HomeMy Public PortalAboutWhite Oak Ln_2U.S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
National Flood Insurance Program Important: Read the instructions on pages 1 -9.
ELEVATION CERTIFICATE
SECTION A - PROPERTY INFORMATION
OMB No. 1660 -0008
Expiration Date: July 31, 2015
FOR INSURANCE COMPANY USE
Al. Building Owner's Name
Andrew Jones
A2. Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No.
2 White Oak Lane
Policy Number:
Company NAIC Number.
City State ZIP Code
Tybee Island GA 31405
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Lot A, Horse Pen Hammock, Fort Ward, 5`" G.M.D., Tybee Island, Chatham County Georgia. Subdivision Map Book 31 -S, p.45. PIN: 4- 0019 -04 -012.
A4. Building Use (e.g., Residential, Non - Residential, Addition, Accessory, etc.)
A5. Latitude/Longitude: Lat. 32.0135 Long. - 80.8502 Horizontal Datum:
A6. Attach at least 2 photographs of the building if the Certificate is being used
A7. Building Diagram Number Z
A8. For a building with a crawlspace or encosure(s):
a) Square footage of crawlspace or enclosure(s) 1,177 sq ft
b) Number of permanent flood openings in the crawlspace
or enclosure(s) within 1.0 foot above adjacent grade 8
c) Total net area of flood openings in A8.b 1.651 sq in
d) Engineered flood openings? ❑ Yes ® No
Residential
❑ NAD 1927 ® NAD 1983
to obtain flood insurance.
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 ❑ No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
Chatham County, 130030,& Tybee Island, City of,135164
B2. County Name
Chatham
B3. State
GA
B4. Map /Panel Number
13051CO213
B5. Suffix
F
B6. FIRM Index Date
08/05/2013
B7. FIRM Panel
Effective /Revised Date
09/26/2008
B8. Flood
Zone(s)
AE
B9. Base Flood Elevation(s) (Zone
AO, use base flood depth)
12' + 1' freeboard
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other /Source:
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ® NAVD 1988 ❑ Other /Source:
B12. 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: ❑ Construction Drawings* ❑ Building Under Construction* ® Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations - Zones A1-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, ARIA, AR/AE, AR/A1-A30, AR/AH, 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 88
Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 El NAVD 1988 ❑ Other /Source:
Datum used for building elevations must be the same as that used for the BFE.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor)
b) Top of the next higher floor
c) Bottom of the lowest horizontal structural member (V Zones only)
d) Attached garage (top of slab)
e) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG)
g) Highest adjacent (finished) grade next to building (HAG)
h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support
9.2
10.8
N /A.
Check the measurement used.
® feet
® feet
❑ feet
® feet
® feet
feet
® feet
❑ feet
❑ meters
❑ meters
❑ meters
❑ meters
❑ meters
❑ meters
❑ meters
❑ 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. / 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 1001.
® Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a
❑ Check here if attachments. licensed land surveyor? ® Yes ❑ No
Certifier's Name Terry Mack Coleman License Number GA RLS# 2486
Title President Company Name Coleman Company Inc.
Address 17 ark of Co rtlr erce, Suite 201 City Savannah State GA ZIP Code 31405
Signa
FEMA Form 08622,3 3 (7/12)
Date 6,/i4 / 12/
Telephone (912)200 -3041
See reverse side for continuation. Replaces all previous editions.
ELEVATION CERTIFICATE, page 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.
2 White Oak Lane
FOR INSURANCE COMPANY USE
Policy Number.
City State ZIP Code
Tybee Island GA 31405
Company NAIC 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 Section A8 -9: A garage attached to an elevated building is considered an enclosure.
Section ABb: All flood openings within 1 foot of interior grade elevation of enclosure,
Section B9: The 1' (one foot) freeboard is a provision of the Tybee Island Flood Damage Prevention Ordinance.
Section C2: Be hmark utiliz -. is same as that noted in a plat prepared by Kem- Coleman & Co., Inc. (Job No. 120348)
Section C2b: evation is - • • f finished floor for living space.
Section C2e: owest ele '• n of machinery servicing building is electrical outlet beneath stairs in garage.
Signature Date it fi
SECTION - BCI(LDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AO and A,( ithout 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 Ite - 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 El feet ❑ meters ❑ above or ❑ below the HAG.
b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 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.
E3. Attached garage (top of slab) 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 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. 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 information 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 official 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
G6. Date Certificate Of Compliance /Occupancy Issued
G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) of the building:
G9. BFE or (in Zone AO) depth of flooding at the building site:
G10. Community's design flood elevation:
❑ feet ❑ meters Datum
❑ feet ❑ meters Datum
❑ feet ❑ meters Datum
Local Official's Name
Title
Community Name
Telephone
Signature
Date
Comments
❑ Check here if attachments.
FEMA Form 086 -0 -33 (7/12)
Replaces all previous editions.
ELEVATION CERTIFICATE, page 3
Building Photographs
See Instructions for Item A6.
IMPORTANT: In these spaces, copy the corresponding information from Section A.
FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
2 White Oak Lane
Policy Number
City
Tybee Island
State
GA
ZIP Code
31405
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.
FEMA Form 086 -0 -33 (7/12)
Replaces all previous editions.
FRONT VIEW
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REAR VIEW
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RIGHT SIDE VIEW
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FEMA Form 086 -0 -33 (7/12)
Replaces all previous editions.
ELEVATION CERTIFICATE, page 4
Building Photographs
Continuation Page
IMPORTANT: In these spaces, copy the corresponding information from Section A.
FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No.
2 White Oak Lane
Policy Number:
City
Tybee Island
State
GA
ZIP Code
31405
Company NAIC Number.
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. 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.
FLOOD VENTS (LEFT)
FLOOD VENTS
(RIGHT)
SMALL FLOOD VENT
(RIGHT)
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FEMA Form 086 -0 -33 (7/12)
Replaces all previous editions.
ELEVATION CERTIFICATE, page 5
Building Photographs
See Instructions for Item A6.
IMPORTANT: In these spaces, copy the corresponding information from Section A.
IFOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No.
2 White Oak Lane
Policy Number
City
Tybee Island
State
GA
ZIP Code
31405
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.
DOOR FLOOD VENT
(FRONT)
ELECTRICAL OUTLET IN GARAGE
FEMA Form 086 -0 -33 (7/12) Replaces all previous editions.