HomeMy Public PortalAboutROSEWOOD AV_8.pdfU.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-OOpB
Federal Emergency Management Agency Expiration Date: November 30, 2018
National Flood Insurance Program
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 agenttcompany, and (3) building owner.
SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name Policy Number:
STEVE BUCKNER
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No. I Company NAIL Number,
8 ROSEWOOD AVENUE
City State ZIP Code
TYBEE ISLAND Georgia 31328
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 12A, SUBD OF LOT 12, FORT SCREVEN WARD TAX PARCEL 4-0003 -09-032
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc) RESIDENTIAL
A5. Latitude/Longitude: Lat. 32' 00'57.28" Long. 080° 50'38.81 " 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.
A7. Building Diagram Number 5
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) 1,560 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.b 0 sq in
d) Engineered flood openings? ❑ Yes x❑ 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 ❑x 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 95. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s)
Number Date Effective/ (Zone AO, use Base
Revised Date Flood Depth)
13051C 0213 F 07/07/2014 09/26/2008 AE 11.0'
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 89:
❑ FIS Profile 0 FIRM ❑ Community Determined F] Other/Source:
B11. Indicate elevation datum used for BFE in item 69: ❑ NGVD 1929 0 NAVD 1988 ❑ Other/Source-
612. 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 (7115) Replaces all previous editions. Form Page 1 of 6
ELEVATION CERTIFICATE
OMB No. 1660-0008
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IMPORTANT: In these spaces, copy the corresponding information from Section A.
FOR INSURANCE COMP ANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
Policy Number:
8 ROSEWOOD AVENUE
City State ZIP Code
Company NAIC Number
TYBEE ISLAND Georgia 31328
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. 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, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO.
Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: GPS ESTABLISHED Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below.
❑ NGVD 1929 0 NAVD 1988 ❑ Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 7.5 x❑ feet ❑ meters
b) Top of the next higher floor 13, 1 feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) N/A 0 feet ❑ meters
d) Attached garage (top of slab) N/A 0 feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 136 ❑x feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 7.5 x❑ feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 11.2 feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including 7 5 x❑ feet ❑ meters
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.
I certify that the information on this Certificate represents my best efforts to interpret the data available. t 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? ❑x Yes ❑ No ❑ Check here if attach ts.
Certifier's Name License Number
MICHAEL J. GARDNER GA R.L.S. NO. 2285
l
Title
LAND SURVEYOR
"&i
Company Name
MICHAEL J. GARDNER, LAND SURVEYOR
Address
120 VARNEDOE AVENUE /
J.
City State ZIP Code
GARDEN CITY Georg 31408
Signaturet Telephone
101//17 (912) 661-0479
Copy all pg6es of thi Elev on Certificate and all attachments fo 1) community official, (2) insurance agent/company, and (3) building owner.
Comments (includ g of equipment and location, per C20), if applicable)
NOTE: C2(e) Elevati n of Air Conditioner Pedestal = 13.6', AC Pedestal is located at Left rear of of Structure. AC Pedestal Elevation
= 14.6' at Right Rear of Structure. NOTE: Part of this residence is a Diagram 1B (936 sq.ft.), Part of this Residence appears to be
a
Diagram 5 (1,560 sq. ft.). Area under Overhead Living Space is Not enclosed and is used for Storage. NOTE: Residence Built in 1940.
PROJECT NO. STEVE BUCKNER , 1012312017, (01), FB. MJG 2014 D, PG. 53 & 54
t -LMA corm Ube -U-33 (itlo) Replaces all previous editions. Form Page 2 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:
8 ROSEWOOD AVENUE
City State ZIP Code
Company NAIC Number
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 E1—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.
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 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, 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:
8 ROSEWOOD AVENUE
City State ZIP Code
Company _NA IC Number
TYBEE ISLAND Georgia 31328
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
GB. 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: ❑ feet ❑ 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 OB6-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6
BUILDING PHOTOGRAPHS
ELEVATION CERTIFICATE See Instructions for Item A6.
OMB No. 1660-0008
Expiration Date: November 30, 2098
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:
8 ROSEWOOD AVENUE
City State ZIP Code
Company NAIC 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
"Leff 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.
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Photo One
Photo One Caption FRONT VIEW
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Photo Two
Photo Two Caption REAR VIEW
FEMA Form 086-0-33 (7115) Replaces all previous editions.
Form Page 5 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE Continuation Wage 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, andtor Bldg. No.) or P.O. Route and Box No.
Policy Number:
8 ROSEWOOD 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 "!_eft Side View." When applicable,
photographs must show thpefoundation with representative examples of the flood openings or vents, as indicated in Section A8.
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Photo Ow
Photo One Caption LEFT VIEW
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Photo Two
Photo Two Caption RIGHT VIEW
FEMA Form 086-0-33 (7115) Replaces all previous editions. Form Page 6 of 6