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HomeMy Public PortalAboutTWELTH ST_3.pdfU.S.DEPARiMENTOFHOMELANDSECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY [=ExpiationlDate: 08 i`aunnrd r ruoa,><S, Ta„Ce t',og,Y,r,= _ Important: Read the instructions on pages 1-9.y 3't , 2015 uf SECTION A - PROPERTY INFORMATION FOR INSURANCE C:OMPqNY USE A1. Building Owner's Name Raymond Frewer Policy Number: ------------._ A2 Building Street Address (inciud ng Apt, Unit Suite, and/or Bldg. No.) or P.0 Route and Box No Company NAIC Number 3 121". Street City Tybee Island State GA 71P Code 31324 A3. Property Dr>scnptic,n (Lot and Block Numbers. Tax PEaTcel Nimber. Legal Description, etc.) - pt of lot H of a sibdivision of beach lot 73, ward 4 PIN 4-000703-002 A4. Building Use (e.g., Residential, Non -Residential, Addition Amessory, etc,' Residential A5 Latitudell-ongitude- Lat. N-31 dg59.8510 min Long. W-80 deg 50 7220 min Horizontal Datum ❑ NAD 1927 NAD 1983 A6 Attach at least 2 photographs at the building if the Cerbfoate is being Usec to obtain flood insurance. A7 funding Diagram Number 1A A8 For a building with a crawlspace or enclosure(s) A9 Fora building with an attached garage, a) Square footage of crawlspace or enclosures) 21a sq ft a) Square footage of attached garage 210 s(f ft b) Numbe, of pen-nanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosures; within 1.0 fool above adjacent grade nla within 1 0 foot above adjacent grade nia c) Total net area cf flood uper Ings in A3 b n1a scl in c} Total net area of flood openings in Ag.b n1a sq in d) Engineered flood openings'? ❑ Yes 0 No d) Engineered flood openings? ❑ Yes ® No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION iB1 NFIP Community Narne & Comlaunity, Nurriber 132. County Name B3. State Tybee Island 135164 Chatham it GA B4^ MaplPane Number 65. Suffix j B6. FIRM Indey, Date 67 FIRM Panel B8. Flood 69 Base Flood Elevation(s) {"Lane 13051CO326 711114 FifeclivelRevised Dale Lone(s) AO, use base flood depth) l 912,1108 AE 14 610. Indicate this source of the Base Flood Elevatioit (BFE) data or base flood depth entered in Item B9 ❑ FlS Profile ® FIRM ❑ Community cetermineo ❑ OtherlSource B11 Indicate elevation datum used for BFF in Item R9 ❑ N( --,VD 1929 ex] NAVD 19813 ❑ Other/Source: 812. Is the building Iocaied in a Coe stat Barner Resources System (CBR& area of Otherwise Piotected Area (OPA)? _ ❑ Yes ® No Designation Date:._—_- LlCBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl Budding elevalions are based o1. ❑ Construction Drawings' LJ Building Lorider Construction' ® Finished Construction 'A naw Elevation Certificate w+li he required when construction of the building is complete C2. Elevations- Zones At -A30, AE, AH, A (with BFE), VE, V1 -V30, V {with BFE'). AR, ARIA, ARAE, ARIA1-A30. ARlAH, ARlAO, Complete Iterns C2.a-h below according to the building diagram specified in Item A7 in Puerto Rico only, enter meters Benchmark Utilized: local VertiCa€ Daum NAVD 1983 Indicate elevation datum used for the elevations in dems a) through h) below ❑ NGVD 1929 0 14AVD 1988 ❑ Otherlsource Datum used for building elevations most be the same as that used for She BFE. a) Top o1 bcltom floor (includine basement crawlspace, of enclosure floor) U) Top of tho next higher floor C) Bottom Q` the lowest horizontal structural member (V ZonE:S only) d) Attached garage (top of slab'. e) Lowest e,evatlon of machineiy or equipment servicing the building (Describe type of equipment and location in Comments) 1) Lowest adjacent (finished) grade next 10 building (LAG) g) Highest adjacent (finished) grade next to budding (HAG) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support SECTION D - SURVEYOR, ENGINEER, OR ARCHITt_CT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized ay law to certify elevation information. 1 c,,rfify that the information on this Cerfirjcate represents my Best efforts to rnterpret the data available. I r,nderstand that any false statement may be punishable by lifw or „nprrsonmemf under 18 U S Code, Section 1001 ® Check here ifcomments are fTovided on back of form. Were latitude and longitude in {section A provided by a ® Check here if attachments. licensed land surveyor? M Yes ❑ No e --- y---Re--ynol..._.ds _ - Certifier's Name S. Whitl I icense Number 2249 Title Land Suioeyor Company Name _ r� Address F36 3tepheri -1 Avenue City Savannah State GA ZIP Cede 31405 Signature _ Date 3110,16 Telephone 912-352-0464 FEM� A o 036-0-33 (7112) See reverse side fol continuation Replaces all previous editions Check the measurement used 102 © feel ❑ meters 19 9 0 feet 0 motors feet ❑ meters n1a. 10 feet ❑ meters 11) 1 ® feet ❑ meters 98 ® teet ❑ meters 101 9 feet ❑ meters 9 B. ® feet ❑ meters SECTION D - SURVEYOR, ENGINEER, OR ARCHITt_CT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized ay law to certify elevation information. 