Loading...
HomeMy Public PortalAboutTenth St_405U.S. DEPARTMENT of HOMELAND SECURITY ELEVATION CERTIFICATE Federal Emergency Management Agency National Flood Insurance Program Important Read the instructions on pages 1-8. OMB No. 1660 -0008 Exoires February 28. 2009 I SECTION A PROPERTY INFORMATION Al. Owner's Name ►vi: S1 F-1,17-0 ��NST2.sc,a`s oc-a A2- Address (indurir►9 UU17. Suite, and/or Bldg No.) or P.O. Route and Box No y 05 S t r.") �rr�'►► _ `rye, r: For insurance Company Use: Poicy Number Company NAIC Number c4r/ State G RD a G I ea ZIP Code 3 1 3 Z a A3. Property (lot and 8lockAimb , Tax Parcel Number. Legal etc.) (.. o a".2. t<E cSDM lil N c.-Ti o ra e,r os d 10(.. wrft-o.o 3 A4. A5. Lau longitude: tat. N 32° QD . O°12 Long_ A6. Attach at least 2 photo of the bullring if the Certificate a being used to A7. Building Diagram Number (o A8. For a bolding with a crawl space or endosure(s), provide: a) Siloam footage of crawl space or endasure(s) 131 ° sq ft b) No. of permanent flood openings n the crawl space or endosure(s) walls wain 1.0 foot above aejac ent grade I c) Total net area of flood openings n AB.b / sq n Building Use (e .g., Residential, Non-R dential, Addition, Accessory_ - c.I f S1"*� Pt" Horizontal Datum: p NAD 1927 NA1 963 obtain flood insurance_ A9. For a b►�ng with an attached garage, provide: a) Square footage of attached garage © sq It b) No_ of pemane t flood openings n the attacher>,garage walls within 1.0 foot above adjacent grade ..'1 c) Total net area of flood openings in A9 -b 0 sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community i'rQ *cTs�+ Number 64- State 1 P B4. Map Panel Number ' 13s 114 -CIAO► 65. Suffix 66, FIRM Index Date _4 - I.1 -dr 67_ FIRM Panel seised Date (- 1-t -1°� B& Flood s) 69. Base Flood Elevation(s) (Zone AO, use base good depth) VI,.. a B10. Indicate the source of the Flood Elevation (BFE) data or base food depth entered in Item B9. [] AS Profile FIRM ❑ Common y Dined ❑ Other (Describe) BI 1. IndIcafe elevation datum used for BFE in item B9: NGVD 1929 ❑ NAVD 1988 Daher (Desarbe) B12. Ism in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? CBRS 0 OPA Yes ['Til) SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Budding elevations are based on 0 Construction Drawings* ❑ Burling Under Construction• [ 'xiis ,ed Constrodon *A new Elevation Cerilicate wit be required rahen construction of the budding is complete. C2. Elevations -Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (wi h BFE), AR, ARIA, AR/AE, AR/A1 -A30, AR/AH, AR/AO. Complete Items C2.a -g below according to the building diagram specified in Item A7- Bendemark Maimed L o Gar 1- a) b) c) d) e) 9 g) NIP* Vertical Datum NC V p 19 29 Top of bottom floor (including basement, crawl space, or enclosure floor) Top of the next higher floor Bottom of the lowest horizontal structural member (V Zones only) Attached garage (top of slab) Lowest elevation of machinery or equipment servicing the butch g (Describe type of equipment in Comments) Lowest adjacent finished) grade (LAG) 1- fightst adjacent (finished) grade (HAG) Check the measurement used. �t "tent ambers (Puerto Rico only) � - Lrr'ieet El meters (Puerto Rico only) 1'7 u feet ❑ meters ers (Puerto Rice only) i n feet ❑ meters (Puerto Rico olty) 9 [feet ❑ meters (Puerto Rico only) - D meters (Puerto Rica 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 archtieci authorized by law to certify elevation information. 