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Home My Public Portal AboutMILLER AV_205B.pdfU.S. IMPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood Insurance Program important: Read the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION Al. Building Owner's Name PEGGY OMB No. 1660-0008 Expiration Date: July 31, 2015 FOR INSURANCE COMPANY USE A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number. 205 B MILLER AVENUE T City TYBEE ISLAND State GA ZIP Code 31328 A3. Property Qescription (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT B, SUB OF LOT 146 & S HALF LOT 147 WARD 1, TYBEE ISLAND TAX PARCEL 4-0004-12-008 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL AS, Latitude/Longitude: Lat. 32-00-40.42 Long. 080-50-42.35 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 1A AS. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) NIA sq R a) Square footage of att h d garage NIA `q ft 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 NIA within 1.0 foot above adjacent grade WA 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 ® No d) Engineered flood openings? ❑ Yes ® No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number 62. County Name B3. State CITY OF TYBEE ISLAND 135164 1 CHATHAM GEORGIA B4. Map/panel Number 13051C 0213 10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other/Source: 11 . Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ® NAVD 1988 ❑ Other/Source: 12. 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) I. 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. ?. 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: LOCAL 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) 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) 6.7 ® feet ❑ meters NIA._ ❑ feet ❑ meters NIA. ❑ feet ❑ meters N/A.— ❑ feet ❑ meters 6.4 ® feet ❑ meters 0 Lowest adjacent (finished) grade next to building (LAC) 6.0 g) Highest adjacent (finished) grade next to building (HAG) 6.3 h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 6.0 ® feet ❑ meters ® feet ❑ meters ® feet ❑ meters SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION tis certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation 'ormation. / certify that the information on this Certificate represents my best efforts to interpret the data available. inderstand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a Check here if attachments. licensed land surveyor? ® Yes ❑ No !rtifier's Name MICHAEL J. GARDNER License Number GA. RLS 2285 le LAND SURVEYOR _ Company Name MICHAEL J. GARDNER, LAND SURVEYOR dress 120 VARNEDO NU City GARDEN CITY State GA ZIP Code 31408 Inature f Date 02/10/2015 Telephone 912-661-0479 (CELL) 1A Form 066-0-33 (7112) See reverse side for continuation. *t (J 41L V1 ' f 1t.� �_4 su:+ •' �� Reolaces all nrevinnm aA 0^n. tL=VA I IVN L:ImK 111 KATE, 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: 205 B MILLER AVENUE City TYBEE ISLAND State GA ZIP Code 39328 Company NAIC Number: SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenticompany. and (3) building owner. Comments C2 (e) Elevation of AC Pedestal =8.6'. AC Pedestal located at Center Rear of Residence. Note: Elevation of Floor of Utility Room behind residence is elev. 6.4'. Note: This Residence Constructed in Compliance with City of Tybee Island Requirements in 1972 which was Prior to any FEMA REQUIREMENTS. PROJECT NO: PGC9Ff EY, 02J1 ORD 1 §10 X, FS, MJ , 2014, "D" 33 Signature Date 0 211 012 01 5 SECTION E - BUILD114G ELFWATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT IBFE) 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 he 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) r Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. 'roperty Owner's or Owner's Authorized Representative's Name .ddress City State ZIP Code ignature Date Telephone omments ❑ Check here if attachments. SECTION G - COMMUNITY INFORMATION (OPTIONAL) r local official who is authorized by iaw or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, _C(_0r E), and G lis Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in items G8 -G10, In Puerto Rico only, enter meters. ❑ The information in Section C was taken from other documentation that has been signed and seated 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.) ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. ❑ The following information (Items G4 -G10) is provided for community floodplain management purposes. Permit Number G5. Date Permit issued G6. Date Certificate Of Compliance/Occupancy Issued This permit has been issued for: ❑ New Construction ❑ Substantial improvement Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters Datum BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum Community's design flood elevation: ❑ feet ❑ meters Datum ;,al Official's Name Title mmunity Name Telephone inature Date mments Check here if attachments IA Form f1RR-fl-R3 (71191 Ganl�re �u -i-_ _ _�:,: --- ELEVATION CERTIFICATE, page 3 BuRding Photographs See Instructions for Item A6. IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE TBuilding Street Address (including Apt., Unit, Suite, and/or Bldg No.) or P.O. Rouse and Box No. Policy Number: 205 B MILLER AVENUE City TYBEE ISLAND State GA ZIP Code 31328 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 appticabte, photographs must show the foundation with representative examples of the ftaod openings or, vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page, FRONT VIEW REAR VIEW LEFT VIEW RIGHT VIEW AA Form 086-0-33 (7172) Replaces at! previous editions. MICHAEL JIM GARDNER LAND SURVEYOR 120 VARNEDOE AVE. GARDEN CITY, GA. 31408 912-964-8262 912-661-0479 (CELL) Invoice Invoice Number: PGCOFFEY, (01) EC 02/10/2015 Tw PEGGY G. COffEY (ELEVATION CERTIFICATE REQUESTED BY BETTY LOU FUTRELf,) Project: ELEVATION CERTIFICATE, 205 B MILLER AVENUE, TYBEE ISLAND, CHATHAM COUNTY, GA. Manager: JIM GARDNER (soil Fixed Fee — ELEVATION CERTIFICATE, 205 B MILLER AVENUE, TYBEE ISLAND, GA. Billing Fee: $ 250.00 THANK YOU FOR ALLOWING ME THE OPPORTUNITY TO DO THIS FOR YOU. PLEASE CALL ME SHOULD YOU HAVE ANY QUESTIONS. (1-912.661-04'19) Phase Phase Fee % of Fee % Complete Fee Earned Prior Billin8 Current Fee ELEVATION CERTIFICATE $ 250.00 100.00 100.00 $ 250.00 $0.00 $ 250.00 Billing Total: $ 250.00 I *** Total invoice Amount 2x0.00 Aged Receivables: Current 31-60 Days 61-90 Days 91-120 Days %120 Days $ 250.00 NOTICE LEGAL ACTION LEGAL ACTION LEGAL ACTION FIELD CREW: J. GARDNER, V. HUNTER