The URL can be used to link to this page

Home My Public Portal AboutCenter PL_3U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE important Read the instructions on pages 1 -9. SECTION A - PROPERTY INFORMATION Al. Building Owner's Name ...J Pr IN% � F F3 N *�► ! IS C U i"1 A2. Building Street Address (including Apt.. Unit, Suite. andtor Bidg. No) or P.O. Route and Box No. 3 GEry rT 1 - OMB No_ 1660 -0008 Expires Mach 31, 2012 :Fririnsurarnce,Compa4y`U : "T''a te S5 L--A n} a state G g 0 ea I a A3. Property scripton (Lot and Block Numbers. Tax Parcel Number, Legal Description etc.) hs� 1 e t= R (�FfSv fa �+ u r S i +r o1 2....71-s 3 5 '� # Co NN Z- ZIP Code A5 Lafibrde/t_ongitude A A6. Attach at least 2 photographs of the building lithe Certificate is being used to A7. Building Diagram Number 4 A8. For a building with a crawispace or enclosure(s): a) Square footage of csawlspace or enclosure(s) . (o sq ft b) No. of permanent flood openings in the crawtspace or Q enclosure(s) within 1.0 foot above adjacent grade c) Total net area of flood openings in AS.b _ �_ sq In d) Engineered food openings? 0 Yes 3)328 A4. Building Use (e.g.. Residential. Non - Residential. Addition. Accessory eta / Dt • t ►. Lat. aL N 3 Z ° 0 0. 3 9 3 Long. W v . S 3) ' Horizontal Datum: ❑ NAD 1927 obtain flood Insurance. I 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 attach arage within 1.0 foot above adjacent grade E'J c) Total net area of flood openings in A9.b ---Er- sq in d) Engineered flood openings? ❑ Yes [o SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 131. NFiP %y Community Name & Community Number B2. County Name & E. 3 Sl (. 1 I t-)41-5-1-AVM. B3. State G£6R6 /Pt B4. Map/Panel Number 13eS'1 CooZ3+ B5. Suffix B6. FIRM Index - �- e B7. FIRM Panel Effective/Revised Date 9 -2G -os 98. Flood Zone(s) v147 B9. Base Flood Elevation(s) (Zone AO. use base flood depth) o B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in item B9. 0 FIS Profile I FIRM Community Determined ❑her (Describe) B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 VD 1988 ❑ Other (Describe) 912. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Designation Date 0 CBRS 0 OPA El Yes [r•'tdo SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ construction Drawings' ❑ Building Under Construction' [Tin fished Constrictor 'A new Elevation Certificate will be required when construction of the building is complete. C2. 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. Complete Items C2a-h below according to the building diagram spectfied,in item A7. Use the same datum as the BFE. 1 B Q Benchmark Utilized 4 m G P - j Vertical Datum C� Conversion/Comments N IN a) b) c) d) e) 1) 9) h) Top of bottom floor (including basement, creelspace, or enclosure floor) Top of the next higher floor Bottom of the lowest horizontal structural member (V Zones only) Attached garage (top of stab) Lowest elevation of machinery or equfpmeM servidng the building (Describe type of equipment and location in Lowest adjacent (finished) grade next to (LAG) Highest adjacent (finished) grade next to building (HAG) Lowest adjacent grade at lowest elevation of deck or stairs. including structural support Check the measurement used. I 3 ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) n feet ❑ meters (Puerto Rico only) £J ❑ meters (Puerto Rico only) / O ._ v et ❑ meters (Puerto Rico only) j I .- Z EI meters (Puerto Rico only) 0 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. I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001. [3 Check here if comments are provided on bads of form. • • Were latitude and longitude in n A Rrovided by a licensed land surveyor? MIYes L._J No C'elifier's Name ) M "t Company Name `. Y 1-44 c e-,4 T 14 G. M ot* atty s A V h r`n r3 Art H State ZIP ZIP Code 3 1405 • Date Telep are i S Z 3 l Ii 9ZS- -3 See reverse side for continuation. Replaces all previous editions &nia Suevc-, adjass9 Signature 13ureThr4 FEMA Form 81 -31. Mar 09 License Number 18 82. IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (inclurrlig Apt.. Unit. Suite, and/or Bldg. No.) or P.O. Route and Box No. 3 G 5IYZ. t-A-c. City State ZIP ESL- A-r.►O �ab2Gi" a(3" SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) For Insurance Company Use: Policy Number TY 3 Company NAIC Number Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenticampany, and (3) bolding owner. Comments C. 2.Ce) r= A- rt. Cerr+Oilltrr, u—N&— Signature Date 1 0 - S . _ 1 l Check here If attachments SECTION E - BUILDING ELEVATION INFORMATION (S - VEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items El -E5. lithe 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 approp ate boxesto show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (kxluding basement. ccawtsp or ) is /� . _ Oteet Dmeters Dabove or Dbelow the HAG. b) Top of bottom floor (including basement, crawispa • s ) is Dfeet Dmeters Dabove or Dbelow the LAG. E2. For Building Diagrams 6-9 with permanent flood .. in - - Items S and/or 9 (see es 8-9 of instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ■ feet ■ meters 0 above or LI below the HAG. Attached garage (top of slab) is • feet D meters D above or D below the HAG. E3. E4. Top of platform of machinery and /or equipment servicing the building is D feet 0 meters 0 above or 0 below the HAG. ES. Zone AO only If no flood depth number is avaRaNe, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? 0 Yes 0 No D 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 know ledge. Property Owner's or Owner's Authorized Representative's Name Address Signature Comments State ZIP Code Telephone 0 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 items) and sign below. Check the measurement used in Items G8 and G9. G1. D The information in Section C was taken from other doramentaiion that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (indkcate the source and date of the elevation data in the Comments area below.) G2. 0 A community official completed Section E for a building located in Zone A (without a FEMA-issued or cold BFE) or Zone AO. G3. 0 The following information (items G4-G9) is provided for community floodplain management purposes. 04. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy issued 07. This permit has been issued for. 0 New Construction 0 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the bolding 0 feet 0 meters (PR) Datum 69. BFE or (in Zone AO) depth of flooding at the bislang site ( D feet 0 meters (PR) Datum G10. Community's design flood elevation 1 ❑ 0 meters (PR) Datum Title Telephone Date Local Official's Name Community Name Signature Comments 0 Check here if attachments FEMA Form 81 -31, Mar 09 Replaces all previous editions 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. 3 CENER PLACE Policy Number City TYBEE ISLAND State GA ZIP Code 31328 Company NAIC 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. FRONT VIEW 10 -5 -11 REAR VIEW 10 -5 -11