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Home My Public Portal AboutFIRST ST_725B.pdfCITY OF TYBEE ISLAND CERTIFICATE OF OCCUPANCY DATE COMPLETED: 12/05/2014 This Certificate issued pursuant to the requirements of the Standard Building Code Certifying that at the time of issuance this structure was in compliance with the various ordinances of the Jurisdiction regulating building construction or use. PERMIT #: PROPOSED USE: OCCUPANCY TYPE: CONTACT NAME CONTACT ADDRESS CONTACT CITY STATE ZIP PROPERTY ADDRESS APPROVED BY: 130438 INTERIOR RENOVATIONS - COMMERCIAL P CHU, LLC PO BOX 449 TYBEE ISLAND GA 31328 725 FIRST ST #B e * PROPOSED PAVER INSTALLATION REQUIRES A SEPARATE PERMIT/PLAN OUTDOOR SEATING NOT ALLOWED UNLESS APPROVED BY CITY COUNCIL BOLLARDS REQUIRED AT LP TANK IF VEHICULAR TRAFFIC PATTERN IS ROUTED TO THAT AREA P. O. Box 2749 - 403 Butler Avenue, Tybee Island, Georgia 31325 (912) 756-4573 - FAX (912) 786-5737 www.cityoftybee.org r4ot;"�k w-ml City of Tybee Island Community Development Dept. ►�� Inspection Report403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 31328,. Phone 912.472-5032 • Fax 912.786.9539 C%ODECOUNC L MEMBER Permit No. Date Requested Owner's Name Date Needed Gen. Contractor Subcontractor Contact Information Project Address r- - Scope of Work Inspector Date of Inspection Inspection Pss Fail Fee Inspection Pass ❑ Fail ❑ Fee Inspection Pass ❑ Fail ❑ Fee Inspection Pass ❑ Fail ❑ Fee CHATHAM COUNTY DI RTMENT OF BUILDING SAFETY _AGULATORY SERVICES FIRE SAFETY INSPECTION DIVISION FOR THE CITY OF TYBEE ISLAND YEAR OF / ('�APPROVED DATE DISAPPROVE You are hereby notified that this is an Official Order of the County Fire Marshall, stating the defects found to exist in the referenced structure, and further requiring that you, as owner, agent or person in charge of structure, shall have days to complete specified repairs or improvements. Business Phone Occupant Load _ Name of Facility Address Owner Occupancy: �-Business Assembly Storage Personal Care Home Mercantile Factory 1. Number of Exit Doors Educational Day Care Residential Hazardous 2. Blocked Locked OK ✓ r1 p� M✓vO K "j 3. Exit Sign Good 00 Unsatisfactory _� NA 4. Emergency Lights Good co Unsatisfactory ✓ NA 5. Panic Hardware Good , e"' Unsatisfactory NA 6. Self -Closing Device Good _ V,' Unsatisfactory NA 7. Fire Alarm Yes No ✓ NA 8. Smoke/Heat Detectors Yes_ No NA 9. Sprinkler System Yes No ✓ NA 10. Standpipe Yes No �— NA 11. Number of Fire Extinguishers �3 Proper Type? X s Inspected/Charged Yes _ No NA 12. Fixed Hood System Yes �6/ No NA 13. Date of Last Service o V Z -ZDi (REQUIRED EVERY 6 MONTHS) 14. Electrical Good Fair Unsatisfactory 15. Overloaded Sockets/Outlets Yes No ✓ 16. Missing Electrical Covers Yes No 17. Other (explain) 18. Excessive Storage of Combustibles Yes No List Details 101 -SEC 5 101 -SEC 5 101 -SEC 5 101 -SEC 5 101 -SEC 5 NFPA 72 NFPA 73 NFPA 13 NFPA 13 NFPA 10 NFPA 10 NFPA 96 NFPA 70 NFPA 70 NFPA 70 NFPA 30 The signatur�ee below of Owner, Occupant, Agent, signifies Inspection was made. '1141;� Owner/Occupant/Agent Signature Chatham County Fire Marshall CADocrrnrents and SeltingsVIMMY\Desktop\City Tybee 3 PartVire Inspection Fonn.doc le 000 ( r1 p� M✓vO K "j �j►'jr/sp rr C.�f%.�i� � � jl�f C�e,., L. d f'ri /'0v' ! �.. I'CS.1 rl'�B•' /��0/1' y l+�/ 101 -SEC 5 101 -SEC 5 101 -SEC 5 101 -SEC 5 101 -SEC 5 NFPA 72 NFPA 73 NFPA 13 NFPA 13 NFPA 10 NFPA 10 NFPA 96 NFPA 70 NFPA 70 NFPA 70 NFPA 30 The signatur�ee below of Owner, Occupant, Agent, signifies Inspection was made. '1141;� Owner/Occupant/Agent Signature Chatham County Fire Marshall CADocrrnrents and SeltingsVIMMY\Desktop\City Tybee 3 PartVire Inspection Fonn.doc Georgia Department of Community Health PERMIT APPUCATION FOOD SERVICE ESTABLISHMENTS C AND MOBILE FOOD SERVICE OPERATIONS Name of FadllW. U #' G'O 5+LQ"1�U�2 Faeili#y# Check riate Blocks: Ll mobile Food Service ❑ Food Service Establishment ❑ Catering Operation NNew 0 Change of Owner ❑ Plans ❑ Renovation of Existing ❑ Equipment hist ❑ Menu ❑ Multi -Service ❑ Single Service ❑ Bar Only Supporting Doeumen"on: ❑ Plan Review Checklist ❑ Food Preparation Review ❑ Construction Review Food Service Risk Cattegod7ati0n: ❑ Risk Type i ❑ Risk Type IIARisk Type IIUHACCP Plan Address of Facility: i [' LJ 'R� � 5 - C... C (Street, Highway, of RED) (City) (County) Clip Code) Physical Location of Mobile Unit(s) if Applicable: (Countries in which mobile units will operate) BusinessOt�vnershW , f -Tf Phone:°�) (Individual, Association, Partnership, Corporation or Legal Entity) tnj(Street, Highway, or RFD) (City) (County) (State) (Zip Code) 0'�aqA� The undersigned hereby applies for a permit to operate a food service establishment pursuant to 0-C.G.A. 26-2,371-373, et seq, and hereby attests to the accuracy of the information provided in on the application and affirms to comply with the Rules and Regulations for Food Service, Chapter 240-5-14, Georgia, DCH. tt� Applicant's Name: 1 Address: (Street, Highway, or RFD) Appllcetuts CC',), C1nr !