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HomeMy Public PortalAboutBUTLER AV_411B.pdfU.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-OW8 Federal Emergency Management Agency Exoires February 28, 2009 National Flood Insurance Program Important: Read the instfuctions on pages 1-8. SECTION A - PROPERTY INFORMATION For Insurance Company Use: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.Company NAIC Number R30TLEtZ AVEpiuA esli 3 AS Pt=r2 C-14'.TTl4 .vt CO, _ City State ZIP Code Amt 0 C0E02CDIA -3132. A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) N E VJ c o ►a ^.e E, -r L -ru S -M le F a' P. 1I . N LA - o a 044 -- Z. R A4. Budding Use (e.g., Residentiat, Non -Residential, Addition, Accessory, etc_) A5. Latitude/Longitude: Lat." Z S . !r Jong. Irl & .O S,0 r _3i . Q 'r Horizontal Datum: ❑ NAD 1927 N NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance - A7. Building Diagram Number_ A8. For a building with a crawl space or enclosure(s), provide: A9. For a building with an attached garage, provide_ a) Square footage of crawl space or enclosure(s) it f sq It a) Square footage of attached garage A'1- ^-, sq ft b) No. of permanent flood openings in the crawl space or Z b) No. of permanent flood openings in the attached garage enclosure(s) walls within 1.0 foot above adjacent grade walls within 1.0 foot above adjacent grade /,4 - M*, c) Total net area of flood openings in A8. b 44 2__CA2_ sq in c) Total net area of flood openings in A9.b tit - A► sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name ❑ mcters (Puerto Rico only) B3_ State C t T- e d F rV 86 c IS, -11---0- 13 61 �0 .a c) Bottom of the lowest horizontal structural member (V Zones only) Cy r D. -e C.v "'a - B4. MaplPanel Number B5. Suffix B6. FIRM Index ❑meters (Puerto Rico only) B7. FIRM Panel B8. Flood 89. Base Flood Elevatiort(s) (Zone (Describe type of equipment in Comments) Date Q Lowest adjacent (finished) grade (LAG) Effective/Revised Date Zone(s) AO, use base flood depth) I L3QS��-DZIy F 0q--2co-e 04-zC,-09 A, r-- I B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe) 1311. Indicate elevation datum used for BFE in Item 139: ❑ NGVD 1929 2] NAVD 1988 ❑ Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area ar Otherwise Protected Area (OPA)9 Resignation Date ❑ CBRS ❑ OPA ❑ Yes N No 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, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR1AE, ARIA1-A30, AR/AH, AR1AO. Complete Items C2.a-g below according to the building diagram specified in Item A7. Benchmark Utilized Pi S K 13-_ 07S,- 4 Vertical Datum "Co VQ 9 2 13 Conversion/Comments 6-94' r=f:ZOM t-J(-vVio 1929 VAt_U6 To COA[v I^ Td NAVt7 !g% Check the measurement used. a) Top of bottom floor (including basement, crawl space, or enclosure floor) 8. 8 W feet ❑ mcters (Puerto Rico only) •b) Top of the next higher floor i �® feet ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) - A _❑ feet ❑ meters (Puerto Rico only) d) Attached garage (top of slab) feet ❑meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building .�© feet ❑ meters (Puerto Rico only) (Describe type of equipment in Comments) Q Lowest adjacent (finished) grade (LAG) S 7J ® feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade (HAG) feet ❑ meters (Puerto Rico only) 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. t 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 10.9f _ ® Check here it comments are provided on back of form. Cerfifeec Nemo - License Number JAMES K KEATON, RLS GEORGIA #2743 Title Company Name _ LAND SURVEYOR _ CHATHAM SURVEYING SERVICES, INC. Address Citv State ^ZIP Code P. O. BOX 61649 SAVANNAH GEORGIA 31420 912-303-0302 r_1 ' 7 14o.2743 41%1 v��S 81-31, February 2006 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding 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 t 1 F3VTr..AV5 P4LJf= City State ZIP Code Company NAIC Number IY E C E CADEo 2 3 2_$ 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 ITLM CUs. IS M111G1.95En._._,PA214t-tCx ,d,..tt] srelza.CflE T}(t a-eeerr rrr:aT POFg f40 -r G.Ei2_T1F'1&' I t Tb 13E H� 1TA�3LE� LTA C2b t, T'h4 1.t� gr�Lf T— (-00 s '. e- UtV 11 -17 C Date ,{ _,WCTION)F - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT RFF] 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, N available. Check the measurement used. In Puerto Rico only, enter meters. E1. 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, crawl space, or enclosure) is _ ❑ feet ❑ meters ❑ above or ❑ below the HAG, b) Top of bottom floor (including basement, crawl space, or enclosure) is ❑ feet ❑ meters ❑ above o G, E2. For Building Diagrams 6-8 with permanent flood openings provided in Sec' Items 8 andlor 9 (see (elevation C2.b in the diagrams) of the building is _ 1-1 feet Lia e 8 of In ctions), the next higher meters ❑ above or below a 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 ❑ ab 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 plain 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, S, and E for Zone A (without a FEMA -issued or community -issued BFE) or Zone AO must sign here. The statements In Sections A, 8, 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 �OL 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, B, C (or E), and G of this Elevation Certificate. Complete the applicable items) and sign below. Check the measurement used in Items G8. and G9. Gt . ❑ 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.) G2. ❑ A community official completed Section E for a building located In Zone A (without a FEMA -issued or community -issued 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 GB. 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: ❑ feet ❑ meters (PR) Datum GS. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters (PR) Datum Local Official's Name Title Community Name Telephone Signature bate ( r 1 ❑ Check here if attachments FEMA Form 81-31, February 2006 Replaces all previous editions Building Photographs Continuation Page Building Street Address (including Apt„ Unit, Suite. and/or Bldg. No.) or P.O. Route and Box No. 9411 B T3U-11... F ,z Av E AJ u i~ City State ZIP Code TY G E E. 1 o CaE0I2 co I A �-3 [ 3 Z8 If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; 'Front View' and 'Rear View"; and, if required, "Right Side View"and "Left Side View," Building Photographs See Instructions for Item A6. Building Street Address (including Apt., unit, Suite, andlor Bldg. No.) or P.O_ Route and Box No.� Policy Numter 9 4 t t auTLE,Z ,4VE�rUP City State ZIP Code CaTparry NM Neter 7"VaEr= r-oe aiz�-D /6. 31.37-8 If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two 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.' If submitting more photographs than will fit on this page, use the Continuation Page on the reverse. v ST zb 2 O p r.. 3'4ZFM , fT'►2v�.�Y �t ��.1