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FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1 - 7.
O.M.B. No. 3067 -0077
Expires July 31, 2002
SECTION A - PROPERTY OWNER INFORMATION
For Insurance Company Use:
BUILDING OWNER'S NAME
JOSEPH LAYTON
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and /or Bldg. No.) OR P.O. ROUTE AND BOX NO.
3 LEWIS AVENUE
CITY STATE ZIP CODE
TYBEE ISLAND GA 31328
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 35, PALM TERRACE SUBDIVISION, HAMMOCK WARD
BUILDING USE (e.g., Residential, Non - residential, Addition, Accessory, etc. Use Comments section if necessary.)
RESIDENTIAL
( L ATIITUDE /LONG ITU DE(OPTIIONAL)
#te - y4. - twyty " or /14.l4/#/FM)
Policy Number
Company NAIC Number
HORIZONTAL DATUM:
❑ NAD 1927 ❑ NAD 1983
SOURCE: ❑ GPS (Type):
❑ USGS Quad Map
❑ Other:
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER
TYBEE ISLAND 135164
B2. COUNTY NAME
CHATHAM
B3. STATE
GEORGIA
B4. MAP AND PANEL
B5. SUFFIX
B6. FIRM INDEX
B7. FIRM PANEL
B8. FLOOD
B9. BASE FLOOD ELEVATION(S)
NUMBER
DATE
EFFECTIVE /REVISED DATE
ZONE(S)
(Zone AO, use depth of flooding)
135164 0001
C
6/17/1986
5/17/1986
A8
12
B10. 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):
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ❑ No
Designation Date
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. Building Diagram Number 1 (Select the building 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 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 C3a -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 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 Conversion /Comments
Elevation reference mark used Does the elevation reference mark used appear on the FIRM? ❑ Yes ® No
o a) Top of bottom floor (including basement or enclosure) 7. 9 ft.(m)
o b) Top of next higher floor N/A . _ft.(m)
o c) Bottom of lowest horizontal structural member (V zones only) N/A . ft.(m)
o d) Attached garage (top of slab) N /A. _ft.(m)
o e) Lowest elevation of machinery and /or equipment
servicing the building 6 . 8ft.(m)
o f) Lowest adjacent grade (LAG) 6 . 6ft.(m)
o g) Highest adjacent grade (HAG) 7. Oft.(m)
o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 0
o i) Total area of all permanent openings (flood vents) in C3h 0 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 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 WRIGHT C. POWERS, JR. LICENSE NUMBER 2612
TITLE REGISTERED LAND SURVEYOR COMPANY NAME CONNOR & ASSOCIATES, INC
ADDRESS
P O BOX 10091
7
SIGNATURE
FEMA Form 81 -31, AUG 99
CITY
SAVANNAH
DATE
DECEMBER 5 2001
STATE
(�A
TELEPHONE
1- 912 - 897 -5460
ZIP CODE
31412
SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
IMPORTANT: In these spaces, copy the corresponding information from Section A.
For Insurance Company Use:
:1 • ' I••
3 LEWIS AVENUE
CITY
TYBEE ISLAND
ncu.ing pt., Unit, uite,an. or .g. lo. • • •.•. -•I •' �•
oicy um.er
STATE ZIP CODE
GA 31328
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Company NAIC Number
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
COMMENTS JOB No. GA01728 F.B. (505 -17) DJP
El Check here if attachments
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zone AO and Zone A (without BFE), complete Items El through E4. If the Elevation Certificate is intended for use as .supporting
information for a LOMA or LOMR -F, Section C must be completed.
El. Building Diagram Number (Select the building 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.)
E2. The top of the bottom floor (including basement or enclosure) of the building is ft.(m) in.(cm) 0 above or ❑ below (check one)
the highest adjacent grade.
E3. For Building Diagrams 6 -8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is
_ ft.(m) in.(cm) above the highest adjacent grade.
E4. For 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? D Yes j=1 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 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.
PROPERI Y OWNER'S OR OWNER'S AUTHORIZED REPRESENT ATIVE'S NAME
ADDRESS Cll Y Sl ATE ZIP CODE
SIGNATURE
DATE TELEPHONE
COMMEN TS
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.
G1. The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor,
engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.)
G2. fl 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. D.The following information (Items G4 -G9) is provided for community floodplain management purposes.
Gd. FERMI I
V: •
• • y
.. •,
ISSUED
•,• ,' • /•'. •
G7. This permit has been issued for: 11 New Construction Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) of the building is:
G9. BFE or (in Zone AO) depth of flooding at the building site is:
. ft.(m)
. ft.(m)
Datum:
Datum:
—LOCAL OFFICIAL'S NAME
Tll LE
COMMUNII Y NAME
TELEPHONE
SIGNATURE
DATE
COMMEN IS
El Check here if attachments
FEMA Form 81 -31, AUG 99
REPLACES ALL PREVIOUS EDITION