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Home My Public Portal AboutMILLER AV_1515-EC.pdfU.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 National Flood Insurance Program Important: Read the instructions on pages 1-9. Expiration mate_ .July 31, 2015 SECTION A - PROPERTY INFORMATION FOR INSURANCE CCDMPANY USE M Al. Building Owner's Name Whitlow Construction Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg No_) or P.O. Route and Box No. Company NAIC Number 1515 Miller Avenue City Tybee Island State GA ZIP Code 31328 A3, Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) lot 171 ward 4 PIN 4-0008-11-020 A4. Building Use (e -g., Residential, Non -Residential, Addition, Accessory, etc.) Residential A5. Latitude/Longitude: Lat. N 31d 59' 37" Long. W 80d 51' 07" 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. AT Building Diagram Number 5 A8. For a building with a crawlspace or enciosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosures) n1a sq ft a) Square footage of attached garage nla sq 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 n1a within 1.0 foot above adjacent grade nla c) Total net area of flood openings in A8.b n1a sq in c) Total net area of flood openings in A9.b Na sq in d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes ® No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFIP Community Name & Community Number B2. County Name B3. State Tybee Island 135164 Chatham GA B4. Map/Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 13051C0326 F 717/14 Effective/Revised Date Zone(s) AO, use base flood depth) 9/26108 AE 12.0 B10. 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: 511. 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 (OAA)? ❑ Yes No Designation Date: ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building tinder Construction'" ® 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 SFE), VE, V1 -V30, V (with BFE), AR, ARIA, ARIAE, AR/Al-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) 15.63 ® feet ❑ meters b) Top of the next higher floor 26.86 ® feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) n1a.. ® feet ❑ meters d) Attached garage (top of slab) n1a. ® feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 13.20 ® feet ❑ meters (Describe type of equipment and location in Comments) 0 Lowest adjacent (finished) grade next to building (LAG) 6.5 ® feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 6.7 ® feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 6.5 ® 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. 1 certify that the information on this Certificate represents my best efforts to interpret the data available.y I understand 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 O -STS ® Check here if attachments. licensed land surveyor? ® Yes El No 4n� rn Certifier's Name J. Whitley Reynolds License Number 2249 Title Land Su rsr yo Company Name Address 1336 Ste e6on venue City Savannah State GA ZIP Code 31405 Signa re I/Date 1111116 Telephone 912-352-0464 Nc K� V. orm 086-0-33 (7112) See reverse side for continuation. Replaces all previous editions. LEVATION 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: 1515 Miller Avenue City Tybee Ilsland 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 Signature / Date 1111116 SECTION E — UILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO Ad A (without BFE), complete Items E1-1=5_ 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, craw€space, 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 platfomn of machinery and/or equipment servicing the building is ❑ feet ❑ meters ❑ above of ❑ 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, 8, and E are correct to the best of my knowledge. Property Owner's or Owners Authorized Representative's Name Address City State ZIP Code Signature Date Te€ephone Comments Check here if attachments SECTION G — COMMUNITY INFORMATION (OPTIONAL) rhe local official who is authorized by law or ordinance to administer the community's floodptain management ordinance can complete Sections A, B, C (or E), and G if 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. 31. ❑ 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.) ;2_ ❑ A community official completed Section E for a building located in zone A (without a FEMA -issued or community -issued BFE) or Zone AO. �3. ❑ 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 37. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement �,8. Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters Datum 39. BFE or (in Zone AO) depth of flooding at the building site- ❑ feet ❑ meters Datum 310. Community's design flood elevation: ❑ feet ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments Check here if attachments 7EMA Form 086-0--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, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 11515 Mitler 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 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. Front View October 28, 2016 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 COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number. 1515 Miller Avenue City Tybee €,land State GA ZIP Code 31328 Company NAIC Number: If submitting more photographs than will ft 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 "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. FEMA Form 086-0-33 (7112) Replaces all previous editions.