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HomeMy Public PortalAboutLEWIS AV_139.pdfJ.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY Natlonall7ood lresrrrmrcc Piagrux' Important: Read the instructions on pages 1-9. SECTION A- PROPERTY INFORMATION Al A2. Building Street Address (including AApL, Unit, Suite, andlor Bldg. No.) or P.O. Route and -Box No. { -k —1 IL— F1N bS P'" irV;' OMB No. 1660-0608 Expiration Date-, July 31, 2015 FOR jNSURANCE COMPANY USE j Policy Number. Company NAIC Number, State e5 A ZIP Code------�..-_-_.�_ 3 [ 32,E A3. Property Description (Lot and acts Numbers, "Fax Parcel Number, Legal Desai tion, etc.) i— % "I cam.- -- -T- --in. 'W A r, f'K r — t 1 l_.,n _n A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) A5. LatitudetLongitude: Lat." Long. =ft HorizontatDatum: 0 NAD & 1927 NAD 1983 � 1`11-� • � 3Z' +S a - �� � p e A6. Attach at least 2 photographs of the building ifthe Certificate its being used to obtain flood insurance. �, a nrC4 • — C3 C �� • �i �2. i AT Building Diagram Number _f A A8, For a buikiing with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace orenclosure(s)' sq ft a) Square footage of attached garage sq ft b) Number of permanent flood openings in the crawtspace b) Number of permanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent gia¢e within 1.0 foot above adjacent grade Q c) Total net area of flood openings in A8.b - sq in c) Total net area of flood openings in A9.h O�q in IT d) Engineered flood openings? ❑ Yes No , d) Engineered flood openings? ❑ Yes SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name -- 84, Map/Panel Number 65. Suffix 66. FIRM Index Date B7. FfRM Panel B8. Flood Effective/Revised Date ones) .610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile 64 t -IRM L1 Community Determined ❑�therlsource: 811. Indicate elevation datum used for BFE in item 69: ❑NGVD 1929 ilj If.AVD 1988 ❑ OthedSource: 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Designation Date: ❑ CBRS ❑ OPA B3. State C+] B9. Base Flood Elevation(s) (Zone AO, use base flood depth) 11.0 ❑ Yes OK N'e o 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 Construclton of the building is complete. C2. Elevations -Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, ARIA, ARIAE, ARIA) -A30, ARiAH, ARMO. Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters_ Benchmark Utilized: �--a C Vertical Datum: N PY D 11369 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 o NAVO 1988 0 Other/Source: Datum used for building elevations must be the same as that used for the BFE. Fj Lowest adjacent (finished) grade next to building (LAG) -. J meters g) Highest adjacent (finished) grade next to building (HAG) ( ._I— Ei<eet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support —4.g_ ❑ 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. I certify that the information on this Cerfificate represents my bast efforts to interpret the data available. IIund rstand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. t_y` Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a [jKCheck here if attachments. licensed land surveyor? SKyes ❑ No r Certifiers Name License Number �- \61V C N -r i -A - L �j t SL Q ° t*r AIM mqaz e b o- Z2-- Titie Company Name L..a►,�a �vlzvC-YoR V, �f~�y_► �-���t•nt�Y _ �;�� aao�a Address City S vR i Pb H State 6 A•ZIP Code f z �i A v o t� 0+x+5 4 fl, Signature Date Telephone ���! - 22- t3 -p- C9%w)-- FEMA Form 086-0-33 (7112) See reverse side for continuation. ei 4� -4 P i311 i-q-ouv� Replaces all previous editions. Check the measurement used. a) Top of bottom floor (including•basement, crawlspace, or enclosure floor) �. jest © meters b) Top of the next higher floor ❑ feet ❑ meters c) Bottom of the lowest horizonlat structural member (V Zones only) �) . ❑ feet ❑ meters d) Attached garage (top of slab) � 9 ❑ feet ❑ meters a) Lowest elevation of maclfinery or equipment servicing the building _�._ 2 -feet ❑ meters (Describe type of equipment and Location in Comments) Fj Lowest adjacent (finished) grade next to building (LAG) -. J meters g) Highest adjacent (finished) grade next to building (HAG) ( ._I— Ei<eet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support —4.g_ ❑ 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. I certify that the information on this Cerfificate represents my bast efforts to interpret the data available. IIund rstand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. t_y` Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a [jKCheck here if attachments. licensed land surveyor? SKyes ❑ No r Certifiers Name License Number �- \61V C N -r i -A - L �j t SL Q ° t*r AIM mqaz e b o- Z2-- Titie Company Name L..a►,�a �vlzvC-YoR V, �f~�y_► �-���t•nt�Y _ �;�� aao�a Address City S vR i Pb H State 6 A•ZIP Code f z �i A v o t� 0+x+5 4 fl, Signature Date Telephone ���! - 22- t3 -p- C9%w)-- FEMA Form 086-0-33 (7112) See reverse side for continuation. ei 4� -4 P i311 i-q-ouv� Replaces all previous editions. ELEVATION CERTIFICATE, IMPORTANT: In these spaces, copy the corresponding information from Section A- FOR INSURANCE COMPANY USE Buildina Street Address (including Apt..Unil, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: oily1S L tom. nil n '+ I - State / c.0 � Zip Code a � � p j Company NAIC Number —} - j SECTION D -SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CON'T'INUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenticompany, and (3) building owner. -'L (<5") 7=Pet Signature ( 1 (1. �} date SECTION E - BUILDING ELEVAT19N INFORMkMNON (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 0" the a ropriate boxes to show whether the elevation is above or below the highest adjacent grade (NAG) and the lowest adjacent grade (LAG)..._ a} Top of bottom floor (including basement, G p ceor en re) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, Har a sure) is. ❑ feet El meters El above or ❑ below the LAG. E2. For Building Diagrams 6--9 with permanentrigs p vided 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 L ❑ 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 tical 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 Owners or Owner's Authorized Representative's Name Address Signature Comments Giity Date State ZIP (;Ode Celephone Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by taw tw ordinance to administer the con ncurity's floodplain management amE)G dtnanoe can complete Sections A, B, C (or , and of this Elevation Certificate. Complete the applicable items) and sign below. Check the measurement used in items GB -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 cort1p4eted Section E for a building located in Zane A (without a FEMA4ssued or community -issued BFE) or Zone AQ G3. ❑ The following information (Items G4 --G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Crate Certificate Of ComprrancefOccupancy Issued G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-buiR /most 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. Communitys design flood elevation: ❑ feet ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments I_] Check here if attachments FEMA Form 086-0-33 (7112)-, Replaces all previous edi5ons. ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6 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. 139 LEWIS AVENUE City TYBEE ISLAND State GA ZIP Code 31328 FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number: 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. 3 REAR VIEW: 10-22-13 11111111111 111111 Wgi;;L:0 I&M. rtmv corm wo-u-3i i(ri;e) Replaces all previous editions. Vincent Helmly 129-A BURTON ROAD Savannah, Ga. 31405 (912) 429-9395 FAX (912) 925-3523 October 22, 2013 Job No.: 13-159 Alida G. Smith 139 Lewis Avenue Tybee Island, Georgia 31328 Surveying Services: Finished Construction Elevation Certificate Lot 17 Palm Terrace 139 Lewis Avenue TotalDue .....................................................$300.00