HomeMy Public PortalAboutLEWIS AV_120.pdfU.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency OMB No. 1660-0008
National Flood Insurance Program Expiration Date: November 30, 2018
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner.
SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name Policy Number.
Colette Cassedy
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No. Company NAIC Number:
120 Lewis avenue
City State ZIP Code
Tybee Island Georgia 31328
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Lot 62, Palm Terrace PIN 4-0004-14-003
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential
A5. Latitude/Longitude: Lat. N 32" 00'46" Long. W 80'50'51" Horizontal Datum: [] NAD 1927 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 1A
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) 0 sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.h 0 sq in
d) Engineered flood openings? ❑ yes 9 No
A9. For a building with an attached garage:
a) Square footage of attached garage 0 sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? ❑ Yes Q No
SECTION B — FLOOD INSURANCE RATE MAI' (FIRM) INFORMATION
B1. NFIP Community Name & Community Number 132. County Name B3. State
Tybee Island 135164 Chatham Georgia
B4. MaplPanel 85. Suffix B6. FfRM Index B7. FIRM Panel BB. Flood Zone(s) B9. Base Flood Elevation(s)
Number Date Effective/ (Zone AO, use Base
Revised Date Flood Depth)
13051 00213 F 07/07/2014 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 Z FIRM ❑ Community Determined ❑ Other/Source.-
Bl 1.
ther/Source:B11. Indicate elevation datum used for BFE in Item 139: E❑ NGVD 1929 Z NAVD 1988 ❑ Other/Source:
812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ❑x No
Designation Date: ❑ CBRS ❑ OPA
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6
ELEVATION CERTIFICATE
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.
120 Lewis avenue
City
Tybee Island
date ZIP Q
Georgia 31328
OMB No. 1660-0008
Expiration Date: November 30, 2018
FOR INSURANCE COMPANY USE
Policy Number:
Company
SECTION C -- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction' ❑x 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, ARIA, ARIAE, AR/A1—A30, AR/AH, AR/AO.
Complete Items C2.a—h below according to the building diagram specified in Item AT In Puerto Rico only, enter meters.
Benchmark Utilized: total Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below.
❑ NGVD 1929 Z NAVD 1988 ❑ 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) 6 20 Check the measurement used.
x
❑
b) Top of the next higher floor n/a feet F-1 meters
❑x feet [I meters
C) Bottom of the lowest horizontal structural member (V Zones only) n/a x feet
El meters
❑
d) Attached garage (top of slab) n/a, � feet ❑meters
e) Lowest elevation of machinery or equipment servicing the building 5 8
(Describe type of equipment and location in Comments) feet El meters
0 Lowest adjacent (finished) grade next to building (LAG) 4 8 x feet
❑ El meters
g) Highest adjacent (finished) grade next to building (HAG) S. 2
❑x feet [] meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, includingn/a
structural support ❑x 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 dataavailable, l understand that any false
statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? Q Yes ❑ No
El Check here if attachments.
Certifier's Name License Number
J. Whitley Reynolds 2249
Title
Land Surveyor C T
Company Name * �6 �
Pia 249
A
Address
636 Stephenson Avenue, Suite C
gate
Savannah
ZIP Code
Georgia
31405
Signature7 Date
Telephone
05/11/2017
(912) 352-0464
Copy all pages of0s, Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments (in ding type of equipment and location, per C2(e), if applicable)
C2.e) is A/C.
The majority of this house diagram 1A (713sf). There is an addition diagram 5 (369sf)
FEMA Form 086-0-33 (7115) Replaces all previous editions. Form Page 2 of 6
ELEVATION CERTIFICATE OMB No. 1660-0008
Expiration Date: Novernber 30, 2018
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.O. Route and Box No. Policy Number:
120 Lewis avenue
City State ZIP Code Company NAIC Numher
Tybee Island Georgia 31328
SECTION E — BUILDING ELEVATION 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. Band C. For Items E1—E4, use natural grade, if 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,
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 1-2 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 top of the bottom floor elevated in accordance with the communitys
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, and E for Zone A (without a FEMA -issued or
community -issued BFE) or Zone AO must sign here. The statements in Sections A. B, and E are correct to the best of my knowledge,
Property Owner or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑ Check here if attachments.
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6
ELEVATION CERTIFICATE OMB No. 1660-0008
Expiration Date: November 30, 2018
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.O. Route and Box No. Policy Number:
120 Lewis avenue
City State ZIP Code
Tybee island Georgia 3132$ Company NA1C Number
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 item(s) and sign below. Check the measurement
used in Items G8—G10. In Puerto Rico only, enter meters.
G1. ❑ 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—G10) 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: ❑ feet ❑ meters
Datum
G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feel ❑ meters Datum
G10. Community's design flood elevation: ❑ feet []meters Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments (including type of equipment and location, per C2(e), if applicable)
❑ Check here if attachments.
FEMA Form 086-0-33 (7/15) Replaces all previous editions_ Form Page 4 of 6
BUILDING PHOTOGRAPHS
ELEVATION CERTIFICATE See Instructions for Item A6. OMB No. Date: 008
Data:
Expiration Noverrtber 30, 2018
IMPORTANT: In these spaces, copy the corresponding information from section A. FOR INnNAIC
E COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or p 0. Route and Box No. Policy
120 Lewis avenue
City State ZIP Code Company Number
Tybee Island Georgia 31328
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
flood openings
"Left Side View." When applicable, photographs must show the foundation with representative examples of the or
vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page.
t ,
` Photo Or*
Photo One Caption Front view 05/10/2017
I
4
l
Photo Two ~ -
Photo Two Caption Rear View 05/10/2017
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE Continuation Page Expiration mate: November 30, 2018
IMPORTANT: In these spaces, copy the corresponding information from Section A. I tFORURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. umber_
120 Lewis avenue
City State ZIP Code Company NAIC Number
Tybee Island Georgia 31328
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." When appli bie,
photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8,
Photo One
Photo One Caption Side View 05/10/2017
Photo Two
Photo Two Caption Side View
FEMA Form 086-0-33 (7115) Replaces all previous editions. Form Page 6 of 6