1 certify that the information on this Certric to represents my best elrirts to interpretD+e data avertable. I understand that any false statement may be punishable by fie ear imprisonment under 18 U.S_ Code, Section 1001. L(d'Chedc here if comments are provided on bads of form. s ame L 1 W C e)YY Title / -a S 13 Rv EY9tL nY Name License Number 1 $$2. c.) Address , Signature ,_ C - c S Av gal /4 04 A114 See (� Ina- ZIP Code3 t 449 Date 4 - 2.9" �`gT C � 9 25 -'352.3 FEMA Form 81 -31, February 2006 See reverse side for continuation_ -29." a8;-,'z. eis' Replaces all previous edtior IMPORTANT: In these spaces, copy the correspon[ling information from Section A. For Insurance Company Use: Sheet Address (inciudrq (Ind. Sole. and/or Bldg_ No.) or P.O. Route and Box No. - ieeiRG t -Pc 3 L 3 stale ZJP Code Policy Number Company HALO Humber SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION ( ) Copy both sides of this Eleven Cergicate for (1) cormntniy official. (2) insurance piny. and (3) bedding cranes_ Comments 1 = Hr 12 G9c-a4 > ; 7 •a �• ,.r • C" P 1,1'!x' f=a 2 ty■ gilakut L Data 4� �i 0(8 2 t here if attachments SECTION E - BUILDING ELEVATION INFORMATION NOT REQ( ED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without Btu. complete Items E1-S. hire Certificate is intended to support a LOMA or LOMFi -F request, complete Sedans A. B, and C. For hems E1-E4, me natural grade. davaiable. Cheat the measurement used. in Puerto Rem orgy enter Nelms. E1- Provide elevaion in%mmion for the following and check the appropriate bites to star whe8rerthe elevation is mauve or below 1w highest adjacent grade (HAG) and the lowest adjacent grade (LAG). ❑ feet 0 ❑ above or a) Top of bottom goer (inducing basement. crawl spas = is ❑ below the HAG. b) Top atbottom floor (ndoding basement. amid - '!!« ! . - - ❑ feet ❑ teeters ❑ above or ❑ below the LAG. E2. For Leg Diagrams 6-8 with permanent food , _ * t hems 8 and/or 9 (see 8 of Instructions), the need higher floor (elevation C2.b In the (Migrants) of the bhtdirg is r feet III{ meters ❑ above or xbelow the HAG. E3. Attached garage (lop assail') is - ❑ 0 ❑ above or ❑ below the HAG. E4. Top of pbaff,n n of machinery amd/orequipevatsevidrg the bhrihig is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Zone AO only. It no flood depth mahber is amiable. is the fop tithe bottom four elevated in aocardanoe mitt the contounly's foodpiaih management ordnance? 0 Yes ❑ No ❑ Unknown. The local oticiai in eerily this i fownhabon in Secion G. SECTION F - PROPERTY OWNER OR OWNER'S ENTAT1VE) CERTIFICATION The properly owner or owners authorized representative who completes Sections A. B. and E for Zone A (without a meted or communilrissued BFE) or Zone AO must sign here. The statements inSecfansA, Q and E are coned bshebestofray'Itnowledge. Property Owner's or Ohrnees Authorized Represestagves Nanhe Address Signature Comments State ZIP Code Telephone ❑ Chedc shoe d attadrnen SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by lair or on: inane to admiri�ierihe eormorrty's floodpiain management ordinance can complete Sections A, 8. C (or E), and G of this 8evabon Certificate. Campietelhe applicable item(s) and sign below_ Check the measurement used in gems G8. and G9. Gi. ❑ The information in Section C was taken mash otter documentation that has been signed and sealed by a /cased surveyor engineer. or aa3>iect who is authorized by lass io redly elevation infant aioa (Indcaie Os source and date of flee amnion data Mite Corrorheeds area beimr.) G2 ❑ A cornoanly afida- I camplaled Section E fora bang located in Zone A (wit hoot a or WE) or Zone AO. G3. ❑ The following inlomhabon (gems G4.-G9.) is provided for community floodpLait management purposes. IG4. Perin Number I G5. Date Permit Issued 436. Date Ceriicaie Of CompliancefOccupancy Issued G7_ bits pewit has been issued kr ❑ New Canstu>c0on ❑ Sllbsease i koprovertent G8. Elevation of ass -bait lowest Poor (inducing afire bwui i g: - ❑ feet ❑ melees (PR) Omen G9_ BFE orlon Zone AO) depth of footing ante bolding dim , ❑ feet ❑ airless (PR) Daher [.oral Officials iNarne Commonly Name Signature i The Telephone Dale comments ❑ Check here if attachrnei nn.•ss.:azic .,.onei,,..c. sa.r ., 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. 403 10th STREET 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 3 -28 -08 REAR VIEW 3 -28 -08