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Home My Public Portal AboutCAMPBELL AV_3.pdfU.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY Marional Flood Insurance Program Impt,.-dnt: Read the instructions on pages 1-h. SECTION A - PROPERTY INFORMATION Al. Building Owners Name RMC OMB No. 1660-0008 Expiration Date: July 31, 2015 FOR INSURANCE COMPANY USE A2. Building Street Address (including Apt., Unit, Suite, andlor Bldg. No_) or P.O. Route and Box No. Company MAIC hlumtoer: 3 N Campbell Street City Tybee Island State GA ZIP Code 31328 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc_) Lots 17, 18, 19, 38, 39, 40 and 41, Foft Ward, Tybee; Tax Parcel Number 4-0003-02-012 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Re ii A5. Latitude/Longitude: Lat. 32'00'58.2"N Long. 80'50153.2'W Horizontal Datum: ❑ NAD 1927 0 NAI? 1983 A6. Attach at least 2 photographs of the build)ng If the Certificate is being used to obtain flood insurance. AT Building Diagram Number 18 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) Na sq ft a) Square footage of attached garage n/�r sq ft b) Number of permanent flood openings in the crawlspaoe b) Number of permanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade n/a within 1.0 foot above adjacent grade n/a c) Total net area of flood openings in A8.b nla sq in c) Total net area of Hood openings in A9.b n/a sq in d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes ❑ No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name -- - ( B3. State City of Tybee island 135164 Chatham Georgia B4. Map/Panel Number 85. Suffix 66. FIRM index Bate 87. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 13051C/0213 F 09/26/2008 EffectivelRevised Date Zones) AO, use base flood depth) 09/26/2008 AE 11 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 139. ❑ FIS Profile 0 FIRM ❑ Community Determined ❑ Other/Source. B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ® NAVD 1988 ❑ Other/Source: 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes No Designation Date: ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. 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. Elevations --Zones Al A30, AE, AH, A (with BFE), VE, Vi -V30, V (with BFE), AR, ARIA, AR1AE, AR1AIA30, ARIAH, AR1AO. Complete Items C2.a-ti below according to the building diagram specified in Item AT In Puerto Rico only, enter meters. Benchmark Utilized: NQS Mgnwment E 6 Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 ® NAVD 1,988 13 Other/Source: Datum used for building elevations must be the same as that used for the BFE. 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) f) 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 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. l certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishabie by fine or imprisonment under 18 U.S. Code, Section fool.!� .01 ® Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a V QST ❑ Check here if attachments. licensed land surveyor? ® Yes ❑ No Q�' Certifier's Name Robert K. Morgan, III License Number Ga. RLS#3087 Title Principal Company Name Morgan Land Surveying, LLC► Address 104 Regalours City Savannah State GA ZIP Code 31410 '91 k� Signature ZAAV-Ad, - Date !j(j 11LA1-2 Telephone 912-658-4302 FEA/1A Form 068-0-33 (7112) See reverse side for continuation. Replaces all previous editions. Check the measurement used. $.oe ® feet ❑ meters Na. ❑feet ❑ meters P& ❑ feet ❑ meters Na. ❑ feet ❑ meters 5.84 El feet ❑ meters 5.8 ® feet ❑ meters 8.0 ® feet ❑ meters nom. ❑ 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. l certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishabie by fine or imprisonment under 18 U.S. Code, Section fool.!� .01 ® Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a V QST ❑ Check here if attachments. licensed land surveyor? ® Yes ❑ No Q�' Certifier's Name Robert K. Morgan, III License Number Ga. RLS#3087 Title Principal Company Name Morgan Land Surveying, LLC► Address 104 Regalours City Savannah State GA ZIP Code 31410 '91 k� Signature ZAAV-Ad, - Date !j(j 11LA1-2 Telephone 912-658-4302 FEA/1A Form 068-0-33 (7112) See reverse side for continuation. Replaces all previous editions. LEVATION CERTIFICATE, page 2 IMPORTANT: In these spaces, copy the con onding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No. Policy Number: 3 N Campbell Street City Tybee Island State GA ZIP Code 31328 Company NAIC Number SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy troth sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments The elevation shown in item C2.e is for top of concrete A/C equipment pad located in the rear of the building. Signature Date 4P/;7 -,?/Z0 — /;7-,?JZR !-3 SECTION E — BUILDING ELEVA]fION INFORMATION JSURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1—E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items EI—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. Ell. 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, crawispace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG_ b) Top of bottom floor (including basement, crawispace, or enclosure) is ❑ feet ❑ meters ❑ 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 ❑ feet ❑ meters ❑ above or ❑ below the FLAG, E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG_ E5. 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 i= — PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owners authorized representative who completes Sections A, B, and E for Zone A (without a FEMA -issued or community -issued SFE) 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 Check here if attachment) SECTION G — COMMUNITY INFORMATION (OPTIONAL) 'rte local official who is authorized bylaw or ordinance to administer the community's floodplain management ordinance can complete Sections A, 8,T (or E), and G if this Elevation Certificate. Complete the applicable ttem(s) and sign below. Check the measurement used in Items G8—G1 0. In Puerto Rico only, enter meters. '1. ❑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 taw to certify elevation Information. (indicate the source and date of the elevation data in the Comments area below.) ,2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO - 1 O_ 33. ❑ The following information (Items G4—G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit issued G8. Date Certificate Of Compliance/Oocupancy Issued '7. This permit has been issued for, ❑ New Construction ❑ Substantial Improvement ;8_ Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters Datum a9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum 110. Community's design flood elevation: ❑ feet ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Datc Comments Check her if attachm n . 'EMA Form 086-0-33 (7112) Replaces all prevlous editions. ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6. IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 3 N Campbell Street City Tybee Island State GA ZIP Code 31328 FOR INSURANCE COMPANY USE Policy Number: 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" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. 0 FRONT VIEW (0612912013) REAR VIEW 13 -EMA Form 086-0-33 (7112) Replaces all previous editions.