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HomeMy Public PortalAboutFIFTH AV_1211.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 agenttcompany, and (3) building owner. SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Policy Number: JENNIFER ROBIN PORTANO A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number: Box No. 1211 5TH AVENUE City State ZIP Code TYBEE ISLAND GEORGIA 31328 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) CHATHAM COUNTY I 4-0011-02-003A / LT 269 WD 4 TYBEE A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) A5. Latitude/Longitude: Lat. ! ®® Long: 1 e ®® Horizontal Datum: ❑ NAD 1927 >g 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 1®' SEE NOTES A8.' For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) N/A sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade / c) Total net area of flood openings in A8.b N/A sq in d) Engineered flood openings? Yes X 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 / c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? E3 Yes 0 No SECTION B - FLOOD INSURANCE T (FIRM) INFORMATION - - :*ISBN fill"MOR. - c GEORGIA rCHATHAM r a• W IndexlI�7 r i ... � i Flood ♦ - I • Y � Base Flood El 1 Date i Eff Zone(s) 1 Depth) (Zone AO, use Base Flood - 08/1612018 pp 100; B10. Indicate the source of the Base Flood Elevation (FE) data or base flood depth entered in Item . E] FIS Profile X FIRM ❑ Community Determined E]Other/Source: / 811. 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 No Designation Date: N/A EJ CBRS E3 OPA FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 '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. "-'P-olicyNumber: 12 11 5 TH AVENUE City State ZIP Code Company NAIC Number TYBEE ISLAM GEORGIA 31328 SECTION i9t a • INFORMATION sNy i i ':i _ .:.r . "". i.. "-• i.' • • « i jrr • f f_ • ':. i "E3 '1 • i • a i i a.. ■ i • .,. 1 is • - �..„ i�.._ •i. r`. �© -_, � _ SECTION SURVEYOR, ::..ni OR ARCHITECT a' -," � •— •. • i • is i «.. 1'" : i1- Q •... jj' ra lx.,.. a + f i• a x r x �. d i a ^ EM •1^` if a a, a' f .�.# .. . ! k. '. / i i J: .. •' i..'. i. .e a i. i i i+, ^ y ♦ ~ l� i. " s x r� i � r # � s tr � c �! � r r �, Z M �a i rrt' � • '- a FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 OMB No. 1660-000$ ELEVATION CERTIFICATE 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: 1211 STH AVENUE City State ZIP Code Company MAIC Number TYBEE ISLAND GEORGIA 31328 SECTION BUILDING TI INFORMATION ( V Y 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 4, 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 / ?C feet [:]meters [:]above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is N/A sC 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 N/A El feet ❑ meters ❑ above or ❑ below the HAG. E3: Attached garage (top of slab) is / >C feet ❑ meters ❑ above or ❑ below the HAG. E4.Top of platform of machinery and/or equipment servicing the building is N/A Efeet ❑ 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 2C Unknown. The local official must certify this information in Section G. SECTION — PROPERTY OWNER (OR OWNER'S P SETTIV 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 orOwner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone / / / Comments ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 OMB No. 00 ELEVATION CERTIFICATE Expation1Date®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: 1211 STH AVENUE City State ZIP Code Company NAIC Number TYBEE ISLAND GEORGIA 31328 SECTION 0 ® 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—G1 0. 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 (lems G 10) 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 Gg. BFE or (in Zone AO) 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 (7/15) Replaces all previous editions. Form Page 4 of 6