HomeMy Public PortalAboutLEWIS AV_137.pdfU,S. DEPARTMENT OF HOMELAND SECURITY 'OMB No. 166:0-000�8
Jra:Federal Emergency Management Agency EE#piratio�:n :Dat:e::November 30, 2022
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
Coat/ all Rages 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
_-
A—I.Building Owner's Name Policy Number:
SUSAN D. HILL
A2. Building Street Address (including Apt., Unit, Suite, and/or I. No.) or P.O. Route ari—dI company NAIL Number:
Box No.
137 LEWIS AVENUE
City State ZIP Code
TYBEEISLAND Georgia 31328
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 18 PALM TERRACE
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. N 32 ® 00' 40. 9 " Long. W 80 ® 50' 54, 7 Horizontal Datum: EJ NAD 1927 x 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 5
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) 0.00 sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b 0.00 sq in
d) Engineered flood openings? El Yes Z No
A. For a building with an attached garage:
a) Square footage of attached garage 0.00 sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A9.b 0.00 sq in
d) Engineered flood openings? E] Yes Z No
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Number B2 ' County B1. NFIP Community Name & Community Number B2. County Name 133. State
TYBEE ISLAND 135164 CHATHAM Georgia
x M P 1
B4. Map/panel B5. Suffix B6. FIRM Index 67. FIRM Panel B8. Flood B9. Base Flood Elevation(s)
Effective/
Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth)
Revised Date
13051 CO213 G 0816-2018 08-16-2018 AE 9.0
1310. Indicate the source of the Base Flood Elevation (13FE) data or base flood depth entered in Item 139:
EJ FIS Profile E] FIRM E] Community Determined E] Other/Source:
1311. Indicate elevation datum used for BFE in Item B9: [] NGVD 1929 Z NAVD 1988 E] Other/Source:
B12. Is the building located in a Coastal Barrier Resources System (C S) area or Otherwise Protected Area (OPA)? [] Yes Z No
Designation Date: E] C E] OPA
FEMA Form 086-0-33 (12119) Replaces all previous editions. Form Page 1 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 2022
IMPORTANT-. In the 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:
137 LEWIS AVENUE
City ' State ZIP CodW_ --domPanY NAIC —Number
TYBEE ISLAND Georgia 31328
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: E] Construction Drawings* [-] Building Under Construction* Z Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C. Elevations —Zones Al—A30, AE, AH, A (with BF), VE, V1 —V30, V (with BFE), AR, AR/A, AR/AE, Al -30, AR/AH, ARIAO.
Complete Items C2.a—h below according to the building diagram specified in Item A7. 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.
E] NGVD 1929 Z NAV D 1988 E] 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) 17.3 Z feet EJ meters
b) Top of the next higher floor N/A Z feet [] meters
c) Bottom of the lowest horizontal structural member (V Zones only) N/A N feet E] meters
d) Attached garage (top of slab) N/A 2] feet E] meters
e) Lowest elevation of machinery or equipment servicing the building 17.2 Z feet E] meters
(Describe type of equipment and location in Comments)
Lowest adjacent (finished) grade next to building (LAG) 6.7 E] feet E] meters
g) Highest adjacent (finished) grade next to building (HAG) 6.8 Z feet E] meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support 6.7 Z feet ®meters
SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
Thiscertification 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? Z Yes EJ No E] Check here if attachments.
Certifier's Name License Number
VINCENT HELMLY 1882
Title
LAND SURVEYOR
Company Name
VINCENT HELMLY
Address
129 A BURTON ROAD
City State ZIP Code
SAVANNAH Georgia 31405
Signature p
Date Telephone Ext.
07-08-2021 (912) 429-9395
Copy all pages of this Elevation Ce ificate and all atikhments for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments (including type of equipment and location, per C2(e), if applicable)
C2 (e) = AIR CONDITION UNIT PLATFORM
FEMA Form 086-0-33 (12119) Replaces all previous editions. Form Page 2 of 6
OMB o.1660-0
ELEVATION CERTIFICATE Expiration Date: November 30, 2022
IMPORTANT: 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:
137 LEWIS AVENUE
City State ZIP Code Company NAIC Number
TYBEEISLAND 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 EI—E5. If the Certificate is intended to support a LOMA or LOMR-F request,
complete Sections A, Band C. For Items EI—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only,
enter meters.
El. 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 E] feet EJ meters E] above or below the HAG.
b) Top of bottom floor (including basement,
crawlspace, or enclosure) is feet EJ meters EJ above or below the G.
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 E] above or below the HAG.
E3. Attached garage (top of slab) is EJ feet E] meters above or below the HAG.
E4. Top of platform of machinery and/or equipment
servicing the building is EJ feet E] 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 communitys
floodplain management ordinance? E] Yes E] No E] 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
Address city State ZIP Code
Signature Date Telephone
Comments
E] 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 CERTIFICATE Expiration Date: November 30, 2022
IMPORTANT: In these spaces, copythe corresponding information r ecti FOR INSURANCECOMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. o.) or P.O. Route and Box No. Policy Number:
137 LEWIS AVENUE
City State ZIP Code Company NAIC Number
TY EE ISLAND Georgia 3132
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.
1. 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 fora building located in Zone A (without aFEMA-issued or community -issued E)
or Zone AO.
3. The following information (Items 1) is provided for community floodplain management purposes.
. Permit Number G5. Date Permit Issued G6. Date Certificate of
Compliance/Occupancy Issued
7. This permit has been issued for: New Construction Substantial Improvement
8. Elevation ofas-built lowest floor (including basement)
of the building: feet 0 meters Datum
G. BFE or (in Zone AO) depth of flooding at the building site: feet meters Datum
G10. Community's design flood elevation: feet Ej meters Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments (including type of equipment and location, per C(e), if applicable)
Check here if attachments.
FEMA Form 086-0-3 (12/19) 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, 2022
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route at 10 DOX 140. Policy Number:
137 LEWIS AVENUE
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.
Photo One
Photo One Caption F 07/0812021
Photo Two Caption BACK: 07/08/2021
FEMA Form 086-0-33 (12119) Replaces all previous editions. Form Page 5 of 6
BUILDING PHOTOGRAPHS OMB
No. 1660-0008
ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 2022
IMPORTANT: In these spaces, copy'the corresponding information fr ci FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. o.) or P.O. Route and Box No. Policy Number:
137 LEWISVNU
City State ZIP Code Company NAIL 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.
Ph,oto Three
Photo Three
Photo Three Caption Clear Photo Three
Photo Poet*
Photo Four
Photo Four Caption Clear Photo Dour
FEMA Form 086-0-3 (12/19) Replaces all previous editions. Form Page 6 of 6
1. All development — Base Flood Elevation Data 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 r NO
H. Development in Zones A, AE, Al -A30 and .
A. Solid foundation perimeter walls located below BFE:
1. There are at least two (2) openings?
YES or NO
2. Square footage of enclosed area subject to flooding
3. Square inches of venting required
4. Square inches per opening (multiply I by w)
5. Number of required vents (3 above divided by 4 above)
6. Foundation contains the minimum number of vents?
YES or NO
7. The bottom of each opening is no higher than one (1) foot above grade?
YES or NO
8. Any cover on openings will permit the automatic flow of floodwaters
In both directions?
YES OR NO
B. Base flood elevation and/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 C1 was "yes", has a No -Rise Certification been submitted?
YES or NO
Reviewer's Name: Date reviewed
M. Development in Zones V, VE and V! -V30, VO (Coastal High Hazard Areas).
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: _
Local • diSignature:
City of Tybee Island
Tybee Island, Ga. 31328-2749
Date:
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