HomeMy Public PortalAboutSIXTH AV_1217.pdfU.S. DEPARTMENT OF HOMELAND SECURITY t3M13 No. 1660 0008
Federal Emergency Management Agency Expiration Date: November 30, 2018
National Flood insurance Program �v
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 agentfcompany, and (3) building owner.
SECTION A — PROPERTY INFORMATION
FOR INSURANCE COMPANY USE
Al. Building Owner's Name
Policy Number
Carl Burrell
A2. Building Street Address (including Apt., Unlit, Suite, and/or Bldg. No.) or P.O. Route and
Company NA1C Number;
Box No.
1217 Sixth Avenue
City State ZIP Code
Tybee Island Georgia 31328
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
lots 339 & 340, ward 4 PIN 4-0019-01-006
A4_ Building Use (e,g_, Residential, Non -Residential, Addition, Accessory, etc.) Residential
A5. Latitudell-ongitude: Lat. N 31 ° 59' 27" Long. W 80° 51' 07" Horizontal Datum: ❑ NAD 1927 Cx] 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 1A
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) NIA sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade NIA
c) 'total net area of flood openings in A8.b N/A sq in
d) Engineered flood openings? ❑ Yes ❑x No
A9. For a building with an attached garage:
a) Square footage of attached garage N/A sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade NIA
c) Total net area of flood openings in A9.b NIA sq in
d) Engineered flood openings? ❑ Yes E) No
SECTION S — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NF1P Community Name & Community Number B2. County Name
B3. State
Tybee Island 135164 Chatham
Georgia
B4. Map/Panel
B5. Suffix
$6. FIRM Index
B7. FIRM Panel
B8. Flood B9_ Base Flood Elevation(s)
Number
Date
Effective/
Zone(s) (Zone AO, use Base Flood Depth)
Revised Date
1305100326
IF
07-07-2014
09-26-2008
AE l 12.0
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 89:
❑ FIS Profile xN FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BEE in item B9: ❑ NGVD 1929 0 NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes N No
Designation Date: ❑ CBRS ❑ OPA
FEMA Form 086-0-33 (7115) Replaces all previous editions. Form Page 1 of 6
FI_FVATION 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
1217 Sixth 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, ARIA, AR/AE, AR/Al—A30, ARIAH, AR/A0.
Complete items C2.a- h below according to the building diagram specified in Item AT In Puerto Rico only, enter meters.
Benchmark Utilized: local Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below_
❑ NGVD 1929 ❑x 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) 6.23 feet ❑ meters
b) Top of the next higher floor 7.03 feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) NIA [] feet ❑ meters
d) Attached garage (top of slab) NIA feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 7.Q4 Q feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 5.80x❑ feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 6.70 feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including NIA 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.
1 certify that the information on this Certificate represents my best efforts to interpret the data available_ 1 understand that any false
statement may he punishable by fine or imprisonment under 16 U. S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? N Yes ❑ No ❑ Check here if attachments.
Certifier's Name License Number
J. Whitley Reynolds 2249
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✓
Tithe
Registered Land Surveyor
Company Name
AddressSA60
636 Stephenson Avenue, Suite C-
>
City State ZIP Code
Savannah Georgia 31405
Signature Date Telephone Ext
10-25-2017 (912) 352-0464
Copyall pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) buiiding owner_
Comments' (including type of equipment and location, per C2(e), if applicable)
C2.e) isl=a water heater_
The majority of this house diagram 1A. There is a 155 square foot room that is diagram 8. It has 2 smart vents model 1540 570.
FEMA Form 086-0-33 (7/15) Replaces all previous editions. rarm rage L or b
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:
1217 Sixth 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 E7—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 [I 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 Representatives Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑ Check here if attachments.
i
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:
1217 Sixth Avenue
City State ZIP Code
Company NAIC 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_ [j 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: ❑ feet CI meters Datum
G10. Community's design flood elevation: ❑ feet n 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
008
ELEVATION CERTIFICATE See Instructions for Item A6. OMB No. 16
Expiration Date:
te: Nov November 30 2098
IMPORTANT: In these spaces, copy the corresponding information from Sections A.
FOR INSURANCE COMPANY USE
Building Street Address (including Apt-, Unit, Suite, and/or Bldg. No.) of P.Q. Route and Box No.
Policy Number
1217 Sixth Avenue
City State ZIP Code
Company MAIC 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 lfiew" 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.
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Photo One
Photo One Caption Front view 10-23-2017 Clear Photo One
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Photo Two Caption Rear View 14-23-2017 Clear Pbvto Two
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6
BUILDING PHOTOGRAPHS OMs No. 1660-O008
ELEVATION CERTIFICATE Continuation Page Expiration Date- November 30, 20.18
IMPORTANT- In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address (including Apt.. Unit, Suite, andfor Bldg_ No.) or P.O, Route and Box No_ Policy Dumber
1217 Sixth Avenue
City State ZIP Code Company NA1C Number 71
Tybee island Georgia 31328
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify allpitotograpias
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_
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Photo Three
Photo Three Caption Side View 10-23-2017 Clear Photo Three
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Photo Four Caption Side View Clear Photo Four
FEMA Form 086-0-33 (7115) Replaces all previous editions. Form Page 6 of 6