-nr'm 't?) $ (City) (County) (State) (;Lip Code) Date t 13 ) %4 Approval of these plans and specifications by this Regulatrity Authority does not indicate compliance with any other code, law or regulation that may be required (Le., federal, state, or local)_ Furthermore, it does not corutitute endorsement or acceptance of the completed establishment (structure or equipment). A reopening inspection of the establishment, with equipment in place and operational, will be necessary to determine if it complies with the local andllstate laws governing food service establishments, Regulatory Authority: APPROVAL. w DATE: Permit Restriction DISAPPROVAL: DATE: Reason(s) for Disapproval: GEDRem DWAffW'— OF PUBLIC HEftTH Food arww Exts" bWP-U n RIW r! TESUMIshowd Hum s v A B 5 aty f Yflrr'." Tlm• in: ,�,w TInr Bt+� Ant w up•Cam Date: _! Y GF8M . urpm - - of In-p-cUm M ftw i Roa" 0 Foliaw.up 0 T pgary 0 Rork T"m: 1 0 s 0 3 0 P•rrnEti W Lb Flwbn w Pm66�� Pm'� � Y+� Good RvW P#m:d • u.r e.r du.le.a M"GOMM WwI I bt..Qwiwfl0FD%W..* pnrWlb mN/ ftso IY011M A.Z. Rub9e NNNh M or.. ..-mm wy� doft m sd yes 0 Wo 3! .amu Jv.. , w.. - -_.. ; J..._ `,_G.A,�� _'� __.. ❑�0❑ . .,I k . A t . •.j't • o� EVEN To MIT Ulm ... �02181 ONEo0 109910c]= MINES+7p o0 orn on :;�• n : : oQa�a '.MW ,l.:y ilJi �'`v'!�'•-JA.J? c I"r -•- ■❑000 NEE -.x-`+[ty.r•+, it �. r 1. i' � Imo• :J L• .I �. 1 :.'k �� 19 ISO so a..K 1';r•,4.:.�uL�.:lk.:1:.:''-ii low - - _��f�`- .li ��y'iii'r •." i. �..'��n�_"ice., _ �','�n1 SIM NUNN P mlmm��=E MUM low +w ..:�t... :'i.;:: -.i. "•AJ. .J ''.1�-. ---.. R_.� 1.:J M LULU =0 4 �� OWN WA 149 "a DI [sj to Wel �.. _.-.... .. -- _. �� r.� �. - .. -. ..--. ►.:rte m sd yes 0 Wo 3! Permit No. Owner's Name Gen. Contractor City of .h ,.jee Island • Community Develop...ent Dept. Inspection Report 403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 31328 Phone 912.472-5032 • Fax 912.786.9539 Contact Information Project Address Scope of Work Inspector Inspection Inspection Date Requested Date Needed Subcontractor Date of Inspection Fail F� Fee Fail ❑ Fee INTERNATIONAL CODE COUNCIL MEMBER Inspection Pass r-1F-1F-1Fee �— /L.! �CJ'7r /y LlJli ..f..J.JL ;7c�•ti)�-:Jf.�. /�`,Y]/c�c:.�✓.../x_� .r � � VI/�� Inspection Pass ❑ Fail ❑ Fee City of I ,.wee Island - Community Develop, nt Dept. Inspection Report 403 Butler Ave. - P.O. Box 2749 - Tybee Island, GA 31328 ==�• Phone 912.472-5032 - Fax 912.786.9539 CODE COUNCIL Permit No. Owner's Name Gen. Contractor Contact Information Project Address Scope of Work Inspector Inspection Date Requested Date Needed Subcontractor Date of Inspection Pass ❑ F Fee Inspection PassElFail ❑ Fee 5 Inspection Inspection Pass ❑ Fail ❑ Fee Pass ❑ Fai Fee MEMBER y City of Tybee Island . Community Developm. -t Dept. Inspection Report 403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 31328 ==ter NTERNATIONAL Phone 912.472-5032 • Fax 912.786.9539 CODE COUNCIL MEMBER Permit No. Owner's Name Gen. Contractor Contact Information Project Address Scope of Work Inspector Inspection Inspection Inspection Date Requested Date Needed _ Subcontractor Date of Inspection Pass Pass ❑ Pass ❑ Fail9d Fe 0 Fail ❑ Fee Fail ❑ Fee Inspection Pass ❑ Fail ❑ Fee Permit No. Owner's Name l City of Tybee Island • Community Developrt.�nt Dept. Inspection Report 403 Butler Ave. - P.O. Box 2749 • Tybee Island, GA 31328 Phone 912.472-5032 - Fax 912.786.9539 Date Requested Date Needed INTERNATIONAL CODE COUNCIL MEMBER Gen. Contractor Subcontractor - + Contact Information Li Project Address Scope of Work Inspector Inspection Inspection Inspection Date of Inspection Pass Fail ❑ Fe Pass ❑ Fail ❑ Fee Pass ❑ Fail ❑ Fee Inspection Pass ❑ Fail ❑ Fee a City of Tybee Island • Community Development Dept. �� wl Inspection Report 403 Butler Ave. - P.O. Box 2749 - Tybee Island, GA 31328 ==�' Ilk,�,�'� Phone 912.472-5032 • Fax 912.786.9539 CODECO'uNCii MEMBER Permit No. •-0430 Owner's Name N 140_1 L L 21414 Gen. Contractor Q 38 � L40Ns r Contact Information Project Address Scope of Work 7-e Date Requested 190% ISIAl Date Needed aq ,::,2 /A/ Subcontractor Inspector Date of Inspection Inspection`NS f SLI N Pass Fail Fee r� �1L t__iA� j• J / � • i Inspection Pass ❑ Fail ❑ Fee Inspection Pass ❑ Fail ❑ Fee Inspection Pass ❑ Fail ❑ Fee City of Tybee Island • Community Development Dept. Inspection Report 403 Butler Ave. - P.O. Box 2749 - Tybee Island, GA 31328 2- mow o.. Phone 912.472-5032 - Fax 912.786.9539 CODECOUNNAL MEMBER Permit No. Date Requested Owner's Name Date Needed Gen. Contractor Subcontractor Contact Information Project Address Scope of Work Inspector Inspection Date of Inspection '7 c� Pass Fail ❑ Fee Inspection 114 r ' - Pass Favi Fee Inspection Inspection -4" PassFail ❑ Fee ELI � Pass ❑ Fail ❑ Fee Fax Transmission Result Rep Date/Time Model Name Machine Serial Number Line Line I Name Line2 Line2 Name 07-17-2014 09:04 AM CLX -9352 Z94U$1 ED500022H City of Tybee 9127869539 is not available is not available Page [1 ] of [1 ] Job Destination Start Time Duration Mode Job Type Page User Result 16401 Georgia Power rele07-17-2014 09:03 00'59" G3 H -Tx 111 ase118888514411 AM 2 Tybee Island, GA GEORGIA POWER RELEASE FOR ELECTRIC SERVICE PHONE: 1-888-748-6843, Press 1, Extension 32855 or 32856 FAX: 1-888-851-4411 Location Address:�Z t7i t'rfZS; /_.