Loading...
HomeMy Public PortalAboutSeventh Av1416_20050428RFR- 28 -2t. 05 16 :2`C Cbbl r.U.4/aa IEDERAL EMC RGENCY MANAGEM NT AMP' NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important: Read the kistructions on pages 1.7. BUILD G OWNER'S NAME A,".1 - FAIL 46.. SECTION TION BUILDING STREET ADDRESS txitdicA AUl�t .141.4 '7? A{ EMO art G1%-y GF' E as areas Bldg. No' UDC 1 CS P. . RVU M O BOX NO. aT'}LAai AVE A.tr, STA etwE 101.M_B_ No. 3067 -0077 Expires December 31, 2003 A• PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Neer, Legal Daacrtpdon. eta ) 1 gD 26 - 1% . AV4.h1�Ar BUILDING SE (e.g., Residential, t eStf:laNtrercti°e� LATITUDE/LONGITUDE (OPTIONAL) ( ##° - ##' - our or ff# °) LA MAD 1327 Li NAD 128S E fief, Addlttott, Accessory, etc. Use Comments area If necessary.) i Ftv Cltttititel. ` BP CODE l HORIZONTALDAWVkt NFIP CQUMUNI Y NAME & COMMUNITY NUMBER B2. COLWY NAME 83. STAT dweera . Indicate the source of ttte Base Flood EIeva bn (EFEI date or L j FIS Profile 'SPERM LI Co moor #y Deteitrtlned Ll Other (Desaibe): Bit . Indicate the elevation datum used for the BFE h B9: NGVD 1929 U NAVES 1988 U Other (Dese ibek 812. Is the building located In a Coastal Barrier Resumes System (CBRS) area or Otherwise Protected Area (OPA)7 Lj Yes IN No Designation Data: r'yf rs ill: Ci uI rng etevatlans are based on: • :, «, an Drawings" r:<, ul.,ng tinder Cons . •. = jjFtnished Construction *A new Elevation Certificate will be required when construction of the building-le complete. C2. Building Diagram Number I (Select the thrldlrng disgtain Most elmller to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the buflding, provide a sketch or photograph.) C3. Elevations - Zones Al-A30„ AE, AH, A (with BEE), VE, V4 V30, V (with BEE). AR, ARIA, ARIAE, AR/A1-A30, AR!AH, ARIAO Complete Items C3.a -i below according to the tinkling dram specified In Rem C2. State the datum used. If the datum is different from the datum used for the BFE In Sr: AY* B, cofnreft the datum to ihet used for the SFE. Show field measurements and datum conversion calculation ii essgicepnnrided or the Comments area of y D or Section Q as appropriate, to document the datum conversion. Datum "121 C o n v e r s i o n f C o m m e n t e t 0 Elevation reference mark used Does the elevation reference mark used appear' on the F Yes r>st No (a) Top of bottom floor (including basement or er osure) 0 . it(m) I jab) Top of next higher floor Alm --A. _ . ft(m) w 0 c) Bottom of lowest horizontal strudiwdl member (V ernes only) 1..4 '. b. . Um) 1 g 0d) Attached garage (top of slab) r t - 4 . tk(m) .5 ca e) Lowest elevation of mach' and/or equipment N re r servicing the building (� in a Comments area.)1 t'E,...— .(m) fa f) Lowestadiaoent (finished) grade (LAG) — S- IL(m) @.2 0 g) Highest adjacent (finished) grade (HAG) it(m) ❑ It) No. of permanent openings (flood vents) w18rin 1 ft. above *cent grade C: _ § °" C".) i) Total area dell permanent openings (food vents) in C3.h 0 eq. In. (sq. cm) g OR t- ITE CA This certification Is to be signed and sealed by a land surveyor, engineer, or architect authorized by Iaw to certify elevation information. I Certify that the information in Sections A, B, and Con this certificate represents my best efforts to Interpret the data available. I understand that any false statement may be punishable by trine or Imprisonment under 18 U.S. Code, Section 1001. CERTIFIER's NAME 110Eas ER JABS H. XN G # 2743 TITLE ADDRESS SIGNATURE REGISTERED LAND SURVEYOR LQ SSURVEYING SERVICES, INC. P. 0. BOX 61649 CRY STATE SAVANNAH GEORGIA - 31420 DATE TELEPHONE Pate 28 240 912) 303 -0302 A Cow., 44 .24 !......__.+anon ZIP CODE M. MAP ANA HUMBER 1351414 0002 85. SU G 8fi. A DATE t» - 17 -8 87. EFFEGTIVEIREVISED DATE ©G- t 1 -94 88. FL ZONES .�.8 Hs. BAST; Ft.QCD SVATIO (s) 114 . Indicate the source of ttte Base Flood EIeva bn (EFEI date or L j FIS Profile 'SPERM LI Co moor #y Deteitrtlned Ll Other (Desaibe): Bit . Indicate the elevation datum used for the BFE h B9: NGVD 1929 U NAVES 1988 U Other (Dese ibek 812. Is the building located In a Coastal Barrier Resumes System (CBRS) area or Otherwise Protected Area (OPA)7 Lj Yes IN No Designation Data: r'yf rs ill: Ci uI rng etevatlans are based on: • :, «, an Drawings" r:<, ul.,ng tinder Cons . •. = jjFtnished Construction *A new Elevation Certificate will be required when construction of the building-le complete. C2. Building Diagram Number I (Select the thrldlrng disgtain Most elmller to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the buflding, provide a sketch or photograph.) C3. Elevations - Zones Al-A30„ AE, AH, A (with BEE), VE, V4 V30, V (with BEE). AR, ARIA, ARIAE, AR/A1-A30, AR!AH, ARIAO Complete Items C3.a -i below according to the tinkling dram specified In Rem C2. State the datum used. If the datum is different from the datum used for the BFE In Sr: AY* B, cofnreft the datum to ihet used for the SFE. Show field measurements and datum conversion calculation ii essgicepnnrided or the Comments area of y D or Section Q as appropriate, to document the datum conversion. Datum "121 C o n v e r s i o n f C o m m e n t e t 0 Elevation reference mark used Does the elevation reference mark used appear' on the F Yes r>st No (a) Top of bottom floor (including basement or er osure) 0 . it(m) I jab) Top of next higher floor Alm --A. _ . ft(m) w 0 c) Bottom of lowest horizontal strudiwdl member (V ernes only) 1..4 '. b. . Um) 1 g 0d) Attached garage (top of slab) r t - 4 . tk(m) .5 ca e) Lowest elevation of mach' and/or equipment N re r servicing the building (� in a Comments area.)1 t'E,...— .(m) fa f) Lowestadiaoent (finished) grade (LAG) — S- IL(m) @.2 0 g) Highest adjacent (finished) grade (HAG) it(m) ❑ It) No. of permanent openings (flood vents) w18rin 1 ft. above *cent grade C: _ § °" C".) i) Total area dell permanent openings (food vents) in C3.h 0 eq. In. (sq. cm) g OR t- ITE CA This certification Is to be signed and sealed by a land surveyor, engineer, or architect authorized by Iaw to certify elevation information. I Certify that the information in Sections A, B, and Con this certificate represents my best efforts to Interpret the data available. I understand that any false statement may be punishable by trine or Imprisonment under 18 U.S. Code, Section 1001. CERTIFIER's NAME 110Eas ER JABS H. XN G # 2743 TITLE ADDRESS SIGNATURE REGISTERED LAND SURVEYOR LQ SSURVEYING SERVICES, INC. P. 0. BOX 61649 CRY STATE SAVANNAH GEORGIA - 31420 DATE TELEPHONE Pate 28 240 912) 303 -0302 A Cow., 44 .24 !......__.+anon ZIP CODE APR -28 -2005 16 :27 CSS I I BUILDING STREETAOORESS (IncludingApL, U ? , &ndiarlitdg. Na_) ORPA. ROWEAl, CITY "U ..�. �.rtE ' is L +�t 1 C� t�#t /k - 44 - V C STATE SQX NO 4,44 ud ZIP CODE ii'tljstiityNPIC-Nurnber 3,3243 ... SECTION D - SURVEYOR, ENGINEER, ORARCHITECT CERTIFICATION (CONTINUFj3 Copy both sides of this Elevation Certificate for (t) community official, (2) insurance agent/company, and (3) building owner. COMMENTS:, J T ifF !!+r f ob t S 71-11. AA"., a.r Oil -oorat S► Pieat. Csiztaim ..pr'i+ 7" c -us i1!SU ten ce. c.onl P.03/03 Use: ik+G9re • a- t'S. : -u - f'Rd IF, t - .M A.AtO /iv 04 E P40,1 SE +ZV i C-1 ' s 9 t Q1h.,o "IG► or At Cia C,h.VS& et ewe iatt." -i y i+s+ e7Y,es.T`I0ega _ + # U Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION SURVEY NOT RBQUt tE OR ZONE AO AND ZONE A OUT 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 buffeting 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 lop of the bottom floor (including basement or enclosure) of the building is it {m) I jin. {txn) above or I_ ;below (check one) the highest adjacent grade. (Use natural grade, If available.) E3. For Building Diagrams 6-8 with openings (see page 7), the net higherSoor or elevated floor (elevation b) of the building is I j_J ft.(m) I I (iin.(crn) above the highest adjacent grade. E4. The top of the platform of machinery and /or equipment servicing the building Is { I { ft. (m) { ; I in. (cm) - e or u 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 munity's floodplain management ordinance? U Yes I j No I 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 C3.1 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, 6, C, and E are correct to the best of m knowted'e PROPERTY OWNER'S OR OWNER'S AUTHORiZED REPRESENTATIVE'S NAME ADDRESS CITY . STATE ZIP CODE SIGNATURE COMMENTS DATE TELEPHONE Chec ' attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) a T 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. G t . I� 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.) 02. l_i A community official completed Section E for a building located In Zone A (without a FEMA- issued or community- issued BFE=) or Zone AC). G3. i.,.�I The following information (Items G4-G9) is provided for community floodplain management purposes. 04. PERMIT NUMBER 05. DATE PERMIT ISSUED G8. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been issued far:) `( New Construction) I Substantial Improvement GS. Elevation of as -built lowest floor (including basement) of the building 1st G9. BFE or (in Zone AO) depth at flooding at the building site is: ft.(m)Datum: ft.(m)Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE TOTAL P.03