEVATION SURVEY OF LOT
following informati . . sed on the construction drawings and site plan:
# Units = - drooms
Lot Area Living : • ce (total sq. ft.
# Off - street parking spaces
Trees located & listed on site plan
Access:
Driveway (ft.) With culvert?
Setbacks: Front Rear
nd complete the
# Bathrooms
With swale?
Sides (L) (R)
# Stories Height Vert.. distance measured from the average adjacent
grade of the building to the extreme • . point of the building, exclusive of chimneys, heating
units, ventilation ducts, air conditioning units, elevators, and similar appurtances.
During construction:
On -site restroom facilities will be provided through
On -site waste and debris containers will be provided by
/- Construction debris will be disposed by Co PLRc r _ by means of 11.Jc I LF f.—,
I understand that I must comply with zoning, flood damage control, building, fire, shore
protections and wetlands ordinances, FEMA regulations and all applicable codes and regulations.
I understand that the lot must be staked out and that the stakes will be inspected to ensure that the
setback requirements are met. I understand also that a certified plot plan showing elevation must
be attached to this application and that an as -built elevation certification is due as soon as the
habitable floor level is established. Drainage: I realize that I must ensure the adequacy of
drainage of this property so that surrounding property is in no way adversely affected. I accept
responsibility for any corrective action that may be necessary to restore dr. ' . ge i paired by this
permitted construction.
Date: (L i Z- 20 /1
Signature of Applicant
Note: A permit normally takes 7 to 10 days to process.
The following is to be completed by City personnel:
Zoning certification
Approved rezoning/variance?
Street address and number: New
Is it in compliance with City map?
If not, has street name and/or number been reported to MPC?
FEMA Certification attached
State Energy Code Affidavit attached
Utilities and Public Works:
Describe any unusual finding(s)
NFIP Flood Zone
Existing
Access to building site
Distance to water main tap site
Distance to sewer stub site
Water meter size
Storm drainage
Approvals: Signature Date
Zoning Administrator
Code Enforcement Officer
Water /Sewer
Storm/Drainage
Inspections
City Manager
FEES
Permit
Inspections
Water Tap
Sewer Stub
Aid to Const.
TOTAL
LEAD -BASED PAINT
Adapted from http: / /www.epa.aov/lead /pubs /renovation.htm. Please use that site to access the following information.
Information for Property Owners of Rental Housing, Child- Occupied Facilities
Property owners who renovate, repair, or prepare surfaces for painting in pre -1978 rental housing or space
rented by child -care facilities must, before beginning work, provide tenants with a copy of EPA's lead hazard
information pamphlet Renovate Right: Important Lead Hazard Information for Families, Child Care Providers,
and Schools. Owners of these rental properties must document compliance with this requirement. EPA's sample
pre- renovation disclosure form may be used for this purpose.
After April 22, 2010, property owners who perform these projects in pre -1978 rental housing or space rented
by child -care facilities must be certified and follow the lead -safe work practices required by EPA's Renovation,
Repair and Remodeling rule. To become certified, property owners must submit an application for firm
certification and fee payment to EPA. The Agency has up to 90 days after receiving a complete request for
certification to approve or disapprove the application.
Property owners who perform renovation, repairs, and painting jobs in rental property should also:
• Take training to learn how to perform lead -safe work practices. [ z_
• Learn the lead laws that apply regarding certification and lead -safe work practices beginning in April 2010.
• Keep records to demonstrate that you and your workers have been trained in lead -safe work practices and that you followed lead -
safe work practices on the job. To make recordkeeping easier, you may use the sample recordkeeping checklist that EPA has
developed to help contractors comply with the renovation recordkeeping requirements that took effect April 2010.
• Read about how to comply with EPA's rule in the EPA Small Entity Compliance Guide to Renovate Right.
• Read about how to use lead -safe work practices in EPA's Steps to Lead Safe Renovation, Repair and Painting.
Information for Homeowners Working at Home
If you are a homeowner performing renovation, repair, or painting work in your own home, EPA's RRP rule does not cover your project.
However, you have the ultimate responsibility for the safety of your family or children in your care. If you are living in a pre -1978 home
and planning to do painting or repairs, please read a copy of EPA's Renovate Right: Important Lead Hazard Information for Families, Child
Care Providers, and Schools lead hazard information pamphlet. You may also want to call the National Lead Information Center at 1 -800-
424 -LEAD (5323) and ask for more information on how to work safely in a home with lead -based paint.
Information for Tenants and Families of Children under Age 6 in Child Care Facilities and Schools
As a tenant or a parent or guardian of children in a child care facility or school, you should know your rights when a renovation job is
performed in your home, or in the child care facility or school that your child attends.
• Before starting a renovation in residential buildings built before 1978, the contractor or property owner is required to have tenants
sign a pre- renovation disclosure form, which indicates that the tenant received the Renovate Right lead hazard information
pamphlet.
• Beginning in December 2008, the contractor must also make renovation information available to the parents or guardians of
children under age six that attend child care facilities and schools, and to provide to owners and administrators of pre -1978 child
care facilities and schools to be renovated a copy of EPA's Renovate Right: Important Lead Hazard Information for Families, Child
Care Providers, and Schools lead hazard information pamphlet.
Information for Contractors
As a contractor, you play an important role in helping to prevent lead exposure. Ordinary renovation and maintenance activities can create
dust that contains lead. By following the lead -safe work practices, you can prevent lead hazards. 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. EPA's pre- renovation disclosure form may
be used for this purpose. Understand that after April 22, 2010, federal law will require you to be certified and to use lead -safe work
practices. To become certified, renovation contractors must submit an application and fee payment to EPA. See: Application for firm
certification. The Agency has up to 90 days after receiving a complete request for certification to approve or disapprove the application.
Contractors who perform renovation, repairs, and painting jobs should also:
Take training to learn how to perform lead -safe work practices.
• Find a training provider that has been accredited by EPA to provide training for renovators under EPA's Renovation, Repair,
and Painting (RRP) Program. Please note that if you previously completed an eligible renovation training course you may
take the 4 -hour refresher course instead of the 8 -hour initial course from an accredited training provider to become a
certified renovator. Click here for a list of eligible courses.
• Provide a copy of your EPA or state lead training certificate to your client.
• Tell your client what lead -safe methods you will use to perform the job.
• Learn the lead laws that apply to you regarding certification and lead -safe work practices beginning in April 2010.
• Ask your client to share the results of any previously conducted lead tests.
• Provide your client with references from at least three recent jobs involving homes built before 1978.
• Keep records to demonstrate that you and your workers have been trained in lead -safe work practices and that you followed lead -
safe work practices on the job. To make recordkeeping easier, you may use the sample recordkeepinq checklist that EPA has
develope• .help contractors comply with the renovation recordkeeping requirements.
• Read - •out ow to comply with EPA's rule in the EPA Small Entity Compliance Guide to Renovate Right.
• R alp.. how to se lead safe work practices in EPA's Steps to Lead Safe Renovation, Repair and Painting.
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Printed Name
-2v>i
Date
Permit Acknowledgement of
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.
Un ersigned
Printed Name
12 /IZ 1-2-0 rl
Date
Office Use Only:
Project Address:
Permit Number: