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HomeMy Public PortalAboutCampbell Av_149B Dec 20 01a 11 :2Sa Nuu- 14 -20V75 13: 15 CSSI P.1)2iO3 FEDERAL EMERGENCY MANAGEMENTAGENCY 10.M.B. No. 3067 - 0077 NATIONAL. FLOOD INSURANCE PROGRAM Expires December 31, 2UU5� ELEVATION CERTIFICATE Important: Read the instruction& on pages 1- 7. 9,FC,TION A - PROPIE1y CANNER iNFORMI•IRN1 1f rAronitanter,Omppnv Use. BUILDING OWNER'S NAME F)k . :- t Oki t. Cr . R. -T 1 v'U ] . e ,;,;, , . . BUILDING STREET ADDRESS (lncluding Apt.. Unit Suite, andfor Bldg. No.) OR P.O. ROUTE AND BOX NO Cr}iijp ry*11:lVt►rl►bef , ` ; - - CITY STATE ZIP CODE i yeEE t'S c...4.A.1 0 to fro. .3r32$ PROPERTY DESCRIPTION (Lot and Block Numbers. 'lilac Reoel Number, Legal Description. etc%) z- 'r 4(°t", QF /r► Pe rJ 0 "1 LC OthlDI V l 5I Cyr OF Lr r 41 , 4Lo PEnr HAaAauc BUILDING USE (e.g.. Residential, Non- residentlai, Addition, Accessory, etc. Use COn rncnta area 0 necessary,) ~SIOSAIrtA LATITUDEILONCITUOE (OPTIONAL) HORIZONTAL DATUM: SOURCE: U Gl'S (Type); t ea % dq' - kli.#W or ft#.0foff •) U NAD 19V U NAD 1983 U USGS Quad Map U Other: ___. -. SEDDDON N - FLOOD INSURANCE RTE MAP NM) INFORMATION gi. NFI' COMMUNi1' NAME G COMMUNITY NUMBER 82. COUNTY NAME I iii,, I 16 Ile oC !reE Ist..A AJ 0 / 351(0'4 I C1 4.113146,A011 Cf v�.C.c /A. B4. MAP PANEL as. SUFFrx Be. FIRM INIS) 67. r IFtwi PANEL U5. FLOOD 89. BABE FLOOD W .,EVATiON(B) Nu nn + � DATE EFFECTIVE /REVISE[) DATE ZONES 135/ (40-4 awl C- 64-0-42,4 O le °f7 - re, (:, A8 13 B10 Indicate the source bt the Base Reed Elevation WO antra or be flood depth entered In 09, Li F15 Profile Ki FIRM I_( Community Determined [,_ j Other (Describe): B11. Indicate the elevation datum used for the ®FE In 139: IMI NGVD 1929 L( NAVD 198E U Other (Describe): B12. Is the building located Ina Coastal Barrier Resouroac System (CIIRG) area or Othorwtto Pruteded Arno (QPA)? L__ Vey 2,;( No Ue &Ignotlon Dato: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRER) C1, Building elevations ere based on: UConsttuctfon Drawings" ( Under Construction' ()Finished Construction 'A nvw Elevation Cann - ate will be required when construction of the building is comptete, C2. Building Ulegram Number (p (Soled the building diagram moot &miler to the building for wtiloh this certificate 1s being completed - see pages 6 and 7.1f no diagram accurately represents the building, provide a sketch or photograph.) - C3. Elevations -. Zones Al •A30. AE, A14. A (with BFI, VC, Vi -V30, V (w$h BFE), AR, ARIA. AR/AE. ARIA1 -A30, ARIAH, ARIAO I Complete items C3,aa below according 10 the building diagram specified In Item C2. Sidle this datum used. it the datum Is diflemnt from the datum used for the BFE in Section 13, convert the datum to that used for the BFE. Show field measurements and datum conversion . colculetion, Use the v ♦dad or the Comments area of Se DD or on 4 as appropriate, to document the datum conversion. Datum �,CbV b, in ` l CornrorsloniComents "ice ` -- Elevation reference mark used Does the elevation rererence mark used appeal:On the F Yes VC7 No , Da) Top of bottom floor (including basement or enclosure) `7 ft(m) V "1` ti �� � Qb) Top of next higher floor 1 Ca, . ft,(m) 1 Cj c) Bottom of lowest horizontal structural member (V zones only) - film) 13 P � c;IS I'� R . pd) Attached garage (top of slab) ''T . IL:(m) a * ��cj �,.; I De) Lowest elevation of machinery andlor equipment 1 3 (ri tt {rn ' ` -tit l �� aorvIcwtg the w,adlrrg (Describe In a Commune area.) - r t] Lowest adiacen( (finished) grade (LAG) _ S R (m) 1 v 4. �aa lag) Highest ed)0Cant (finished) grade (IiAG) - 'Urn) 17 Q S U R V F. Z f Cl h) No. of permanent openings (food motel vnlian t R above nrtmeet gild, b — r - , O ' " Total area o all coin s Road v.nio In C3.h bt. cm 1 I'i 0 S A7. y �� ',�' (31) i ) permanent o 9 ( 1 _ 1 -P e9 (IQ. ) . sECT1ON U - SURVEYOR. ENOr I1LER, ORARcJ4ITECT CERTIFICATION Trill certification 1. to be signed and sealed by a land surveyor, engineer, or architect authorised by 11aw to cerilfy etovation Information. l certify that the iraformstlon M Settlers, A, R. and C on this ccrlitleats represents my beat efforts to interpret the data 6va1413te -1 undar,tand that any fake etatemunt mar be putriehable by fine or Imprisonment under 10 U.S. Code. Section loot CERTIFIER'S NAME LICENSE NUMBER JAMES M. KEATON GAj 2743 TITLE RECXSTEREP LAND SURVEYOR C CHATHAM 5ERVZCE.",, 124.C. ADDRESS CITY STAN ZIP CODE 1'. 