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Home My Public Portal AboutLOVELL AV_1003.pdfU,S. DEPARTMENT OF HOMELAND SECUR" ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY National fiYoodlnsuranca Program Important: Read the instructions on pages 1-9 •e 7, ff#TX, 57TYUM A1. Building Owner's Name Lauren OMS No, 1660-0008 Expiration Date: July 31, 2015 A2. Street Address (including Apt,, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company N= Nwm-ber, 1003 Lovell Avenue City Tybee Island State GA ZIP Code 31328 B1, NFIP Community Name & Community Number B2. County Name B3. State Tybee Island 135164 1 Chatham GA I 510. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in item B9. [] FIS Profile Z FIRM [I Community Determined El Other/Source: 811, Indicate elevation datum used for BFE in Item B9., El NGVD 1929 Z NAVD 1988 n Other/Source: 812, Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? F1 Yes No Designation Date: - El CBRS n OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1, Building elevations are based on: 0 Construction Drawings* ❑ Building Under Construction* Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations - Zones Al-A30, AE, AH, A (With BFE), VE, VI-V30, V (with BFE), AR, AR/A, ARIAE, AR/A1 -A30, AR/AH, AR/A0, Complete Items C2.a-h below according to the building diagram specified in Item AT In Puerto Rico only, enter meters. Benchmark Utilized: local Vertical Datum: NAVD 1_988 Indicate elevation datum used for the elevations in items a) through h) below. 0 NGVD 1929 0 NAVD 1988 0 Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used, 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) 9 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 103 0 feet ❑ meters 19.3 0 feet 0 meters n1a. 0 feet EJ meters n1a. Z feet 0 meters 10.3 0 feet ❑ meters 8.5 0 feet El meters 9.3 0 feet meters 8,5 0 feet 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. I certify that the information 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. 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 IN 17 Certifier's Name J. Whitley Reynolds License Number 2249 Title Land Sujv6y-or- Company Name Address 6 ., .,6 6 Ste arson Avenue -, City Savannah State GA ZIP Code 31405 Sionat re dr "" Date 2/16116 Telephone 912-352-0464 EMA For 086-0.33 (7/12) See reverse side for continuation. H L E-Y ggg folk, Aagulomign M", 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. Policy Number: 1003 Lovell Avenue City Tyb,ee Island State GA ZIP Code 31328 Company NAIL 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 C2.e) is Plumbing etc. on the first floor. Signature LIN isrimrii For Zones AO and A (without BFE), complete Items E1 —E5. if the Certificate is intended to support a LOMA or LOMB -F request, complete Sections A, B, and C. For Items E1 —E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters, El. 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 ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑feet ❑ -1 meters El 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 [:1 feet ❑ meters F-1 above or [_-] below the HAG. E4, Top of platform of machinery and/or equipment servicing the building is _._ ❑ feet [:1 meters ❑ above or ❑ below the HAG. E5, Zone AC, 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 F'EMA-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 1:1 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, 137 (or � E), and G af 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. Gi, ❑ 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 un the Comments area below.) 32. 171 A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BEE) 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 37. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as••built lowest floor (including basement) of the building: ❑ feet ❑ meters Datum 39. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum 310. Community's design flood elevation: ❑ feet ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments Check here if attachments, =EFTA Form 086-0-33 (7112) Replaces all previous editions, ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6, If using the Elevation Certificate to obtain N:FIP flood insurance, affix at least 2 building photographs bellow according to the instructions for Item A6. Identify a l p hotographs 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 vent:s, as, indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. I- ront view i-e yr ua 1;e, 2U] b \ M \� ~\� � \�� FEMA Form 086-0-33 (7/12) Replaces all previmaw (m\ MR IN; 09 HIM I - Is, ID I wyl e fe-7 a f I i p::::: • ne opening ENIA Form 086-0-33 (7112) Rep6aces all previous editions.