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Home My Public Portal AboutSecond Av_611F KAL tMtt' UtPI .T M141/AUcmtn r i i w NATIONAL FLOOD FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important: Read the instructions on pages 1- 7. O.M.B. NO. SUbf -Uuf f Expires December 31, 2005 SECTION A - PROPERTY OWNER INFORMATION BUILDING OWNER'S NAME THE COTTAGE COMPANY For Insurance Company Use: Policy Number BUILDING STREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. 611 SECOND AVENUE Company NAIC Number CITY TYBEE ISLAND, STATE GA ZIP CODE 31328 PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 57 -A & PT. LOT 58-A, WARD 2 BUILDING USE (e.g., Residential, Non - residential, Addition, Accessory, etc. Use a Comments area, if necessary.) RES LATITUDE/LONGITUDE (OPTIONAL) ( ##O - ##' - ##.##" or ##. � 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 GA B4. MAP AND PANEL NUMBER 135164 0001 B5. SUFFIX C B6. FIRM INDEX DATE 6/17/86 87. FIRM PANEL EFFECTIVEIREVISED DATE 6/17/86 B8. FLOOD ZONE(S) A8 B9. BASE FLOOD ELEVATION(S) (Zone AO, use depth offloading) 12 B 10. Indicate the source of tfi Base Flood Elevation (BFE) data or base flood depth entered in B9, ❑ FIS Profile ii FIRM ❑ Community Determined ❑ Other (Describe): 1311. Indicate the elevation datum used for the BFE in 139: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe): 812. 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 Constnxion* ® Finished Construction *A new Elevation Certificate will be required when constriction of the building is complete. C2. Building Diagram Number 8 (Select the budding diagram most similarto 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/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 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 29 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) 11. 3 it(m) v \ o b) Top of next higher floor 14.9 ft.(m) o c) Bottom of lowest horizontal structural member (V zones only) NA . __ft(m) y W o d) Attached garage (top of slab) 11. 311.(m) t o e) Lowest elevation of machinery and/or equipment u, `6 servicing the buiding (Describe in a Comments area) 11.5 ft(m) o f) Lowest adjacent (finished) grade (LAG) 11.2 ft.(m) z' o g) Highest adjacent (finished) grade (HAG) 11. 5 ft.(m) o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 0 --✓' J � o i) Total area of all permanent openings (flood vents) in C3.h _sq. in. (sq. cm) r �~ RG44 NO. 2249 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. t certify that the information in Sections A, B, and C 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. CERTIFIER'S NAME J. Whitley Reynolds LICENSE NUMBER 2249 TITLE Land Surveyor ADDRESS 636 STEPHE SIGNAT COMPANY NAME CITY STATE ZIP CODE Savannah, GA GA 31405 __DATE TELEPHONE 3/16/06 912 - 352 -0464 IMPO^TANT: In these spaces, copy the corresponding information from Section A. BUILDING STREET ADDRESS (Including Apt, Lint Suite, andla No.) OR P.O. ROUTE AND BOX NO. 611 SECOND AVENUE CITY STATE ZIP CODE TYBEE ISLAND, GA 31328 For Irsuranre Company Use Policy Number 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 C3.e) =A/C PAD ❑ 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. tithe 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) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if available). E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the budding is _ ft(m) _in.(c m) above the highest adjacent grade. Complete items C3.h and C3.i on front of form. E4. The top of the platform of machinery andlor equipment servicing the budding is ft(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if availa)le). E5. For Zone AO on 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, C (Items C3.h and C3.i only), and E for Zone A (without a FEMA- issued orcommuniy- issued BFE) or Zone AO must sign here. The statements in Sections B, C, and E are coned to the best ofmyknowfedge PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS 0 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. 0 A community official completed Section E for a building tooted in Zone A (without a FEMA- issued or community- issued BFE) or Zone AO. G3. ❑ The following information (Items G4-G9) 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 (induding basement) cite building is: G9. BFE or (in Zone AO) depth of flooding at the building site is: LOCAL OFFICIAL'S NAME COMMUNITY NAME SIGNATURE COMMENTS ff(m) —_• th(m) Datum: Datum: TITLE TELEPHONE DATE ❑ Check here if attachments