HomeMy Public PortalAboutSecond Av_1103Apr 2314 01:16p
Sherry Holtzclaw
U.S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
National Flood insurance Program Important: Read the instructions on pages 1 -9.
ELEVATION CERTIFICATE
9128973889
p.1
OMB No. 1660 -0008
Expiration Date: July 31, 2015
SECTION A- PROPERTY INFORMATION
A1_ Building Owner's Name Sherry Holtzclaw
FOR INSURANCE COMPANY USE
Policy Number,
A2. Building Street Address (including Apt., Unit, Suite, andior Bldg. No.) or P.O. Route and Box No.
1103 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 66 -A, ward 3
A4. Building Use (e.g., Residential, Non - Residential, Addition, Accessory, etc.) Residential
A5. LatiiudelLongiude: Lat. N 31 deq 59.994 min Long. W 80 deq 50.867 min Horizontal Datum; ❑ NAD 1927 ® NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 1
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) n/a sq ft
b) Number of permanent flood openings in the crawlspace
or enclosure(s) within 1.0 foot above adjacent grade n/a
c) Total net area of flood openings in A8.b n/a sq in
d) Engineered flood openings? ❑ Yes ® No
A9. For a building with an attached garage:
a) Square footage of attached garage n/a sq ft
b) Number 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 _4 No
SECTION 8 - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFIP Community Name & Community Number
Tybee Island 135164
62. County Name
Chatham
83_ State
GA
54. Map/Panel Number
13051C0326
B5. Suffix
F
B6. FtRM Index Date
9126/08
B7. FtRM Panel
Effective /Revised Date
9/26/05
B8. Flood
Zone(s)
AE
B9. Base Flood Elevation(s) (Zone
AO, use base flood depth)
11
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 89.
❑ FRS Profile ED FIRM ❑ Community Determined ❑ Cther /Source:
811. Indicate elevation datum used for BFE in Item E39' ❑ NGVO 1929
® NAVD 1988 0 Other /Source:
812, 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. Building elevations are based on: 0 Construction Drawings" ❑ Building Under Construction' EI Finished Construction
"A new Elevation Certificate will be required when construction of the building is complete.
02. Elevations -Zones A1-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, ARiAE, AR1A1 -A30, ARIAH, AR/AO. Complete Items C2.a -h
below according to the building diagram specified in Item A7. in Puerto Rico only, enter meters.
Benchmark Utilized: local Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 ❑ NAVD 1988 ❑ Other /Source: NAVD 1988
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 7.1 ® feet ❑ meters
b) Top of the next higher floor 16.5 ® feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) n /a. ® feet ❑ meters
d) Attached garage (top of slab) n /a. 10 feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 7.2 rE feet 0 meters
. (Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 6.8 ® feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 7.2 ta feet ❑ meters
It) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 6.8 ® feet ❑ meters
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. 1 certify that the information on this Certificate represents my best efforts to interpret the data available.
1 understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1 00 1.
0 Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a
licensed land surveyor? 10 Yes ❑ No
❑ Check here if attachments.
Certieer's Name J. Whitley Reynolds
License Number 2249
Title Land Surveyor
Company Name
Address 636 Stephenson.- j ue
Signatures
FEMA, cm 086 -0-33 (7/12)
City Savannah State GA ZIP Code 31405
Date 3127114 Telephone 912- 352 -0464
See reverse side for continuation.
ReolarAs all nravinne
Apr 23 14 01:16p Sherry Holtzclaw
ELEVATION CERTIFICATE, page 2
9128973889
p.2
IMPORTANT: In these spaces, copy the corresponding information from Section A.
Building Street Address (including Apt., Unit, Suite, and/or Bldg_ No.) or P.O. Route and Box No.
1103 Second Avenue
FOR INSURANCE COMPANY USE
Policy Number
City Tybee Island State GA ZIP Code 31328
Company NAIL 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
Sig natuy
Date 3/27/14
SECTIO - 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.
E1. 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, on enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items B 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.
ES. Attached garage (top of stab) 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 owners 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 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 item(s) and sign below. Check the measurement used in Items G8 -G10. In Puerto Rico only, enter meters.
G1. ❑ The intonation 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 of ficial 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-G10) is provided for community floodplain management purposes.
G4. Permit Number
G5. Date Permit Issued
06. Date Certiflcate Of Compliance /Occupancy Issued
G7. This permit has been issued for:
❑ New Construction
❑ Substantial Imp ovement
G8. Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters Datum
G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum
010. Community's design flood elevation: ❑ feet ❑ meters Datum
Local Official's Name
Title
Community Name
Telephone
Signature
Date
Comments
❑ Check here if attachments.
FEMA Form 086-0-33 (7112)
Replaces all previous editions.
Apr 23 14 01:16p Sherry Holtzclaw
ELEVATION CERTIFICATE, page 3
Building Photographs
See Instructions for Item A6.
IMPORTANT: In these spaces, copy the corresponding information from Section A.
9128973889 p.3
FOR INSURANCE COMPANY USE
Building Street Address including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
1103 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 2 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." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as
indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page.
Front View March 26, 2014
FEMA Form 086 -0-33 (7112)
Replaces all previous editions.
Apr 23 14 01:17p Sherry Holtzclaw
ELEVATION CERTIFICATE, page 4
Building Photographs
Continuation Page
IMPORTANT: In these spaces, copy the corresponding information from Section A.
9128973889 p.4
FOR INSURANCE COMPANY USE
Building Street Address (including Apt, Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No.
1103 Second Avenue
Policy Number:
City Tybee Island
State GA ZIP Code 31328
Company NAIC Number.
if submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs
with: dale taken; 'Front View" and 'Rear View; and, if required, "Right Side View" and "Left Side View' When applicable,
photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8.
Rear View March 26, 2014
FEMA Form 088 -0-33 (7/12)
Replaces all previous editions.