-_ Release Date: 7f Type of Release: ��_Temppofrrrar_y// ✓ Permanent Permit p /v ElecWclan: 40116 )"I e— _ PhonQ # _p Builder: — an,—aa' l'.a".'Lzj Phone ll 2:en dSZ •A/6k3 Owner: Phone # (location Address: Release Date: Type of Release: Temporary Permanent Permit # Electrician; Phone # Builder: Phone # [ Owner: Planning and Zoning !erns Bryant 912.472.5033 Phone # LocalUser OK H -Rx: Host Rx M -S: Memory Save P -Rx: Poll Rx D -Tx: Delay Tx H -Tx: Host Tx S -Rx: Secure Rx P -Tx: Poll Tx BC -Tx: BroadCast Tx I v r o9 --- --- Tybee Island,, GA GEORGIA POWER RELEASE FOR ELECTRIC SERVICE PHONE: 1-888-748-6843, Press 1, Extension 32855 or 32856 FAX: 1-888-851-4411 Location Address: Release Date: z Type of Release: Temporary vl-xpermanent Permit # Electrician: 4"71)F.-5 G l L Phone # Builder: 7LJ J Phone # 2 v 40SZ: Owner: Location Address: Type of Release: Temporary Permanent Phone # Release Date: Permit # Electrician: Phone # Builder: Owner: Planning and Zoning Jerris Bryant 912-472-5033 Phone # Phone # City of Tybee Island - Community Development Dept. Report Inspection Ins Re � p p r F 403 Butler Ave. - P.O. Box 2749 - Tybee Island, GA 31328 li City of Tybee Island • Community Development Dept. Inspection Report, 403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 31328 =MSG Phone 912.472-5032 • Fax 912.786.9539 cOOE"couNci MEMBER Permit No.-� Owner's Name �, C, Gen. Contractor#14 Contact Information Project Address Scope of Work Date Requested Date Needed Q 3 Subcontractor C Inspector / Date of Inspection Inspection ( f1S L 14") Pass 0 Fail r-1 Fee V's Inspection Pass ❑ Fail ❑ Fee Inspection Pass ❑ Fail ❑ Fee Inspection Pass ❑ Fail ❑ Fee City of Tybee Island - Community Development Dept. Inspection Report MITA` p p 403 Butler Ave. - P.O. Box 2749 - Tybee Island, GA 31328 ==ft• Phone 912.472-5032 - Fax 912.786.9539 CODECOUh iL MEMBER Permit No. - Q Owner's Name ` kl a `Z Gen. Contractor J w covS'7" Contact Information C� tli'1 Date Requested hi -I Date Needed e3 h321eZ Subcontractor Project Address �J� a TCI RST S7- Scope TScope of Work fC'--1U0 d4 ie AJ -T-6 D �Q Inspector Date of Inspection -%d Inspection `r' Pass 1:1 Fail ❑ Fee / J 4 Inspection Pass ❑ Fail ❑ Fee Inspection Pass ❑ Fail ❑ Fee Inspection Pass ❑ Fail ❑ Fee CITY OF TYBEE ISLAND BUILDING PERMIT DIFFERENCE BETWEEN 1" METER AND %" METER DATE ISSUED: 09-17-2013 PERMIT #: 130438 WORK DESCRIPTION WORK LOCATION OWNER NAME ADDRESS CITY, ST, ZIP PHONE NUMBER CONTRACTOR NAME ADDRESS CITY STATE ZIP I y 1C/Z43 MAIM N BUILDING VALUATION SQUARE FOOTAGE OCCUPANCY TYPE TOTAL FEES CHARGED PROPERTY IDENTIFICATION # PROJECT VALUATION INTERIOR RENOVATIONS 725 FIRST ST B CHU,LLC PO BOX 449 TYBEE ISLAND GA 31328-0449 BOBBY CHU CONSTRUCTION CO INC 1A 6TH STREET TYBEE ISLAND GA 31328 U $1,072.40 PIN #4-0003-02-012 $69,200.00 TOTAL BALANCE DUE: $ 268.40 It is understood that if this permit is granted the builder will at all times comply with the zoning, subdivision, flood control, building, fire, soil and sedimentation, wetlands, marshlands protection and shore protection ordinances and codes whether local, state or federal, including all environmental laws and regulations when applicable, subsequent owners should be informed that any alterations to the property must be approved by the issuance of another building permit. Permit holder agrees to hold the City of Tybee Island harmless on any construction covered by this permit. This permit must be posted in a conspicuous location in the front of building and protected from the weather. If this permit is not posted work will be stopped. The building contractor will replace curb paving and gutter broken during construction. This permit will be voided unless work has begun within six months of the date of issuance. Signature of Building Inspector or Authorized Agent: P. O. Box 2749 - 403 Butler Avenue, Tybee Island, Georgia 31328 (912) 786-4573 - FAX (912) 786-9539 www,cityoftybee.org 4 ` �fg, � City of Tybee Island Community Development Dept. ` Inspection Report - 403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 31328 MJjk -=M �,. Phone 912.472-5032 • Fax 912.786.9539 CODECC OUN R MEMBER Permit No. /-�- &�/51 Owner's Name ep 4 LG Gen. Contractor&gvel-1w (opi/t r Contact Information Project Address /P?6' Scope of Work Date Requested e1h --?h Date Needed Subcontractor Inspector ! 1 Date of Inspection / Inspection &A/ Pass Fail ❑ Fee ? 1A -S f Inspection r -r7 P Pass Fail ❑ Fee Inspection Pass ❑ Fail ❑ Fee Inspection Pass ❑ Fail ❑ Fee City of Tybee Island • Community Development Dept. Inspection Report 403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 3132$ M!M • Phone 912.472-5032 Fax 912.786.9539CODE p'UNCIL MEMBER Permit No. Date Requested Owner's Name Date Needed Gen. Contractor Subcontractor ALL -..