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Home My Public Portal AboutLEWIS AV_116.pdfDEPARTMENT F HOMELAND SECURITY OMB No.1 0-000 Federal Emergency Management Agency Expiration Date: November 30, 2022 National Flood Insurance Program ELEVATION CERTIFICATE important: Follow the instructions on pages 1 Copy all pages of this Elevation Certificate and all attachments for (1)community"official, () insurance agent/ mpa y, and (3) building owner. SECTION— PROPERTY INFORMATION INSURANCE COMPANY USE Al. Building Owners Name Policy Number: STEPHEN E. KNUDSEN Building Street Address (including Apt., Unit, Suite, andlor Bldg. No.) or P.O. Route and Company NAIC Number Box N. 116 LEWISV U City State ZIP Code TYBEEISLAND Georgia 3132 A. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 64 PLM TERRACE 4. Building Use (e.g., Residential, Non—Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. N 32 ® 00' 45. 1 " Long. W 80 ° 50' 50 2 " Horizontal Datum: HAD 1827 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 AS, For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosures) 0.00 sq ft b) Number of permanent flood openings in the crawispace orenclosure(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 x No A9. For 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 c) Total net area of flood openings inAB. 0.00 sq in Engineered flo openings? Yes x No SECTION —FLOOD INSURANCE T (FIRM) INFORMATION Bl. NFIP Community Name & Community Number B2. � CountyTYBEE ISLAND 135164 Georgia 4i r Flood E fi, mber i Date Effective/ � Zone(s) (Zone O, use Revised Date • 1 [. . a 10. Indicate the source of the Base Flood Elevation ( FE) data or base flood depth entered in Item 8: FIS Profile FIR Community Determined E] Other/Source: 11. Indicate elevation datum used for BFE in Item 8: 1829 x NAVD 1988Other/Source: 812. Is the building located in a Coastal Barrier Resources System (C S) area or Othenvise Protected Area ( PA)? Yes o Designation Date: CRS PA FEMA Form 086-0-33 (1 18) Replaces all previous editions. Form a 1 of OMB No. 660-0008 ELEVATION CERTIFICATE Expirationl ante: November 30, 2022 I T :int s Vie, copy t r rrdl In on from Section A. FOR INSURANCE COMP USE Building tr' t Address (includin t., Unit® Suite, and/or Bldg- .) or P,O. Route and Box No. Policy Number: 116 LEWIS V OF city state ZIP Code Company NAIC Number TYBEEISLAND Georgia3132 SECTION— BUILDING ELEVATION I (SURVEY NOT REQUIRED) (WITHOUTFOR ZONE AO AND ZONE A For Zones AD and A (without SFE), 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 , use natural rade, if available. Check the measurement used. In Puerto Ricoonly, enter meters. 1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent gra (HAG) and the lowest adjacent grade (LAG). ) Top of bottom floor (including basement, crawispace, or enclosure) is feet etersabove or below the ) Top of bottom floor (including basement, crawlspace, or enclosure) is El feet El meters 0 above or below the 2. For Building Diagrams' 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 C. in the diagrams) of the building is D feet El meters 0 above or below the HAG, . Attached garage (top of slab) is 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 o Unknown. The local official mu rti this information in Section G. SECTION R (OR OWNEWS REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, 8, and E for Zone A ( °tout a FEMA -issued or community -issued ) or Zone Ac 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 Representative7s Name Address city State ZIP Code inature Date Telephone Comments Check here if attachment& FEMA Form 08&0-33 (12/19) Replaces all previous editions. Form Page <3 of 6 OMB No. 1660-0008 Ex6ratian Oatw. Nnvemhar -n 7n'21' IMPORTANT. In thew spaces, copy the coirresponding Information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. o) or P.O. Route and Box No. Policy Number:' 116 LEWIS AVENUE City State ZiP Code Company NAIC Number TYBEEISLAND Georgia 31328 SECTION INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections AB, C (or E), and G of this Elevation Certificate. Complete the applicable (s) and signbelow. Check the measurement used in Items G 10. 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 G 10) is provided for community floodplain management purposes. G4. Permit Number ` G5. Date Permit Issued G6. Date Certificate of CompliancefOccupancy 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 LocalOfficial'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 (12119) Replaces all previous editions. Form Page 4 of 6 BUILDING PHOTOGRAPHS ELEVATION Continuation Page OMB No. 1660-0008 Expiration Date: November 30, 2022 IMPORTANT: I these spaces, copy e corresponding information f 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:" 116LEWISAVENUE City State ZIP Code Company NAIC Number TYEE ISLAND ' Georgia 31328 If submitting more photographs than will "Front fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; View" and "Rear View`; and, if required, "Right Side View" and "Left Side View," When applicable, photographs must show the foundation with representative ntative examples of the openings or vents, as indicated in Section A8. Photo Three Photo Three Photo Three Caption Clear Photo Three Photo Four Photo Four Photo Four Caption Clear Photo Four FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 6 of 6 xFENIA check list Building Permit Number Applicant's Name: Owner's Name: Site Address, Tax#, Parcel#, :kf Address: 91-i Telephone: Telephone: 1. All _development — Base Flood ElevationData Provided: A. The as -built elevation certificate from a registered land surveyor or Professional engineer has been submitted?Pes r No B. The lowest floor elevation is at or above the required lowest floor elevation? r o C. Electrical, heating, ventilation, plumbing, air conditioning equipment (including Duct work) and other service facilities are located above BFE or flood proofed?or No 11. Development in Zone 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 . Any cover on openings will permit the automatic flow of floodwaters in both directions? Yes or No 111. Development in Zones Y, VE and V! -V30, Y (Coastal i azar 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 of No Reviewer's ante: Date reviewed: Deal Administrator's at re: ate: City of Tybee Island 403 Butler Avenue-P.O. Box 2749 y ee Island, Ga. 31328-2749