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Home My Public Portal AboutFIFTH AV_1307-ECU.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008 Federal Emergency Management Agency Expiration Date: November 30, 2022 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 A1. Building Owner's Name Policy Number: PAUL CHIUCHIOLO A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number: Box No. 1307 5TH AVENUE City State ZIP Code TYBEE ISLAND Georgia 31328 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 262, WARD 4, TYBEE ISLAND 4-0011-05-015 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 31 0 59' 49.97" Long. 0800 51' 05.87" Horizontal Datum: D NAD 1927 [8J 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 crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) 1052.00 sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 5 c) Total net area of flood openings in A8.b 840.00 sq in d) Engineered flood openings? DYes [8J 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 N/A c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? DYes [8J No SECTION B -FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name B3. State CITY OF TYBEE ISLAND 135164 CHATHAM Georgia B4. Map/Panel B5.Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth) Revised Date 13051C 0326 G 08-16-2018 08-16-2018 AE 9.0' B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: D FIS Profile [8J FIRM D Community Determined D Other/Source: B11. Indicate elevation datum used for BFE in Item B9: D NGVD 1929 [8J NAVD 1988 D Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? DYes [8J No Designation Date: D CBRS DOPA . Form Page 1 of 6 FEMA Form 086-0-33 (12/19) Replaces all prevIous editions. OMB No. 1660-0008ELEVATION CERTIFICATE Expiration Date: November 30,2022 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt. , Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No. 1307 5TH AVENUE Policy Number: City TYBEE ISLAND State Georgia ZIP Code 31328 Company NAIC Number SECTION C -BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on : 0 Construction Drawings* 0 Building Under Construction* ~Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations -Zones A 1-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, ARIA, ARIAE, ARIA 1-A30, ARIAH, 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: GPS ESTABLISHED Vertical Datum: NAVD 1988 ----------------------- Indicate elevation datum used for the elevations in items a) through h) below. o NGVD 1929 ~ NAVD 1988 DOtherlSource: Datum used for building elevations must be the same as tha-:t-u-s-ed-:-:-fo-r-:th-:e--=-B=FE=.-------------------------------- Check the measurement used. 5.5a) Top of bottom floor (including basement, crawlspace, or enclosure floor) ______________::....:.=. ~ feet o meters b) Top of the next higher floor 6.2 ~ feet o meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A o feet o meters d) Attached garage (top of slab) N/A o feet o meters 6.2 ~ feet o meterse) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 5.4 ~ feet o meters g) Highest adjacent (finished) grade next to building (HAG) 5.7 ~ feet o meters 5.4 ~ feet o metersh) Lowest adjacent grade at lowest elevation of deck or stairs, including 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. I certify that the information on this Certificate represents my best efforts to interpret the data available. I 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? [8J Yes 0 No Certifier's Name License Number MICHAEL J. GARDNER GA. RLS NO. 2285 Title LAND SURVEYOR Company Name MICHAEL J. GARDNER LAND SURVEYOR Address 120 VARNEDOE AVENUE ZIP Code 31408 Date Telephone Ext. 01-23-2021 (912) 661-0479 CELL ents for (1) community official, (2) insurance agenUcompany, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) C2(e): Air Conditioner Pad at Rear of Residence at Elevation 6.2'. NOTE: C2(b) The Lowest Finish Floor Elevation of this Residence is the Floor of the Room at the Rear (Elevation 6.2'). NOTE: The Finish Floor Elevation of the Main Residential Area of this Residence is at Elevation 6.6'. JOB NO: PAUL CHIUCHIOLO (01) 01/23/2021, F.B. MJG 2020 B, PG 68 Form Page 2 of 6 FEMA Form 086-0-33 (12/19) Replaces all previous editions. ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 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: 1307 5TH AVENUE City State ZIP Code Company NAIC Number TYBEE ISLAND Georgia 31328 SECTION E -BUILDING ELEVATION INFORMATION (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 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 o feet o meters o above or o below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is o feet o meters o above or o 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 o feet o meters o above or o below the HAG. E3. Attached garage (top of slab) is o feet o meters o above or o below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is o feet o meters o above or o 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? DYes o No o 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, B, and E are correct to the best of my knowledge. Property Owner or Owner's Authorized Representative's Name City State ZIP Code Address TelephoneSignature Date Comments o Check here if attachments. Form Page 3 of 6Replaces all previous editions. FEMA Form 086-0-33 (12/19) OMB No. 1660-0008ELEVATION CERTIFICATE Expiration Date: November 30, 2022 IMPORT ANT: In these spaces, copy the corresponding infonnation 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: 1307 5TH AVENUE 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 G&-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, 0 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) G2. 0 or Zone AO. G3. 0 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: o New Construction 0 Substantial Improvement G8. Elevation of as-built lowest floor (including basement) o feet o meters Datumof the building: o feet o metersG9. BFE or (in Zone AO) depth of flooding at the building site: Datum o feet 0 meters DatumG 1 O. Community's design flood elevation: Local Official's Name Title Community Name Telephone DateSignature Comments (including type of equipment and location, per C2(e), if applicable) o Check here if attachments. .. Form Page 4 of 6 FEMA Form 086-0-33 (12/19) Replaces all prevIous editions. BUILDING PHOTOGRAPHS OMB No. 1660-0008 ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date: November 30, 2022 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. 1307 5TH AVENUE Policy Number: City TYBEE ISLAND State Georgia 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. Clear Photo One Photo Two Caption REAR VIEW Clear Photo Two Form Page 5 of 6 Replaces all previous editions. FEMA Form 086-0-33 (12/19) BUILDING PHOTOGRAPHS OMB No. 1660-0008ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 2022 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. 1307 5TH AVENUE City TYBEE ISLAND State Georgia ZIP Code 31328 FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number 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 LEFT VIEW Clear Photo Three Pnoto Four RIGHT VIEW Clear Photo Four Photo Four Caption Form Page 6 of 6 Replaces all previous editions. FEMA Form 086-0-33 (12/19)