-j Contact Information Project Address -i Scope of Work = r Inspector Inspection Inspection Inspection Inspection Date of Inspection _ Pass Fait/ ❑ Fee Pass ❑ Fail ❑ Fee Pass ❑ Fail ❑ Fee Pass 11 Fail ❑ Fee CITY OF TYBEE ISLAND BUILDING PERMIT WATER METER PICKUP DATE ISSUED: 09-17-2013 WORK DESCRIPTION WORK LOCATION OWNER NAME ADDRESS CITY, ST, ZIP PHONE NUMBER CONTRACTOR NAME ADDRESS CITY STATE ZIP FLOOD ZONE BUILDING VALUATION SQUAREFOOTAGE OCCUPANCY TYPE TOTAL FEES CHARGED PROPERTY IDENTIFICATION # PROJECT VALUATION ONE (1) INCH METER INTERIOR RENOVATIONS 725 FIRST ST B CHU,LLC PO BOX 449 TYBEE ISLAND GA 31328-0449 BOBBY CHU CONSTRUCTION CO INC 1A 6TH STREET TYBEE ISLAND GA 31328 U $1,072.40 PIN #4-0003-02-012 $69,200.00 TOTAL BALANCE DUE: PERMIT #: 130438 It is understood that if this permit is granted the builder will at all times comply with the zoning, subdivision, flood control, building, fire, soil and sedimentation, wetlands, marshlands protection and sbore protection ordinances and codes whether local, state or federal, including all environmental laws and regulations when applicable, subsequent owners should be informed that any alterations to the property must be approved by the issuance of another building permit. Permit holder agrees to hold the City of Tybee Island harmless on any construction covered by this permit. This permit must be posted in a conspicuous location in the front of building and protected from the weather. If this permit is not posted work will be stopped. The building contractor will replace curb paving and gutter broken during construction. This permit will be voided unless work has begun within six months of the date of issuance. Signature of Building Inspector or Authorized Agent: Q;AA,4"11 4, Awi=t T� 61 P, O. Box 2749 - 403 Butler Avenue, Tybee Island, Georgia 31328 (912) 786-4573 - FAX (912) 786-9539 www.cityoftybee.org CITY OF TYBEE ISLAND BUILDING PERMIT DIFFERENCE BETWEEN V METER AND 3/4" METER DATE ISSUED: 09-17-2013 WORK DESCRIPTION WORK LOCATION OWNER NAME ADDRESS CITY, ST, ZIP PHONE NUMBER CONTRACTOR NAME ADDRESS CITY STATE ZIP FLOOD ZONE BUILDING VALUATION SQUARE FOOTAGE OCCUPANCY TYPE TOTAL FEES CHARGED PROPERTY IDENTIFICATION # PROJECT VALUATION INTERIOR RENOVATIONS 725 FIRST ST B CHU,LLC PO BOX 449 TYBEE ISLAND GA 31328-0449 BOBBY CHU CONSTRUCTION CO INC 1A 6TH STREET TYBEE ISLAND GA 31328 U $1,072.40 PIN #4-0003-02-012 $69,200.00 PERMIT #: 130438 TOTAL BALANCE DUE: $ 268.40 It is understood that if this permit is granted the builder will at all times comply with the zoning, subdivision, flood control, building, Fre, soil and sedimentation, wetlands, marshlands protection and shore protection ordinances and codes whether local, state or federal, including all environmental laws and regulations when applicable, subsequent owners should be informed that any alterations to the property must be approved by the issuance of another building permit. Permit holder agrees to hold the City of Tybee Island harmless on any construction covered by this permit. This permit must be posted in a conspicuous location in the front of building and protected from the weather. If this permit is not posted work will be stopped. The building contractor will replace curb paving and gutter broken during construction. This permit will be voided unless work has begun within six months of the date of issuance. Signature of Building Inspector or Authorized Agent: 11114A4-1 d zlo P. O. Box 2749 - 403 Butler Avenue, Tybee Island, Georgia 31328 (912) 786-4573 - FAX (912) 786-9539 www.cityoftybee.org CITY OF TYBEE ISLAND BUILDING PERMIT SEPARATE PERMIT FOR HOOD AND SUPPRESSION REQUIRED DATE ISSUED: 07-11-2013 WORK DESCRIPTION WORK LOCATION OWNER NAME ADDRESS CITY, ST, ZIP PHONE NUMBER CONTRACTOR NAME ADDRESS CITY STATE ZIP FLOOD ZONE BUILDING VALUATION SQUARE FOOTAGE OCCUPANCY TYPE TOTAL FEES CHARGED PROPERTY IDENTIFICATION # PROJECT VALUATION INTERIOR RENOVATIONS 725 FIRST ST B CHU,LLC PO BOX 449 TYBEE ISLAND GA 31328-0449 BOBBY CHU CONSTRUCTION CO INC 1A 6TH STREET TYBEE ISLAND GA 31328 U $ 804.00 PIN #4-0003-02-012 $69,200.00 PERMIT #: 130438 TOTAL BALANCE DUE: $ 804.00 It is understood that if this permit is granted the builder will at all times comply with the zoning, subdivision, flood control, building, fire, soil and sedimentation, wetlands, marshlands protection and shore protection ordinances and codes whether local, state or federal, including all environmental laws and regulations when applicable, subsequent owners should be informed that any alterations to the property must be approved by the issuance of another building permit. Permit holder agrees to (told the City of Tybee Island harmless on any construction covered by this permit. This permit must be posted in a conspicuous location in the front of building and protected from the weather. If this permit is not posted work will be stopped. The building contractor will replace curb paving and gutter broken during construction. This permit will be voided unless work has begun within six months of the date of issuance. Signature of Building Inspector or Authorized Agent: P. O. Bax 2749 - 403 Butler Avenue, Tybee Island, Georgia 31328 �(912) 786-4573 - FAX (912) 786-9539 www.cityeftybee.org t'o 7� �hg.� 4 Property Address: City of Tybee Island, Georgia 912-472-5033 or 912-472-5031 - Fax 912-786-9539 f� APPLICATION FOR BUILDING PERMIT ri 2 S •8 Name Mailing Address Telephone `'i Home: �J Owner Ul mac/ / /) Cell: / 7T9S Architect or Engineer a� Officer Contractor !