HomeMy Public PortalAboutJones Av_1301Fr -RAL EMERGENCY MANAGEMENT AGE' Y
..ATIONAL FLOOD INSURANCE PROGRAA.
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1 - 7.
SECTION A - PROPERTY OWNER INFORMATION
O.M.B. No. 3067 -0077
Expire Decekke(3126
For Insurance Company Use:
BUILDING OWNER'S NAME
MICHAEL BANDY
Policy Number
BUILDING STREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
1301 JONES STREET
Company NAIC Number, L
CITY
TYBEE ISLAND
STATE
GA
ZIP CODE
31328
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOTS 122 &123 WARD 4 PIN # 4- 0007 - 13-008
BUILDING USE (e.g., Residential, Non - residential, Addition, Accessory, etc. Use a Comments area, if necessary.)
RESIDENTIAL
LATITUDE/L
.{{O
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/{+ITUD�E
/.�{(OPTIONAL)
( ##O - ##' - ##.##" or ##.11#/#,#°)
HORIZONTAL DATUM:
❑ NAD 1927 ❑ NAD 1983
SOURCE: 0 GPS (Type):
❑ USGS Quad Map ❑ Other.
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER
CHATHAM COUNTY, GEORGIA 130164 0001 -0220
B2. COUNTY NAME
CHATHAM
B3. STATE
GEORGIA
B4. MAP AND PANEL
NUMBER
135164 0002
B5. SUFFIX
C
B6. FIRM INDEX
DATE
06/17/1986
B7. FIRM PANEL
EFFECTIVE/REVISED DATE
06/17/1986
B8. FLOOD
ZONE(S)
A8
B9. BASE FLOOD ELEVATION(S)
(Zone AO, use
12 offlooding)
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
❑ FIS Profile Z 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 5 (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 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 NGVD29 Conversion /Comments
Elevation reference mark used LOCAL Does the elevation reference mark used appear on the FIRM? ❑ Yes Z No
o a) Top of bottom floor (including basement or enclosure) 12. 4 ft.(m)
22 . 9 ft.(m)
N/A . _ft.(m)
N /A. _ft.(m)
o b) Top of next higher floor
o c) Bottom of lowest horizontal structural member (V zones only)
o d) Attached garage (top of slab)
o e) Lowest elevation of machinery and /or equipment
servicing the building (Describe in a Comments area) 12 .2 ft.(m)
o f) Lowest adjacent (finished) grade (LAG) 7 . 6 ft.(m)
o g) Highest adjacent (finished) grade (HAG) 7. 8 ft.(m)
o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade N/A
o i) 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.
1 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 MICHAEL J. GARDNER LICENSE NUMBER 2285
TITLE REGISTERED LAND SURVEYOR COMPANY NAME MICHAEL J. GARDNER, LAND SURVEYOR
ADDRESS
120 VARNEDOE AVE UE
SIGNATURE Li
CITY STATE ZIP CODE
GARDEN CITY GA 31408
DATE TELEPHONE
10//09/06 1- 912- 964 -8262
IMPORTANT: In these spaces, cor he corresponding information from Ser'' 'n A.
BUILDING STREET ADDRESS (Including Apt., U, Suite, and /or Bldg. No.) OR P.O. ROUTE AND BOX . .
1301 Jones Street
CITY STATE ZIP CODE
TYBEE ISLAND GA 31328
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
C 3(e) Elevation of top of air conditioner pedestal is at elevation 12.2'
For Insurance Company Use:
Policy Number
Company NAIC Number
❑ 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.
E1. 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 building is _ ft.(m)
in.(cm) above the highest adjacent grade. Complete items C3.h and C3.i on front of form.
E4. The top of the platform of machinery and /or equipment servicing the building is _ ft.(m) _in.(cm) ❑ above or ❑ below (check one)
the highest adjacent grade. (Use natural grade, if available).
E5. 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? ❑ 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, C (Items C3.h and C3.i only), and E for Zone A (without a FEMA-
issued or community- issued BFE) or Zone AO must sign here. The statements in Sections A, 8, C, and E are correct to the best of my knowledge.
PROPERTY OWNERS OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE
DATE TELEPHONE
COMMENTS
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.
01. ❑ 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. ❑ 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 G409) 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 is: _ft.(m) Datum:
G9. BFE or (in Zone AO) depth of flooding at the building site is: _ ft.(m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
❑ Check here if attachments