1 c,,rfify that the information on this Cerfirjcate represents my Best efforts to rnterpret the data available. I r,nderstand that any false statement may be punishable by lifw or „nprrsonmemf under 18 U S Code, Section 1001 ® Check here ifcomments are fTovided on back of form. Were latitude and longitude in {section A provided by a ® Check here if attachments. licensed land surveyor? M Yes ❑ No e --- y---Re--ynol..._.ds _ - Certifier's Name S. Whitl I icense Number 2249 Title Land Suioeyor Company Name _ r� Address F36 3tepheri -1 Avenue City Savannah State GA ZIP Cede 31405 Signature _ Date 3110,16 Telephone 912-352-0464 FEM� A o 036-0-33 (7112) See reverse side fol continuation Replaces all previous editions ELEVATION CERTIFICATE, pac;e 2 IMPORTANT: In these spaces, copy the corresponding information from Section A Building Street Acdress (including Api., Unit, Suite andlor Bldg- No ) or P O. Route and Box No City Stale GA ZIP Code FOR INSURANCE COMPANY USE Policy Number: Company NAIC Numbor. SECTION D - SURVEYOR, ENGINEER, OF; ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this ESevatlon Certificate for (1) community official. 12) insurance agenb'company, and (3) building owner. Comments C2.a) is AIC pad Signa T .. Dale 3110116 SEC ON E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO acrd A (without 8FE), complete Items E1 -E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A g and C. For Items E i -E4, use nature grade, if available- Check the measurement used. In Puerto Rico only, enter meters EL Provide elevation information f•3r the following and check the appropriwe 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 tee) ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is _-- [l feet ❑ meters ❑ above or ❑ below the LAG E2 For Building Diagrams 6-9 with permanent Mood openings provided in Section A Items 8 andlor 9 (see pages 8-9 of Instructions), the next higher floor (elevation 17.2 b in the diagram;) of the building is __ ❑ feel ❑ meters ❑ above or ❑ below the IIAG €3 Attached garage (top of slab) is __ I =1 feet [-I meters C above os ❑ below the HAG E4 Top of platform of machinery andlor equipment seMcing the budding is E] feet ❑ meters ❑ above or ❑ below the HAG - E5. Zone AO oniy. If no flood depth number is available, is the cop of the bottom floor elevated rr, acccrdance with the community s floodplain management ordinance? ❑ Yes U1 No LJ Unknown '1 he Ictal ofbc.al irwsl Certify :his utformation in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sectio-ra`. A. 3 and F for Zone A (without a FEMA -issued or community -issued BFE) or Zone AO mus sign here. The statements in Sections A, R, and F are correct to the best of my kniowledge. --..__... _ T — -- — -- — �. Property Owners or Owner's Author zed Representative's Name Address City Stale ZIP Code �- Signature Cate Telephone Comments - - ❑ Check here if attachments _ SECTION G - COMMUNITY fNFORMATION (OPTIONAL) The local officsal who is authorized by Aw or ordinance to administer the community's floodplain management ordinance can complete Sections T7 C (or E), and G of this Elevation Certificate. Complete the applicable items) and sigr below, Check the measurement used in Items G8-GiD In Puerto Rico only, enter meters G1 ❑ the information in Section C was taken from other docurnentation that has been signed aqd sealed by a licensed surveyor, engineer, or architect who is authorized bylaw to cerliry elevation information. (Indicate the source anc date of the elevation data in the Comments area below) G2 ❑ A community official completed Section 1= for a building located in Zone: A (wrtnoul a FEMA -issued or cornniunity-issued BFC) of Zone AO G3. ❑ The following information (gems G4 -G40) is provided for community floodplain manadument purposes G4. Permit Numaer G5. ❑ate Permit Issued I G6. hale Certiticate Of CornpliancelOccupancy Issued G7. This permit -ras been issued for ❑ New Construction C Substantial Improvement— G8. Elevation of as -built lowest floor (including basement) of the building ❑ feet ❑ meters Datum G9 8FF or (in Zone AO) depth of flooding at the building site: _.. _ ❑ legit ❑ rneters Datum G10. Community's design flood elevation _ ❑ feet ❑ meters Datum _-- Local Official's Name Community Name Signature Comments Title ------- -- ---- Telephone Date - ---- Date ___—___❑Check. here_____ if�ttachrlrents FEMA Form 086-0-33 {7112) Replaces all previous editions. ELEVATION CERTIFICATE, page 3 Building Photographs See instructions for Item AS 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 Route and Box No Policy Number: 3 121h. Street City Tybee Islar.d State GA 71P Code 31328 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" arid "Leif side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section Ata If subm tting more photographs than will fit on thts nage, use the Continuation Page Front View iVarch 9, 2016 I FEMA Form 086-0-33 (7112) Replaces alf previous editions. ELEVATION CERTIFICATE, page 4 Building Photographs Continuation Page IMPORTANT: In these spaces, copy the corresponding information from Section A. ----_ – _--.. r... _ ._.�— _ FOR INSURANCE CC iMPANY USE Building Street Address {including Apt., Unit, Suite, and/or Bldg Na.) or P t]. Route and Sox No 3 12'" Street Policy Number: F-City Tybee Island ~� — �~ State GA Cade 3i 328 Company NAIL Number. hf-submitting more photographs than will fit on the preceding pagO, affix the additional photographs below. Identify all plo0109raphs 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 exarnples of the flood openings or vents, as indicated in Section Atf. Rear View MlTrch rl FEMA Form 086-0-33 (7/12) Replaces all previous editions.