�� Cell: /� 3 (Check all that apply) ❑ Single Family ❑ DiscoverylTearout ❑ Demolition of Structure ❑ Duplex ❑ Footprint Changes -ElOther Multi -Family units new _ square feetR Commercial units heated/cooled Details of Project: �� X•S7'%✓S C��/ mss. ��rircTre.eT✓�� V�� Estimated dost of Conruction: $ - mOar aterials + labor + profitloverhead) :/�$�it%✓$f'Gs] v3� �o� 1�/Q;,G�ZS - ��a �1%�tij Lta.1='r7r�L ��J` a f��. If applicable, attach a copy of the certified elevation certificate andlbr curve of the ro ert .' D?e�n Y p p Y P g pon thes o ftwork, sets of cons ru tion,d�awings ar�dor Wan ay,�e�rg� uir ri J fpp 6 /0 K�zGl'r�/� Year Built: Listed on National Historic Register or located within a National Historic District? Y 1 N * Buildings older than 50 years may be eligible to be listed on the State / National Register. With this designation, you may be eligible to take advantage of various tax incentive programs while preserving the heritage of Tybee Island. *Also see the Tybee Island Land Development Code Article 14: Historic Preservation Durina construction: On -sit r troo facilitt s wil be provided through�..� s.Js Construction debris will be disposed by M� �� by means of ,, I understand that I must comply with zonin flood damage control, building, fire, shore protection and wetfand ordinances, FEMA regulations and all applicable codes and regulations. I realize that I must ensure the adequacy of drainage of this property so that surrounding property is in no way adversely affected as required by Article 16, Stormwater Management. I accept responsibility for any corrective action that may be necessary to restore drainage impaired by this permi ed construe Date:9" / Signature of Applic 77 7 Printed Name "— Note: A permit normally takes 7 to 10 days to process Approvals: Signat Date Planning & Zoning Manager Building Official ' �p Water/Sewer Storm/Drainage City Manager Orn erre :(A � FEES Permit_ Inspections_ Cap Cost Rec Water Tap Sewer Stub Eng. Fees Aid to Const. ar f � 5D 1-2 �Q' 261 TOTAL j'D Chatham County Board of Assessors: 2r" 3 Property Record Card 4 -0003 -02 -017 - Page 1 of 4 2013 Chatham County Board of Assessors 4-0003-02-012 Property Record Card _ _ 3 N CAMPBELL ST TYBEE ISLAND 'APPRAISER VMMCCUEN LOTS 17, 18, 19, 38, 39, 40 &41 FORT WARD TYBEE PRB 14P 161 RMC TYBEE LLC CAMA ASMT LAST INSP 02/07/2013 APPR ZONE 000008 -Z o I t 4 314, booc1 11 f� /2 P 0 BOX 626 I POOLER GA 31322 1,117,500 1,117,500 LAND 1 97-00124 2 O +2 It j t q' boo 05f F1I? � 95-242 299 700 12,700 299,700 BLDG 2 12,700 ___ 2 3 Z q 1100 p J- 622,000 1,429,900 OBXF 7 1,429,900 Cost - MS SALES BOOK/ INS VI QU RSN PRICE PAGE X22 Dec 3740637 WD I Q 1,625,000 ;2011 GRANTOR: SEYDEN ARNOLD J JR GRANTLL:CHU ROBERT M 22 Dec 375F 560 QC I U UQ 2011 GRANTOR:CHU ROBERT M GRANTEE. -RMC TYBEE LLC 01 Jan 183G 14 QC I U UQ 11997 GRANTOR: EDWARD TOWNS & JAMES MOYE GRANTEE.T & M ENTERPRISES. INC. 101 Jan 183G 16 WD I Q QW 495,000 11997 GRANTOR: T & M ENTERPRISES, INC. GRANTLE:ARNOLD J. SEYDEN, JR. PERMITS TYPE DATE AMOUNT 120531 RN 01 Jan 2013 Camp 1,000 110096 CM 02 Feb 2012 Insp 16,400 110099 CM 02 Feb 2012 Insp 4,500 98-00012 AD 01 Jan 1999 Comp 10,000 97-00124 136631 84461 01 Jan 1998 Comp 95-242 CM 01 Jan 1997 Comp 8,935 COMMENTS: REAR STORAGEAREA 06 Dec 2012 COA PER FAX FM OWNER 12 Feb 2010 TY2010 RET VAL ENT 22 May 2003 2003, LAND REVIEW. 14 Dec 2001 2002, HCC, LAND VALUE 136630 UPDATE. 23 Apr 2001 2001, HCC, REVIEWED 136631 84461 PROPERTY. 13 May 2000 ADD CHG FORM 5-13-2000 136632 84461 SSB 20 Sep 1999 TY2000 ADD CHGE PER 622,000 TXYPR NJV 9-20-99 09 Mar 1999 98 PERMIT NEW CANOPY 15 Dec 1997 1998 NEW PIN; SPLIT OUT OF 2,146,000 4-3-2-1 & 4-3-2-4 PRB 14P 161 2007 12/15/97 EXTRA FEATURES ID# BLDG # SYSTEM DESC 136627 84461 Storage/Utility fair SAGIS It 314, 6,0a 2,0Z 1 � YL 50'70 191511 3 oa HISTORY REAR STORAGEAREA 136628 CAN ST 64 STEEL GOOD PROPERTY FUEL CANOPY 136629 CONCRETE PAVE 500 1,419,600 CONCRETE PAVING 136630 ASPHALT PAVE TO 500 327,100 ASPHALT PAVING 136631 84461 CONCRETE SLAB 6" 1,117,500 SIDEWALK 136632 84461 CONCRETE PAVE 500 COMMCATEG TRASH RECEPTICAL SAGIS It 314, 6,0a 2,0Z 1 � YL 50'70 191511 3 oa HISTORY CODES --- -. -- TOTAL PROPERTY 0002 COMMERCIAL 1,117,500 USE 1,419,600 Cama: UTA 0004 Tybee Island 327,100 NBHD 020500.00 T500 TYBEE TO 2010 1,117,500 BULL R EXEMPTIONS Cama COMMCATEG 3200 Convenience Store SAGIS It 314, 6,0a 2,0Z 1 � YL 50'70 191511 3 oa HISTORY LAND IMPR TOTAL 13,536 2012 1,117,500 302,100 1,419,600 Cama: 2011 1,117,500 327,100 1,444,600 Cama i 2010 1,117,500 327,100 1,444,600 Cama 2009 1,524,000 622,000 2,146,000 Over 2008 1,524,000 622,000 2,146,000 Over 2007 0 528.00 2,146,000 AIC 2006 1,524,000 286,500 1,810,500 Cama', 2005 1,016,000 286,500 1,302,500 Cama' 2004 464,500 262,000 726,500 Cama 2003 464,500 262,000 726,500 Cama 2002 228,500 262,000 490,500 Cama 2001 192,500 269,500 462,000 Cama 2000 192,500 164,000 356,500 Cama 1999 137,500 164,000 301,500 Cama 1998 137,500 158,500 296,000 Cama Il -Da 96 - X17 Ivo mal,,¢- �, ,",,dam,ye".eo,, j- $1'000 /3 -O-1ob . foe 4 b� tZoo r- � Qfv,fnC� ,A �-eloulla 1'r4 .t -or * b D, '-7 0 ° re- n, o:. - . DIM 1 DIM 2 UNITS QL UNIT PRICE RCN AYB EYB DT ECON FUNC SP SP% RCNLD MKT VALUE 19 8 152.00 4 7.86 1,075 1981 1981 35 269 200 24 24 576-00 3 23.50 13,536 1998 1998 25 7,580 6,800 0 0 4500.00 3 2.73 12,285 1981 1981 15 2,457 2,200 0 0 8000.00 3 1.46 11,680 1981 1981 15 2,336 2,100 0 0 528.00 3 2,96 1,563 1990 1990 35 860 800 0 0 320.00 3 3.63 1,162 2000 2000 15 360 300 ittp:llboa. chathamcounty. org/DesktopModules/ChathamCountylB oardofAssessors/PropertyRecordCard.asn... 7/10/2013 Chatham County Board of Assessors: 21' 3 Property Record Card 4-0003-02-01" 2013 Chatham County Board of Assessors Property Record Card BUILDING SECTION CONSTRUCTION TYPE 84461-1-2413 Commercial Page 3 of 4 4-0003-02-012 3 N CAMPBELL ST TYBEE ISLAND RCN AYB EYB DEP TYPE PHYS ECON FUNC OBSV 1 % TOTAL DEP % RCNLD U.FACTOR MKTVAL 274,992 1981 1990 MS 45.00 0.00 0.00 0.00 _ 45.00 151,246 .90 136,121 .