0. BOX 61649 SAVANNAIi GEORGIA 31420 SIGNATURE � / A � DATE TELEPHONE /�l-.� ` t'zL 5 O vimobi.? ! . � O$ (9.12) 303 -0302 FE ` Form 8141, January 2003 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDIT IONS 0 on MI nFr- va - -)caG iaiizn Dec 20 06 11:30a -2 NOV - 14 - 20@6 13 :16 CSSI P. ©3%03 untse sueces, cum tna correeponntnq Intormatlon arum zepuon n. 1r- urursur; ce +.ompany use; VILBI G t,- Untt- Sulle.end(or91dg.(iNo.) OR pO.ROUTEANO BOX NO. p CITY STATE ZiP CODE tC i tatty'NAlb- Number - rwr i eZE _ t Lott-.6-4 Cs. Z (4. l 3z. f ." - , SCCCION D • SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Co )y both sides of thi elevatio Certificate for (1) communtty o(ficfat, (Z) Insurance agentfcotmpany, and 3) building owner. I e AI co t t ] Z 7 /a tA. loaf Yc L4t, tt . - f`t4 1 e4 LOMMEN1 c.44 Sta 4. - r ��..s.. e A.ACAPALMIC1 .walr / 3 0 5. ."r. ter ra e 6. AA .A., •.r 4r_ ®o * . Z'r? t✓ s v°.a.s r 're5 �'t ms °{ P rd v�..s(� Fps OAR. � •E t'f«dj #J ckst2 /?7-. . / ,+�On Gr,4s r a 5 ' cP 'S e E E.= v.CA. r e a /5.0. ( {_I Cheek hire if attaehme nts =CTION E - 8 FLEVATIoN INFc kMATION (SURVEY NOT REQUIRED) FOitaiNE MID .tONE (WITHOU aFE} For Zone AO and Zone A (without BFE), complete items El. through E4, if the Elevation Coate Is Intended for use as supporting utiorma for a LOMAor LOMR -F. Section C must be completed. E 1 I uiiding Diagrem Number (Select the building diagram most Olmder to the building for which this certificate Is being completed - see pages 6 and 7.11 no diagram accurately represents the building, provide a sketch or photograph.) E2. The lop of the bottom tioor (including basement or enclosure) of the buttding Is LL tt,(m) � )a ove or (_( below (check one) the highest adjacent grade. (Use natural grade, If available.) E3. par r Building Diagms &•g with openings (see page 7), the next higher floor or elevated floor (el actin p) I the bUildin 'S 11 •(m) �..,,L,,..Iin.(cm) above the highest ad)tttent grade. A. , E4 The too of the atattorm of machinery andlor equipment servicing the building is l l- ft. (m) 11n. (cm) ICI abov 1 boiow (check one) the highest adjacent grade. (Use natural grade. If available.) E 5. For Zone AO only: if no flood depth number Is available, le tho top of the bottom floor elevated In accordance wit!` the community's llaodplain management ordinance? )J Yes 1J No Li Unknown. The levet Octal must certify this Intormalion In Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATNE) CERTIFICATION 1-1c property owner or owner's authorized representative who completes Sections A, B, 0 (Items C3_h and C31 only), and E for Zone A (■ •ilhout a FEMA-issued or community- 1ssUed t FE) or Zone AO must sign here. The statements in Sections A, S, C, and E are correct to the be of my knowledge PROPERTY OWNERS OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CiTY STATE ZiP CODE SIONATURE ! DATA TFr COMMENTS (. — 4 1 .c r L) Check here i�attact)tnents SECTION G • COMMUNITY INFORMATION (OPTIONAL) The IOP.OI ortierat who is authorized by law or ordinance to admintslortho community's tloedploln management ordinance car complete Secuons A, 8, C tor E). and G of this Elevation Certificate. Complete the appltcabto item(s) and sign below. G I__..I The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by stale or local taw to certify elevetiurt information, (Indicate the source and date o1 the elevation data in Me Comments area bellow.) G2 Ii A community official completed Section E for a building located in Zone A (without e F1;MA- Issued or community-issued EWE) or Zone AO. G3 The The following information (items G4 -69) Is provided for community lloodplatn management purposes. G4 PERMIT NUMBER G5a DATE PERMIT ISSUED I 68, DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY i ISSUED G 7. This permit has been issued for: Li New Construction Li Substantial Improvement 06. Elevation of as - built lowest floor (tndudlne basement) of the building Is: ft(m)Datum: Gs FE or (In Zone AO) depth oreisoetng et the building elle is: fl.(m)f7ed,rn. LOCAL OFFI;.IAL'S NAME TITLE CoMMUNiTY NAME TELE ,145NE SIGNATURE I}AT COMMENTS - J J! TOTfhL P.03 DFC- 2t1- 2PPIC, 1 n: iS as p a'D