HomeMy Public PortalAboutSixth Av_1201U.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
Terry O. Carroll
A2. Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No.
1201 6`h Avenue (Tybee Island)
Policy Number
Company NAIC Number
City State ZIP Code
Savannah Georgia 31328
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Lot 347, Ward 4, Tybee Island, 5th G.M. District, - P.I.N. 4- 0011 -01 -015
A4. Building Use (e.g., Residential, Non - Residential, Addition, Accessory, etc.) Residential
A5. Latitude /Longitude: Lat. 31.9993 °N Long. 080.8515 °W 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):
a) Square footage of crawlspace or enclosure(s) 600 sq ft
b) No. of permanent flood openings in the crawlspace or
enclosure(s) within 1.0 foot above adjacent grade 6
c) Total net area of flood openings in A8.b 660 sq in
d) Engineered flood openings? ❑ Yes ® No
❑ 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
City of Tybee Island 135164
B2. County Name
Chatham
B3. State
Georgia
84. Map /Panel Number
13051'C' - 0326
B5. Suffix
'F'
B6. FIRM Index
Date
9/26/08
B7. FIRM Panel
Effective /Revised Date
9/26/08
B8. Flood
Zone(s)
'AE'
B9. Base Flood Elevation(s) (Zone
AO, use base flood depth)
11.0'
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) GIS Mapping for Reference Only
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 0 N
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. 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 Site Vertical Datum 1988
Conversion /Comments N/A
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 8.0
b) Top of the next higher floor 18.0
c) Bottom of the lowest horizontal structural member (V Zones only) N /A.
d) Attached garage (top of slab) N /A.
e) Lowest elevation of machinery or equipment servicing the building 13.0
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 7.8
g) Highest adjacent (finished) grade next to building (HAG) 7.9
h) Lowest adjacent grade at lowest elevation of deck or stairs, including 7.8
structural support
Check the measurement used.
® feet ❑ meters (Puerto Rico only)
0 feet ❑ meters (Puerto Rico only)
® feet ❑ meters (Puerto Rico only)
� feet ❑ meters (Puerto Rico only)
0 feet ❑ meters (Puerto Rico only)
® feet
® feet
® feet
❑ 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.
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
licensed land surveyor? ® Yes ❑ No
Certifier's Name License Number
Carl R. Jackson
Ga.2555
Title Company Name
Ga. Registered Land Surveyor Carl R. Jackson Land Surveyor, Inc.
Address City State
411 Pine Street Bloomingdale Ga
Signatures. Date Telephone
12/21/12 988 -3355 or 596 -2189
ZIP Code
31302
N‘NORG/q��"1,
IMPORTANT: In these spaces, copy the corresponding information from Section A.
For Insurance Company Use:
Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No.
1201 6'" Avenue (Tybee Island)
Policy Number
City
Savannah
State
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 Single -Story Elevated Frame Residence. Parking Slab Elevation = 7.9' M.S.L.
Service Machinery = Elevated A/C Deck.
Enclosed Storage Area = 436 Sq.Ft. at Elevation 8.0' M.S.L. Enclosed Entrance Area = 164 Sq. Ft. at Elevation 8.2' M.S.L
Entrance Area has 2 vents at 220 Sq. In. of Flow Area, Storage Area has 4 vents at 440 Sq. In. of Flow Area.
Due to FEMA having not issued y4-vised Edition of this certificate this document did not expire on March 31,2012.
Signature — A Date
12/21/12 ® Check here if attachments
SECTION E - BUILDING' ION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AO and A (without B , 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 attachment!
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 attachment:
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.
1201 6th Avenue (Tybee Island)
Policy Number
City State ZIP Code
Savannah Ga 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 on the
reverse.
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