----- ..--------------- .......... ....... ..-----,.......----•-••------------------------------ ..................................20 i I i �cax i sae i 6' 1 i I 6 ' 60,; A 3 nr 24OU 4 ' i 4 I 20' 20CAS n. Campy C"eme ShL 46. S28 520 i I [Click for larger picture] "TWO PIRATES TAVERN & PUB"; CONCRETE BLOCK CONSTRUCTION. LOW QUALITY INTERIOR FINISH. MOST ORIGINAL. CANOPY AREA'S ARE ROOF OVERHANG, FIRST CHATHAM ATM & DEPOSITORY MACHINES ON SITE. VM, AREA T 2400 STORIES 1.0 PERIMETER 1 SHAPE 200 1OCCUPANCIES AREA % CLASS HEIGHT QUAL 350 Restaurant 2400 100.00 C 12.00 2 00 COMPONENTS Units % QUAL C2 617 Complete HVAC 100.00 C1 892 Stud -Stucco 100.00 Zttp:llboa.chathamcounty.orgIDesktopModulesIChathamCountylBoardofAssessors/PronertvRecordCard.asn__- 7/100011 Chatham County Board of Assessors: 21" 2 Property Record Card 4-0003-02-01? 2012 Chatham County Board of Assessors Property Record Card APPRAISER VMMCCUEN LOTS 17, 18, 19, 38, 39, 40 & 41 FORT WARD TYBEE PRB 14P 161 LAST INSP 02/0212012 APPR ZONE 000008 SALES BOOK/ INS VI QU RSN PRICE PAGE 22 Dec 3740637 WD I Q 1,625,000 2011 GRANTOR:SEYDEN ARNOLD J JR GRANTEE:CHU ROBERT M 22 Dec 375F 560 QC I U UQ 2011 CRANTOR:CHU ROBERT M GRANTEE: RMC TYBEE LLC 01 Jan 183G 14 QC I U UQ 1997 GRANTOR:EDWARD TOWNS & JAMES A40YE GRANTEE:T & MENTERPRISES, INC. 01 Jan 183G 16 WD 1 Q QW 495,000 1997 GRANTOR:T & M ENTERPRISES, INC. GRANTEE.-ARNOLD J. SEYDEN, JR, Page 1 of 4 4-0003-02-092 3 N CAMPBELL ST TYBEE ISLAND RMC TYBEE LLC CAMA ASMT 7726 JOHNNY MERCER BLVD 1,117,500 1,117,500 LAND 1 SAVANNAH GA 31410 289,600 289,600 BLDG 2 12,500 12,500 OBXF 7 1,419,600 1,419,600 Cost, MS CODES. -- PROPERTY 0002 COMMERCIAL USE UTA 0004 Tybee Island NBHD 020500.00 T50D TYBEE TO BULL R EXEMPTIONS COMMCATEG 3200 Convenience Store HISTORY LAND IMPR TOTAL 2011 1,117,500 327,100 1,444,600 Cama 2010 1,117,500 327,100 1,444,600 Cama 2009 1,524,000 622,000 2,146,000 Over 2008 1,524,000 622,000 2,146,000 Over 2007 2,146,000 AIC 2006 1,524,000 286,500 1,810,500 Cama 2005 1,016,000 286,500 1,302,500 Gama 2004 464,500 262,000 726,500 Cama 2003 464,500 262,000 726,500 Cama 2002 228,500 262,000 490,500 Cama 2001 192,500 269,500 462,000 Cama 2000 192,500 164,000 356,500 Cama 1999 137,500 164,000 301,500 Cama 1998 137,500 158,500 296,000 Cama PERMITS TYPE DATE AMOUNT 110096 CM 02 Feb 2012 Insp 16,400 110099 CM 02 Feb 2012 Insp 4,500 �~ raw GAGIS 98-00012 AD 01 Jan 1999 Camp 10,000 97-00124 01 Jan 1998 Comp 23 Apr 2001 95-242 CM 01 Jan 1997 Comp 8,935 COMMENTS: 12 Feb 2010 TY2010 RET VAL ENT 22 May 2003 2003, LAND REVIEW. 14 Dec 2001 2002, HCC, LAND VALUE UPDATE. 23 Apr 2001 2001, HCC, REVIEWED PROPERTY. 13 May 2000 ADD CHG FORM 5-13-2000 SSB 20 Sep 1999 TY2000 ADD CHGE PER TXYPR NJV 9-20-99 09 Mar 1999 98 PERMIT NEW CANOPY 15 Dec 1997 1998 NEW PIN; SPLIT OUT OF 4-3-2-1 & 4-3-2-4 PRB 14P 161 12/15/97 EXTRA FEATURES - ID# BLDG # SYSTEM DESC DIM 1 DIM 2 UNITS QL UNIT PRICE RCN AYB EYB DT ECON FUNC SP SP% RCNLD MKT VALUE 136627 84461 Storage/Utility fair 19 8 152.00 4 7.86 1,075 1981 1981 35 344 300 REAR STORAGE AREA 136628 CAN ST 64 STEEL GOOD 24 24 576.00 3 23.50 13,536 1998 1998 20 6,768 6,100 GAS PUMP CANOPY 136629 CONCRETE PAVE 500 0 0 4500.00 3 2.73 12,285 1981 1981 15 2,457 2,200 CONCRETE PAVING 136630 ASPHALT PAVE TO 500 0 0 8000.00 3 1.46 11,680 1981 1981 15 2,336 2,100 ASPHALT PAVING 136631 84461 CONCRETE SLAB 6" 0 0 528.00 3 2.96 1,563 1990 1990 35 953 900 SIDEWALK 136632 84461 CONCRETE PAVE 500 0 0 320.00 3 3.63 1,162 2000 2000 15 500 500 TRASH RECEPTICAL 136633 84461 6'WD FENCE PER L.F. 0 0 56.00 3 17.15 960 2000 2000 15 413 400 TRASH RECEPTICAL ittp://boa.chathamcounty.org/DesktopModules/ChathamCounty/BoardofAssessors/PropertyRecordCard.asp,.. 7/11/2013 Chatham County Board of Assessors: 21' ? Property Record Card 4-0003-02-012 Page 3 of 4 2012 Chatham County Board of Assessors 4-0003-02-012 Property Record Card 3 N CAMPBELL ST TYBEE ISLAND BUILDING SECTION CONSTRUCTION TYPE RCN AYB EYB DEP TYPE PHYS ECON FUNC OBSV 1 % TOTAL DEP % RCNLD U.FACTOR MKT VAL 84461-1-2012 Commercial 243,432 1981 1990 MS 39.00 0.00 0.00 0.00 39.00 148,494 .90 133,644 20 ' 20' 6 3 F CA\ C—P) lob G' 6 60' M3 x[,l i 7400 4 ' 4 20 ' 6, 0' c77 h IinnlM' 4:m[rts[Shb 46SZE 521 [Click Ior larger picture] TY2012 "SEAGRASS SALOON & GRILLE"; CONCRETE BLOCK CONSTRUCTION. LOW QUALITY INTERIOR FINISH. MOST ORIGINAL. CANOPY AREA'S ARE ROOF OVERHANG, FIRST CHATHAM ATM & DEPOSITORY MACHINES ON SITE. VM. AREA 2400 STORIES 1.0 PERIMETER 1 SHAPE 200 OCCUPANCIES AREA % CLASS HEIGHT QUAL 350 Restaurant 2400 100.00 C 12.00 2.00 COMPONENTS Units % QUAL C2 617 Complete HVAC 100.00 C1 892 Stud -Stucco 100.00 ittp:llboa.chathameounty.org/DesktopModules/ChathamCountylBoardofAssessors/PropertyRecordCard.asp... 7/11/2013 Chatham County Board of Assessors: 20' 1 Property Record Card 4-0003-02-012 Page 1 of 3 2011 Chatham County Board of Assessors 4-0003-02-012 Property Record Card 3 N CAMPBELL ST TYBEE ISLAND APPRAISER LALOWRIM LOTS 17, 18, 19, 38, 39, 40 & 41 FORT WARD TYBEE PRB 14P 161 SEYDEN ARNOLD J JR CAMA ASMT LAST INSP 0412 4/2 01 0 PO BOX 561 1,117,500 1,117,500 LAND 1 APPR ZONE 440048 TYBEE ISLAND GA 31328-0561 314,600 314,600 BLDG 2 12,500 12,500 OSXF 7 1,444,600 1,444,600 Cost - MS SALES BOOK/ INS VI QU RSN PRICE CODES PAGE PROPERTY 0002 COMMERCIAL 01 Jan 1997 183G 14 QC I U UQ USE GRANTOR:EDWARD TOWNS & JAMES MOYE UTA 0004 Tybee Island GRANTEE:T & M ENTERPRISES, INC. NB HD 020500.00 T500 TYBEE TO 01 Jan 1997 183G 16 WD I Q QW 495,000 BULL R GRANTOR:T & M ENTERPRISES, INC. EXEMPTIONS GRANTEE.