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Home My Public Portal AboutMORTAR AV_910-EC.pdfU.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 — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name + Policy Number: CHRIS KONCUL CONSTRUCTION, LLC Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number: Box No. 910 MORTAR AVENUE City State ZIP Code TYBEEISLAND Georgia 31328 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 4, BLOCK 15, BAY WARD BOOK 51, PAGE 631 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 32.021306 Long. -80.844924 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 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 /A c) Total net area of flood openings in A8.b N/A sq in d) Engineered flood openings? ❑ Yes ❑ 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? ❑ Yes ❑ No GTI — FLOOD INSURANCE (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' 13051 CO213 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: ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item 139: EJ NGVD 1929 ® NAVD 1988 '❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes 0 No Designation Date: ❑ CBRS ❑ OPA FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 1 of 6 OMB No. 1660-0008 Expiration Date: November 30,'2022 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: 910 MORTAR AVENUE City State ZIP Code Company NAIC Number TYBEE ISLAND - Georgia 31328 SECTIO C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) - C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* ® Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. G2. Elevations — Zones Al—A30, AE, AH, A (with BFE), VE, V1—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 PLAT Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 ❑ 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) 15.1 ® feet ❑ meters b) Top of the next higher floor 25.4 ® 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 ❑ feet ❑ meters x 10.6 (Describe type of equipment and location in Comments) I) Lowest adjacent (finished) grade next to building (LAG) 5.2 ® feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 5.6 ® feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 5.2 ® feet ❑ meters SECTIO' D — SURVEYOR, ENGINEER, C ITEC CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. l certify that the information on this Certificate represents my best efforts to interpret the data available. ! 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? ® Yes ❑ No ❑ Check here if attachments. Certifier's Name License Number MICHAEL HUSSEY 2509 Title LAND SURVEYOR 1' Company Name SUNDIAL LAND SURVEYING, PC No.2sog Address' 1410 W U.S. HIGHWAY 80, SUITE 2 City State ZIP Code BLOOMINGDALE Georgia 31302 Signature Date Telephone Ext. 01-24-2022 (912) 235-2477 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) BUILDING PAD/PARKING ELEVATION 5.8' G2e - HVAC UNIT IMPORTANT: FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE . i. I kAM EWA 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: 910 MORTAR AVENUE City State ZIP Code Company NAIC Number TYBEE ISLAND Georgia 31328 BUILDING L TI INFORMATION (SURVEY NOT REQUIRED) R`ZONE AO AND ZONE A (WITHOUT ) For Zones AO and A (without F), complete Items E1-5. 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 ❑ 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 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 El feet ❑ meters ❑ above or below the HAG. 4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. 5. 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. CTI F— PROPERTY OWNER (OR 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 Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments. FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 3 of 6 OMB No. 1660-0008 ELEVATION CERTIFICATEExpiration Date: November 30, 2022 IMPORTANT: Inthese 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: 910 MORTAR AVENUE City State ZIP Code Company NAIC Number TYBEE ISLAND Georgia 31328 SECTIO 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 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 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 (12/19) Replaces all previous editions. Form Page 4:of 6 BUILDING PHOTOGRAPHS OMB No. 1660-0008 ELEVATIONI See Instructions for Item A6. Expiration Dater November 30, 2022 IMPORTANT: In these spaces, copy the corresponding information from cin 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: 910 MORTAR AVENUE 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 SideView." 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. i tit Y r Photo One Photo One Caption FRONT 01-22-2022 Clear Photo One *S s„ n 1� * t. t, R k ji Photo(Two Photo Two Caption REAR 01-22-2022 Clear Photo Two FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 5 of 6 BUILDING T OMB No. 1660-0008 ELEVATIONI I Continuation Page 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: 910 MORTAR AVENUE 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. r a73 , s, v Photo Three ... .. Photo Three Caption SIDE 01-22-2022 Clear Photo Three f� Z 1 S w ➢ y e. r A Photo Four Photo Four Caption SIDE 01-22-2022 Clear Photo Four FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page;6 of 6 0 3 3 Building Permit Number . Applicant's Name:°1 Owner's Name: Site Address, Taxff, Parcel: Address: Telephone: 'Telephone: I. All development — Base Flood Elevation Luta Provided: A. The as -built elevation certification from a registered land surveyor or Professional engineer has been submitted? or NO B. The lowest floor elevation is at or above the required lowest floor elevation? '- or NO C. Electrical, heating, ventilation, plumbing, air conditioning equipment (including duct work) and other service facilities are located above BFE or flood proofed? ES or NO iI. Development in Zones A, AE, AI - A30 and A. Solid foundation perimeter walls located below BFE.° 1. There are at least two (2) openings? YES of NO 2. Square footage of enclosed area subject to flooding 3. Square inches of venting required 4. Square inches per opening (multiply 1 by w) 5. Number of required vents (3 above divided by 4 above) 6. Foundation contains the minimum number of vents? - YES or NO T The bottom of each opening is no higher than one (1) foot above grade? YES or NO &. Any cover on openings will permit the automatic flow of floodwaters In both directions? YES OR NO B. Base flood elevation axd/or floodway data not available orAO Zones: 1. The lowest floor is at least one (1) foot above the highest adjacent grade? YES or NO 2. The development meets the setback requirements of the ordinance? YES or NO 3. If 2 above was "no", has a No -Rise Certification been submitted? YES or NO Reviewer's Name: Date reviewed: B. Floodway data is provided. 1. Did this development encroach in the floodway? YES or NO 2. Do the actual field conditions meet the proposed actions and technical date requirements? YES or NO 3. If Cl was "yes", has a No -Rise Certification been submitted? YES or NO Reviewer's Name: Date reviewed 111. Development in Zones V, VE and V! -V30, VO (Coastal High HazardAreas). A. Development location complies with all coastal setback requirements? YES or NO B. Structure is securely anchored to pilings or columns and certification by a Registered, professional architect or engineer has been submitted? YES or NO Reviewer's Name: Date reviewed: C. Walls permitted below the base flood elevation consist of decorative lattice work or, Where permitted, are breakaway and have been certified by a registered, professional Architect or Engineer? YES or NO Reviewer's Name: Date reviewed: Isocal Administrator's Signature: ILDate; City of Tybee Island w3r� r 403 Butler Avenue - P.O. Bax 2749 { Tybee Island, Ga. 31328-2749 � ;