HomeMy Public PortalAboutVAN HORN_16.pdfU.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008
Federal Emergency Management Agency Expiration Date: November 30, 2018
National Flood Insurance Program I
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 agenticompany, and (3) building owner.
SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name Policy Number:
Bill Kirribrough
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No. Company NAIC Number:
16 Van Hom
city State ZIP Code
Tybee Island Georgia 31328
A3. Properly ptioi�(Lot and Block—Numbers, Tax-'P—arcelNumber, —Legal Description, etc.)—
Lot C, Van Horn Place PIN 4-4443-09-036
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential
A5_ Latitude/Longitude: Lat. N 32* 09 56" Long. W 80* 59 36" Horizontal Datum: M NAD 1927 nx 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 8
A8. For a building with a crawispace or enclosure(s):
a) Square footage of crawlspace or enclosure(s)
1510.00 sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 8
c) Total not area of flood openings in A8.b 1600.00 sq in
d) Engineered flood openings? 9 Yes El No
A9. For a building with an attached garage:
a) Square footage of attached garage
N/A sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade NIA
c) Total net area of flood openings in A9.b
d) Engineered flood openings? FlYes nX No
N/A sq in
SECTION 8 — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Bl. 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 B9. Base Flood Elevafion(s)
Number Date i Effective/ Zone(s) (Zone AO, use Base Flood Depth)
Revised /Date
i
1305104214 F 07-07-2014 09-26-2008 AE 11,0
B10. Indicate the source of the Base Flood Elevation (BFE) data or base good depth entered in Item 59:
n FIS Profile gg FIRM n Community Determined n Other/Source:
B11. Indicate elevation datum used for BFE in Item 89: [3 NGVD 1929 Z NAVD 1988 E] Other/Source:
812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? E] Yes X No
Designation Date: El C13RS El OPA
FEMA Form 086-0-33 (7/15) Replaces all previous editions, Form Page 1 of 6
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:
16 Van Hom
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* n Finished Construction
*A new Elevation Certificate wt8 be required when construction of the building is complete.
C2. Elevations – Zones Al–A30, AE, AH, A (with BFE), VE, V1–V30, V (with BFE), AR, ARIA, AR/AE, 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 n 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)
9.29 Z feet ❑ meters
b) Top of the next higher floor
18.90 ❑x feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only)
N/A ❑ feet ❑ meters
d) Attached garage (top of slab)
N/A ❑ feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments)
14.45 ❑x feet EJ meters
f) Lowest adjacent (finished) grade next to building (LAG)
8.60 Q feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG)
9.20 x❑ feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
feet ❑ 8,60 x 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. 1 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? 0 Yes ❑ No
❑ Check here if attachments.
Certffier's Name License Number
J. Whitley Reynolds 2249
Title
Registered Land Surveyor
Company Name
-n.
Address —• -- — —_�_
�. ;�
r'' - ,
636 Stephenson Avenue, Suite C
•y�[v
City State ZIP Code
Savannah Georgia 31405
Signature ,` Date Telephone
Ext. j
10-31-2017 (912) 352-0464
Copy all pees of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner.
Comme s (tncuding type of equipment and location, per C2(e), if applicable)
C2.e) is HVAC
Engineered vents are Smart Vent 1540-520
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6
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:
16 Van Horn
City State ZIP Coale
Company NAIC Number
Tybee Island Georgia 31328
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED)
FOR ZONE AO AND ZONE A (WITHOUT SFE)
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, Band 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,
crawispace, 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 1-2 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 FEMA4ssued 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 or Owner's Authorized Representative's Name -
Address City State ZIP Code
Signature gate Telephone -
- - - - -
Comments
❑ Check here if attachments.
F1
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6
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:
16 Van Hom
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 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 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 E] meters Datum
G9. BFE or (in Zone AO) depth of flooding at the building site:
G10. Community's design flood elevation:
Local Official's Name
Community Name
Signature _W
'title
Telephone
Date
Comments (including type of equipment and location, per C2(e), if applicable)
❑ feet ❑ meters Datum
❑ feet ❑ meters Datum
n Check here if attachments.
FEMA Form 086-0-33 (7115) Replaces all previous editions. Form Page 4 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date: November 30, 2011
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY LISW
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number.
16 Van Horn
City State ZIP Code Company NAIC Number
Tybee Island Georgia 31328
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.
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Photo One
Photo One Caption Front view 10-30-2017
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Photo Two Caption Rear View 10-30-2017
Photo Two
Clear Photo One 1
Clear Photo Two
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 201E
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:
16 Van Horn
City State ZIP Code Company NAIC Number
Tybee Island Georgia 31328
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 "Left Side View." When applicable,
photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8.
Photo Three Caption Side View 10-30-2017
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Photo Four Caption Side View
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Photo Four
Clear Photo Three
Clear Photo Four
FEMA Form 086-0-33 (7115) Replaces all previous editions. Form Page 6 of 6