-ARNOLD J. SEYDEN, JR, - - - - - COMMCATEG 3200 Convenience Store PERMITS TYPE DATE AMOUNT HISTORY LAND !MPR TOTAL 98-00012 AD 01 Jan 1999 Comp 10,000 '-_��*� 2011 1,917,500 327,100 1,444,600 Cama 97-00124 01 Jan 1998 Comp 2010 1,117,500 327,100 1,444,600 Cama 95-242 CM 01 Jan 1997 Comp 8,935 2009 1,524,000 622,000 2,146,000 Over COMMENTS: 02/07/2013 2008 1,524,000 622,000 2,146,000 Over 12 Feb 2010 TY2014 RET VAL ENT 2007 2,146,000 AIC 22 May 2003 2003, LAND REVIEW. [Click for larger picture] 2006 1,524,000 286,500 1,810,500 Cama 14 Dec 2001 2002, HCC, LAND VALUE 2005 1,016,000 286,500 1,302,500 Cama UPDATE. 2004 464,500 262,000 726,500 Cama 23 Apr 2001 2001, HCC, REVIEWED SAV I S 2003 464,500 262,000 726,500 Cama PROPERTY. Nw 2002 228,500 262,000 490,500 Gama 13 May 2000 ADD CHG FORM 5-13-2000 2001 192,500 269,500 462,000 Cama SSB 2000 192,500 164,000 356,500 Cama 20 Sep 1999 TY2000 ADD CHGE PER 1999 137,500 164,000 301,500 Cama TXYPR NJV 9-20-99 09 Mar 1999 98 PERMIT NEW CANOPY 1998 137,500 158,500 296,000 Cama -��.- 15 Dec 1997 1998 NEW PIN; SPLIT OUT OF 4-3-2-1 & 4-3-2-4 PRB 14P 161 12/15/97 EXTRA FEATURES - ID# BLDG # SYSTEM DESC DIM 1 DIM 2 UNITS QL UNIT PRICE RCN AYB EYB DT ECON FUNC SP SP% RCNLD MKT VALUE 136627 84461 StoragelUtility fair 19 8 152.00 4 7.86 1,075 1981 1981 35 344 300 REAR STORAGE AREA 136628 CAN ST 64 STEEL GOOD 24 24 576.00 3 23.50 13,536 1998 1998 20 6,768 6,100 GAS PUMP CANOPY 136629 CONCRETE PAVE 500 0 0 4500.00 3 2.73 12,285 1981 1981 15 2,457 2,200 CONCRETE PAVING 136630 ASPHALT PAVE TO 500 0 0 8000.00 3 1.46 11,680 1981 1981 15 2,336 2,100 ASPHALT PAVING 136631 84461 CONCRETE SLAB 6" 0 0 528.00 3 2.96 1,563 1990 1990 35 953 900 SIDEWALK 136632 84461 CONCRETE PAVE 500 0 D 320.00 3 3.63 1,162 2000 2000 15 500 500 TRASH RECEPTICAL 136633 84461 6'WD FENCE PER L.F. 0 0 56.00 3 17.15 960 2000 2000 15 413 400 TRASH RECEPTICAL LAND ID# USE DESC FRONT DEPTH UNITS/TYPE PRICE ZONING LCTN TOPO OTHER ADJ1 ADJ2 ADJ3 ADJ4 MKT VALUE 108596 CONVENIENCE STORE 161 180 29,025.00 -SF 35.00 C2A 1117500 http:l/boa.chathameounty.org/DesktopModules/ChathainCounty/BoardofAssessors/PropertyRecordCard.ast)... 7/11/2013 Chatham County Board of Assessors: 21" 1 Property Record Card 4-0003-02-01" Page 3 of 3 2011 Chatham County Board of Assessors 4-0003-02-012 Property Record Card 3 N CAMPBELL ST TY13EE ISLAND BUILDING SECTION CONSTRUCTION TYPE RCN AYI3 EYB DEP TYPE PHYS ECON FUNC OBSV 1 % TOTAL DEP % RCNLD U.FACTOR MKTVAL 84462-1 Commercial 222,884 1981 1990 MS 30.00 0.00 0.00 0.00 30.00 156,019 1.00 156,019 ----------------------------------------------- ------------------- ......---------- �9' 17 —j— i :a xa• 2848 STORIES 16'._ 1,0 PERIMETER 1 SHAPE ax ■ ar -- ----------------- [Click for larger picture - ] GFA 2400 S.F. IS CHU'S CONVENIENCE STORE, CONCRETE BLOCK CONSTRUCTION, GFA 448 S.F. IS FRAME CONSTRUCTION, WITH T1-11 SIDING. BUILT AS STORAGE AREA. NEW OWNER JUST FINISHED OFF +1- 50% FOR OFFICE AREA. OTHER 50% STILL STORAGE AREA. STG OF 152 S.F. IS AREA 2848 STORIES 1,0 PERIMETER 1 SHAPE 288 OCCUPANCIES AREA % CLASS HEIGHT QUAL 419 Convenience Market 448 15.73 C 12.00 2.00 419 Convenience Market 2400 84.27 C 12.00 2.00 COMPONENTS Units % QUAL C2 611 Package Unit 100.00 C1 892 Stud Stucco 100.00 http://boa.chathamcounty.orglDesktopModules/ChathainCounty/BoardofAssessors/PropertyRecordCard.asp... 7/11/2013 I C Food Service Est' lishment Inspection Repor ddendum Ragepf Violations sited In title mpoil must be carrect" within the time framos spaciflod 8elaw, oras stated in the Gearpio Depadmeat ofWriman Resources Pohlic Njtaffh Rales and Regulpftrws Food Service Chapter391i-S-14, l4ute .10 aubseetJona f2 ij and Q}. Establishment Permit # i oats AddressCltylstate Zi3 cede TE�YFP MATURE OSSEF�VA_ oN � E t ItewlLocation Tuts IternA watlon Temp ftem)Locatlon Temp i 14 IT I lumt 77, l��Y NSAl D # 'Tis /.l W �AI �i� Act Person in Charge )rY--\ci&c' C�-�v (Signaturel bate 1 U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 National Flood Insurance Program Imp6.-ant: Read the instructions on pages 1-I2.. Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name RMC Tybee LLC Policy Number A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Numbenr 3 N Campbell Street City Tybee Island State GA ZIP Code 31328 A3. Property Description (Lot and Blocs Numbers, Tax Parcel Number, Legal Description, etc.) Lots 17, 18, 19, 38, 39, 40 and 41, Fort Ward, Tybee; Tax Parcel Number 4-0003-02-012 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Rgjag A5. Latitude/Longitude, Lat. 32'00'58..2" Long. 80150'53.2'W Horizontal Datum: ❑ NAD 1927 W NAD 1983 A6. Attach at least 2 photographs of the building If the Certificate is being used to obtain flood insurance. AT Building Diagram Number 1B 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) nla sq ft a) Square footage of attached garage nla s4 ft b) Number of permanent flood openings in the crawlspace 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 n1a c) Total net area of flood openings in A8.b nla sq in c) Total net area of flood openings in A9.b nla sq in d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes ❑ No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NF1P Community Name & Community Number 82. County Name B3. State City of Tybee Island 135164 Chatham Georgia B4. MaplPanel Number B5. Suffix 88. FIRM Index Date BT FIRM Panel 138. Flood B9. Base Flood Elevation(s) (Zone 13051C11?213 F 09/26/2008 Effective/Revised Date Zone(s) AO, use base Rood depth) 09f26f2008 AE 11 1310. Indicate the source of the Base Flood Elevation (BFE) data or base f400d depth entered in Item 139. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item 139: ❑ NGVD 1929 0 NAVD 1988 ❑ Other/Source: 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes 0 No Designation Date: ❑ CBRS ❑ OPA 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. Elevations -Zones Al A30, AE, AN, A (with BFE), VE, V1 V30, V (with BFE), AR, ARIA, ARAE, AR1A1-A30, AR1AH, ARIAO. Complete Items C2.a--h below according to the building diagram specified in Item AT In Puerto Rico only, enter meters. Benchmark Utilized: NGS Monumgnt E 56 Vertical Datum: NAVD 1988 Indicate elevation datura used for the elevations in items a) through h) below_ ❑ NGVD 1929 ® NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the SFE. a) Top of bottom floor (including basement, craWspace, 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. 1 certify that the information on this Certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under IS U.S. Code, Section 1001. ® Check here if comments are provided an bans of form, Were latitude and longitude in Section A provided by a V �6T ❑ Check here if attachments. licensed land surveyor? 0 Yes ❑ No Certifier's Name Robert K. Morgan, Ill License Number Ga. RLM087 Title PrinGipat Company Name Morgan Land Surveying, LLC Address 104 RegalCourt City Savannah _ State GA ZIP Code 31410 Telephone 912-658-4302 FEMA Form 086-0-33 (7112) See reverse side for continuation. Replaces all previous editions. Check the measurement used. $.08 ® feet ❑ meters Na. ❑ feet ❑ meters n/A. ❑ feet ❑ meters Na. - ❑ feet ❑ meters 5.84 ® feet ❑ meters 5.8 ® feet ❑ meter; 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. 1 certify that the information on this Certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under IS U.S. Code, Section 1001. ® Check here if comments are provided an bans of form, Were latitude and longitude in Section A provided by a V �6T ❑ Check here if attachments. licensed land surveyor? 0 Yes ❑ No Certifier's Name Robert K. Morgan, Ill License Number Ga. RLM087 Title PrinGipat Company Name Morgan Land Surveying, LLC Address 104 RegalCourt City Savannah _ State GA ZIP Code 31410 Telephone 912-658-4302 FEMA Form 086-0-33 (7112) See reverse side for continuation. Replaces all previous editions. _LEVATION CERTIFICATE, page 2 IMPORTANT: In these spaces, copy the tort onding infonrtation 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. 3 N Campbell Street City Tybee Island State GA ZIP Code 31328 Company NAIC Number. SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenticompany, 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 / /;Z0 13 SECTION E — BUILDING ELEVAIrION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items EI—E5. if the Certificate is intended to support a LOMA or LOMR-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 ❑ 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 HAG, 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 fop 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 REPRESENTATNE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA -issued or community -issued 8FE) 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 attachments SECTION G — COMMUNITY INFORMATION (OPTIONAL) 'he 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 f this Elevation Certificate. Complete the applicable items) and sign below. Check the measurement used in Items G8—G10- In Puerto Rica only, enter meters. i1. ❑ 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 in the Comments area below.) i2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone A0- )3. ❑ The following information (Items G4—Gi0) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued 97. This permit has leen issued for ❑ New Construction ❑ Substantial Improvement 98. Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters Datum '9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum '10. Community's design flood elevation: ❑ feet ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments Check here if attachments. 'EMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIRCATE, page 3 Building Photographs See Instructions for [tem 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 VievV'; and, if required, "Right Side VievV' 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. FRONT VIEW (06/2912013) REAR VIEW (06129/2013) FMA Form 086-0-33 (7112) Replaces all previous editions.