HomeMy Public PortalAboutCampbell Av_110-AFEDERAL 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-A SOUTH CAMPBELL AVENUE
CITY STATE
TYBEEISLAND GA
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 42, PAMELA TERRACE SUBDIVISION, FORT WARD, TYBEE ISLAND
Policy Number
Company NAIC Number
ZIP CODE
31328
BUILDING USE (e.g., Residential, Non - residential, Addition, Accessory, etc. Use a Comments area, ri necessary.)
RESIDENTIAL.
LATITUDE/LONGITUDE (OPTIONAL)
( ##° -11#' - ##i1#" or ##.#lam!#)
HORIZONTAL DATUM:
❑ NAD 1927 ❑ NAD 1983
SOURCE: ❑ GPS (Type):
❑
USGS Quad Map 0 Other.
SECTION B • FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFIP CO? UNfTY NAME & COMMUNITY NUMBER
IYBEE ISLAND, GEORGIA - 135164
B2. COUNTY MANE
CHATHAM
83. STATE
GA
B4, MAP AND PANEL
B7. FIRM PANEL
B9. BASE FLOOD ELEVATION(S)
NUMBER
135. SUFFIX
B6. FIRM INDEX DATE
EFFECTIVE/REVISED DATE
88. FLOOD ZONE(S)
(Zone AO, use depth of Ifooding)
135164-0001
C
6117/86
6/17/36
A8
12
B1U. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe):
B11. Indicate the elevation datum used for the BFE in B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe):
612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Other ise Protected Area (OPA)? ❑ Yes ® No Designation Date WA
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 constn 01100 of the bung is complete.
C2. Building Diagram Number 1(Select the buitding diagram most similar to the building 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 Al A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/AIA30, 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 8, convert the datum to that used for the BFE. Show field 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 ConversioniComments NONE
Elevation reference mark used LOCAL Does the elevation reference mark used appear on the FIRM? ❑ Yes ® No
o a) Top of bottom floor (including basement or enclosure) 10. 41 ft.(m)
o b) Top of next higher floor 19.16 ft,(m) co
0 c) Bottom of lowest horizontal structural member (V zones only) NIA . ft.(m)
o d) Attached garage (top of slab) NONE. ft(m)
0 e) Lowest elevation of madminery and/or equipment w
servicing the building (Describe in a Comments area) 9.73 ft(m)
0 1) Lowest adjacent (finished) grade (LAG) 9.6 ft(m) z W
io
N \
0 g) Highest adjacent (finished) gee (HAG) 10. 1 ft(m) ,'
o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade NIA Y
0 i) Total area of all permanent openings (flood vents) in C3.h N/A sq. in. (sq. am)
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 certify 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.
CERTIFIER'S NAME BERT B. BARRETT, JR UCENSE NUMBER GA. 2225
TITLE PRESIDENT
ADDRESS
145 RUNNER ROAD
SIGNATURE
COMPANY NAME BERT BARRETT, JR LAND SURVEYING, P.C.
CITY STATE
SAVANNAH GA
DATE TELEPHONE
2!07/06 912- 897-0661
ZIP CODE
31410