HomeMy Public PortalAboutBILLFISH LN_4-EC.pdfU.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008
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 agent/company, and (3) building owner.
SECTION A — PROPERTY INFORMATION
FOR INSURANCE COMPANY USE
Al. Building Owner's Name
Policy Number:
SAM SHAY
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Company NAIC Number:
Box No.
4 BILLFISH LANE
City State ZIP Code
TYBEE ISLAND Georgia 31328
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT D JONES COTTAGES WARD 3, TYBEE ISLAND
A4. Building Use (e.g„ Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. N 32 ° 00 . 047' Long. W 80 ° 50. 928 ' Horizontal Datum: ❑ NAD 1927 ❑x 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) 0 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 Z 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 n No
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
B2. County Name
B3. State
TYBEE ISLAND 135164
CHATHAM
Georgia
B4. Map/Panel
B5. Suffix
B6. FIRM Index
B7. FIRM Panel
B8. Flood Zone(s)
B9. Base Flood EIO.vation(s)
Number
Date
Effective/
(Zone AO, use Base
Revised Date
Flood Depth)
13051CO213
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 B9:
❑ FIS Profile ❑x FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ❑x NAVD 1988 ❑ Other/Source:
B12. 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 t
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.
4 BILLFISH LANE
City State ZIP Code
Company MAIC Number
TYBEE ISLAND Georgia 31328
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. 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, VII—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: 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 (inciLding basement, crawlspace, or enclosure floor) 15. 4 Z feet ❑ meters
b) Top of the next higher floor 24. 6 ❑x feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) NSA. X feet ❑ meters
d) Attached garage (top of slab) NSA. ❑x feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 14.8 x❑ feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) S 3 feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 5.9 ❑x feet ❑ meters
h) Lowest adjacent grade a- lowest elevation of deck or stairs, including 6 1 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. 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 ❑x Check here if attachments.
Certifier's Name License Number
VINCENT HELMLY 1882
Title
LAND SURVEYOR
c
1%
Company Name
VINCENT HELMLY
ea
Here
Address
129-A BURTON ROAD
City State ZIP Code
SAVANNAH Georgia 31405
Signature Date Telephone
' 02122/2017 (912) 429-9395
Copy all pages of this Elevation Certificate and all altah ents for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments (including type of equipment and location, per C2(e), if applicable)
C2 (e) = AIR CONDITION UNIT PLATFORM
FEMA Form 086-0-33 (7/15) Replaces all previous editions.
Form Page 2 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: Novernber 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:
4 BILLFISH LANE
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 ;his 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
G8. Elevation of as -built lowest floor (including basement)
of the building: ❑ feet ❑ meters Datum
G9. BFE or (in Zone Ad) 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 086-0-33 (7115) Replaces all previous editions. Form Page 4 of 6
BUILDING PHOTOGRAPHS
ELEVATION CERTIFICATE 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.
4 BILLFISH LANE
City
TYBEEISLAND
State ZIP Cc
Georgia 31328
OMB No. 1660-0008
Expiration Date: Novernber 30, 2018
FOR INSURANCE COMPANY USE
Policy Number:
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.
Photo One Caption FRONT 0212 212 0 1 7
-N
Photo Orae
Photo Two Caption REAR 02/22/2017
FEMA Form 086-0-33 (7115)
Replaces all previous editions.
Form Page 5 of 6