The URL can be used to link to this page

Home My Public Portal AboutSECOND PL_5.pdfFEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Read the instructions on pages 1.7 O.M.B. No. 3067-0077 Expires December 31, 2005 SECTION A - PROPERTY OWNER INFORMATION For Insurance Company use: BUILDING OWNER'S NAME Policy Number RODNEY L. VINING BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company MAIC Number 5 SECOND PLACE CITY STATE ZIP CODE TYBEE ISLAND, GA 31328 PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 10 OF A SUBDMSION OF LOTS 19 & 20, BLOCK 4, WARD 1 BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.) RES LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): - ##.##" or ##.##MW) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. N—AP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE TYBEE ISLAND 135164 CHATHAM GA B4. MAP AND PANELB7, FIRM PANEL o a) Top of bottom floor (including basement or enclosure) 12. 9 ft(m) B9. BASE FLOOD ELEVATIONS) NUMBER 135. SUFFIX B6. FIRM INDEX DATE EFFECTIVEIREVISED DATE 138. FLOOD ZONE(S) (Zone A0, use depth of flooding) 135164 0001 C 6/17186 6117/86 A8 16 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. ❑ FIS Profile ® 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 6 (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, ARIA, ARIAE, AR/A1-A30, ARIAH, ARAO Complete items C3.-a� 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 of Section G, as appropriate, to document the datum conversion. Datum NGVD 29 ConversioNComments _ 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) 12. 9 ft(m) v CyF,OR G 19 o b) Top of next higher floor 22.P.0) X18 T� o c) Bottom of lowest horizontal structural member (V zones only) NA.. fl.(m) 00 o d) Attached garage (top of slab) 12. 9 ft.(m) 1 EUWJ o e) Lowest elevation of machinery and/or equipment v e 9 servicing the building (Describe in a Comments area) 19. 0 ft.(m) E A o f) Lowest adjacent (finished) grade (LAG) I'-. AfL(m) v 6 10� SURy'' o g) Highest adjacent (finished) grade (HAG) 12. 4 ft.(m) v '71 o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 1 o 1) Total area of all permanent openings (flood vents) in C3.h 119 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. I certify that the information in Sections A, 8, 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, CERTIFIERS NAME J. WHITLEY REYNOLDS LICENSE NUMBER 2249 TITLE LAND SURVEYOR COMPANY NAME 636 ST SIGNA FEMA Form 01-31, Jrhuary 2003 CITY SAVANNAH DATE 4/11106 See reverse side for continuation. SIAIE LING[ GA 31405 I tLiz rHUNt 912-3524464 Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A, For Insurance Company Llse: BUILDING STREET ADDRESS (Including Apt, Unit, Suite, andlorBkig. No.) OR P.O. ROUTE AND BOX NO, Policy Number 5 SECOND PLACE - CITY STATE ZIP CODE Company NAIC Number TYBEE ISLAND, GA 31326 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 E4 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 buR ing, provide a sketch or photograph.) E2. The top of the bottom floor (induding basement or enclosure) of the building is _ ft.(m) win.(an) ❑ above or El Mow (check one) the highest adjacent grade, (Use natural grade, 9 available). E3. For Building Diagrams 6-8 with openings (seepage 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 C3.1 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, it available). E5. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance vrrth 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 FEMAissued or community - issued BSE) or Zone AO must sign here. The statements in Sections A, B, C, and E are correct to the best ofmyknoWedge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local offidai 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 Rem(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 fn the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (Wthout a FEMA�ssued or communityissued 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 (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 U Check here if attachments FEMA Form 81-31, January 2003 Replaces all previous editions