HomeMy Public PortalAboutSecond Av_607U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1 -8.
OMB No. 1660 -0008
Expires February 28. 2009
SECTION A - PROPERTY INFORMATION
For Insurance Company Use:
Al. Building Owner's Name The Cottage Company
Policy Number
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
607 Second Avenue
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 55-A, ward no. 2
A4. Building Use (e.g., Residential, Non - Residential, Addition, Accessory, etc.)
A5. Latitude/Longitude: Lat. N 32 deg 0.380 min Long. W 80 deg 50.730 min
A6. Attach at least 2 photographs of the budding if the Certificate is being used
A7. Building Diagram Number 1
A8. For a building with a crawl space or enclosure(s), provide
a) Square footage of crawl space or enclosure(s) n/a sq ft
b) No. of permanent flood openings in the crawl space or
enclosure(s) walls within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b
Residential
to obtain flood insurance.
sq in
Horizontal Datum: ❑ NAD 1927 ® NAD 1983
A9. For a building with an attached garage, provide:
a) Square footage of attached garage 812 sq ft
b) No. of permanent flood openings in the attached garage
walls within 1.0 foot above adjacent grade G
c) Total net area of flood openings in A9.b
sq in
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFIP Community Name & Community Number
Tybee Island 135164
B2. County Name
Chatham
B3. State
GA
B4. Map/Panel Number
135164 0001
B5. Suffix
C
B6. FIRM Index
Date
6/17/86
B7. FIRM Panel
Effective/Revised Date
6/17/86
B8. Flood
Zone(s)
A8
B9. Base Flood Elevation(s) (Zone
AO, use base flood depth)
12
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)? ❑Yes CA No
Designation Date ❑ CBRS ❑ OPA
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 A1-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR /A1 -A30, AR/AH, AR/A0. Complete Items C2.a -g
below according to the building diagram specified in Item A7.
Benchmark Utilized local Vertical Datum ngvd 1929
Conversion/Comments
a) Top of bottom floor (including basement, crawl space, or enclosure floor)_
b) Top of the next higher floor
c) Bottom of the lowest horizontal structural member (V Zones only)
d) Attached garage (top of slab)
e) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment in Comments)
f) Lowest adjacent (finished) grade (LAG)
g) Highest adjacent (finished) grade (HAG)
Check the measurement used.
12.4 EI feet
21.$ ® feet
N�. IN feet
11.2 ® feet
15.2 ® feet
❑ meters (Puerto Rico only)
❑ meters (Puerto Rico only)
❑ meters (Puerto Rico only)
❑ meters (Puerto Rico only)
❑ meters (Puerto Rico only)
1 • ® feet ❑ meters (Puerto Rico only)
11.7 ® feet ❑ metals (Puerto Rico only)
SECTION D - SURVEYOR, BIO11EER, OR ARCHITECT CERTIFICATION
This osielcation is to be signed and sealed by a land surveyor, engineer, or architect authorized by Ism to cufify elevation
information. /caddy VW the information on this CertiTcate repellents My bust efforts to interpret the data amiable.
I understand that any fake 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.
Carrier's Name J. Whey Reynolds License Number 2249
Tile Land Surveyor
Company Name J. Whey Reynolds, Land Surveying
Suite C City Savannah, Stale GA ZIP Code 31405
Date 10107 Telephone 912-352-0464
IMPORTANT: In these spaces, copy the corresponding infonnation 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.
607 Second Avenue -
Policy Number
City Tybee Island 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 C3.e) = a/c pad
S', ature Date 4/10/07
❑ Check here if attachments
CTIO E - 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.
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, crawl space, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
b) Top of bottom floor (including basement, crawl space, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Building Diagrams 6 -8 with permanent flood openings provided in Section A Items 8 and /or 9 (see page 8 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.
El.
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, 8, 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 kem(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. Permi Number
G5. Dale Penni Issued
66. Deb Certificate Of ComplancelOccupsncy Issued
G7. This permit has been issued for. ❑ New Construction ❑ Subslniial Impaiwa i1
Gti. Elevation of as-buttt lowest floor (including basement) of the building: _0 Net ❑ mellows (PR) Datum
G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters (PR) Datum
Local Oftriciats Name
Carrnrrarly Name
Signature
Camino*
Tie
Telephone
Date
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.
607 Second Avenue
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 April 11, 2007
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.
607 Second Avenue
City Tybee Island, State GA ZIP Code 31328
Policy Number
Company NAIC Number
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 Vied' and "Left Side View."
Back View A ' 'I 11, 2007