HomeMy Public PortalAboutCampbell Av_110FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1- 7.
O.M.B. No. 3067 -0077
Expires December 31, 2005
SECTION A - PROPERTY OWNER INFORMATION
For Insurance Company Use:
BUILDING OWNER'S NAME
LORENA MITCHELL
BUILDING STREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
110 SOUTH CAMPBELL AVENUE
CITY
TYBEE ISLAND
Policy Number
Company NAiC Number
STATE
GA
ZIP CODE
31328
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 42, PAMELA TERRACE SUBDIVISION, FORT WARD, TYBEE ISLAND
BUILDING USE (e.g., Residential, Non - residential, Addition, Accessory, etc. Use a Comments area, if necessary.)
RESIDENTIAL
LATITUDE/LONGiTUDE (OPTIONAL)
( ##° - #1I - ##.##" or ##.it# {lf)
HORIZONTAL DATUM:
❑ NAD 1927 D NAD 1983
SOURCE: D GPS (Type):
(] USGS Quad Map D Other:
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
61. NAP COMMJNITY NAME &COMMUNITY NUMBER
TYBEE ISLAND, GEORGIA - 135164
B2. COUNTY NAME
CHATHAM
B3. STATE
GA•
B4. WAND PANEL
NUMBER
135164-0001
85. SUFFIX
C
B6. FIRM INDEX DATE
6/17/86
67. FIRM PANEL
EFFECTIVEREVISED DATE
6/I7/86
88. FLOOD ZONE(S)
A8
69. BASE FLOOD ELEVATION(S)
(Zone AO, use depth of flooding)
12
610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in 89.
D F1S Profile FIRM D Community Determined ❑ Other (Describe):
611. indicate the elevation datum used for the BFE in 89: ® NGVD 1929 D NAVD 1988 D Other (Describe):
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes ® No Designation Date N/A
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations am based on: [j Construction Drawings` ❑ Building Under Construction* ® Finished Construction
*A new Elevation Certificate will be required when constriction of the bulldog is complete.
C2. Building Diagram Number 1(Select the building diagram most similar to the budding for which this certificate is being completed - see pages 6 and 7. if no diagram
accurately represents the building, provide a sketch or photograph.)
C3. 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 C3: a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in
Section B, convert the datum to that used for the BFE. Show fietd measurements and datum conversion calculation. Use the space provided or the Comments area of
Section D or Section G, as appropriate, to document the datum conversion,
Datum NGVD 1929 Conversion/Comments NONE
Elevation reference mark used LOCAL Does the elevation reference mark used appear on the FIRM? 0 Yes ® No
o a) Top of bottom floor (including basement or endosure) 9. 73 t(m) a
o b) Top of next higher floor NONE . ft(m)
o c) Bottom of lowest horizontal structural member (V zones only) N/A . `ft(m) 4 0
o did) Attached garage (top of slab) NONE. _ft(m) w 2
o e) Lowest elevation of machinery and/or equipment
servicing the building (Describe in a Comments area) 9.73 ft(m) s., ro
o 1) Lowest adkacent (finished) grade (LAG) 9.2 ft(m) v Jo Jo
o g) Highest ar scent (finished) grade (HAG) 9. 8 ft(m)
o h) No. of permanent openings (flood vents) within 1 ft. above alaoent grade WA
o 1) Total area of all permanent openings (flood vents) in C3.h N/A sq. in. (sq. cm)
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 cen'ify that the information in Sections A, B, and C 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.
CERTIFIERS NAME BERT B. BARRETT, JR LICENSE NUMBER GA. 2225
TITLE PRESIDENT
ADDRESS
145 RUNNER ROAD
SIGNATURE
jr
`di"-`'I T - 60 (cr,.
COMPANY NAME BERT BARRETT, JR. LAND SURVEYING, P.C.
CITY STATE
SAVANNAH GA
DATE TELEPHONE
2/07/06 912- 897 -0661
ZIP CODE
31410
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