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HomeMy Public PortalAboutSIXTH AV_12.pdfU.S,DEPARTMENT OFHOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0�118 Rralionall landlns:rrance Program Important: Read the instructions on pages I-9. P y 31, 2015 Expiration Date: :I SECTION A - PROPERTY INFORMATION FOR INSURANCE C©rOPANY USE Al. Building Owner's Name Lori Haynes Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P O. Route and Box No. Company NAIC Number_ 12 Sixth Avenue City Tybee Island State GA ZIP Code 31328 A3, Property Description (Lot and Block Numbers, Tax Parcel Number, Legal description, etc.) Lot 223 Ward 1 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential A5. Latitude/Longitude: Lat. N 32 deg 00.9180 min Long. W 80 deg 50.7160 min Horizontal Datum: ❑ NAD 1927 0 NAD 1983 A6. Attach at least 2 photographs of the building rf the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 5 A8_ For a building with a crawlspace or enclosure(s): Ag. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) Ilia sq ft a) Square footage of attached garage n/a sq R 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 n/a c) Total net area of flood openings in A8.b n/a sq in c) Total net area of flood openings in A9.b n/a sq in d) Engineered flood openings? ❑ Yes N No d) Fngineered flood openings? ❑ Yes ® No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name � Community Number 62. County Name t33. State Tybee Island 135164 Chatham GA 64, Map/Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel B8. Flood 139. Base Flood Elevation(s) (Zone 1 305 1 0021 3 F 711114 Etfectiv dRevised Date Zone(s) AO, use base flood depth) 9126108 AE 11 810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FiS Profile N FIRM ❑ Community Determined ❑ Other/Source: 1311. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ® NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes 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 Ai -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, ARIA, AR1AE, AR/A1-A30, ARIAH, 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: local Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 N NAVD 1988 0 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) 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) 0 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 Check the measurement used. 7.4 N feet ❑ meters n/a ® feet ❑ meters n/a_ ® feet ❑ meters n/a. N feet ❑ meters 6.6 N feet ❑ meters 5.8 N feet ❑ meters 6.5 N feet ❑ meters 5.8 ® feet ❑ meters SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION ELEVATION CERTIFICATE, page 2 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: 12 Sixth Avenue 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 agent/company, and (3) building owner. Comments C2.e) is AIC pad Sig Date 6/18115 SECTION BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITH(DUT 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 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 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'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) 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 BFI=) 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 ❑ meters Datum G10. Community's design flood elevation: ❑ feet ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments Check here if attachments. FEMA Form 066-0-33 (7112) Replaces all previous editions. ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6 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: 12 Sixth Avenue City Tybee Island State GA ZIP Code 31328 Company NAIC Nurnber_- 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 "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. FEMA Form 086-0-33 (7112) Replaces all previous editions. ELEVATION CERTIFICATE, page 4 Building Photographs Continuation Page IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COhAt::'ANy LisE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 12 Sixth Avenue City Tybee Island State GA ZIP Code 31328 Company NAIC Number- if umber 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 "Leff Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8 - Rear View June 16. 2015 FEMA Form 086-0-33 (7112) Replaces all previous editions.