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Home My Public Portal AboutFifth Av_203-A 1 . 1- n• gVnV'9L rwvu InlatfiVO Rot rKU(atIAM I Expires December 31, 2005 1 05=26002 ELEVATION CERTIFICATE Important Read the instructions on pages 1-7. SECTION A - PROPERTY OWNER INFORMATION II For Insurance Company Use BUILDING OWNER'S NAME Policy Number R. J. GROOVER CONSTRUCTION CO. I BUILDING STREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. i Company NAIC Number 203 A FIFTH AVENUE I CITY STATE ZIP CODE TYBEE ISLAND, GA 31328 PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 2 -A, TYBEE TRACE BUILDING USE (e.g., Residential, Non - residential, Addition, Accessory, etc. Use a Comments area, if necessary.) RES LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): ( ##° - ##' - ##.##' or ##.##;y## 0 NAD 1927 0 NAD 1983 El USGS Quad Map 0 Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NAP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3 STATE TYBEE IISLAND 135164 I CHATHAM GA J f B4. MAP AND PANEL 87. ARM PANEL 89. BASE FLOOD ELEVATION(S) NUMBER B5. SUFFIX 86. ARM INDEX DATE EFFECTIVE/REVISED DATE 88. FLOOD ZONE(S) (Zone AO, use depth of flooding) 135164 0001 C 6/17/86 6/1786 A8 12 B10. Indloate the source of the Base Rood Elevation (BFE) data or be flood depth entered in B9. 0 RS Profile ►'� FIRM 0 Community Determined 0 Other (Describe): B11. Indicate the elevation datum used far the BFE in B9: ei NGVD 1929 0 NAVD 1988 N 812. Is the bud' located in a Coastal Barrier Resources (CBRS) area or Otherwise Protected Area (OPA)? (Describe): m9 ( ) ( ). ❑Yes 0 No Designation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elerattons are based on: 0 Constriction Drawings* 0 Building Under Construction' C; Finished Construction *A new Elevation Certificate wil be required when constnrtion of the building is complete. C2. Building Diagrarn Number 7 (Sept the building diagram most similar to the building for wtich tNss certificate 's Ming completed - see pages 6 and 7. if no cagram axurately represents the budding, provide a ketch or photograph.) C3. 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/A0 Complete Items C3. -a-i below axoding to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and daunt conversion calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Dattam NGVD 29 Conversion/Comments Bevation reference mark used Does the elevation reference mark used appear on the ARM? 0 Yes ► No o a) Top of bottom floor (inducing basement or enclosure) 7. 8 R(m) m ( 4 - 1,0 R G t o h i g h e r 16.9 ft(m) Bolt= of lowest horizontal structural member zones m 1125 GZSTE� ) N may) NA • _ft(m) ,° * c��' � o c e' * -' o d) Attached (top ct�) 7. 81t(m) W ° Lc o e) Lowest elevation of machinery and/or equipment r I30. • 22 A servloing the twdComments yg (Describe in a Comments ) 12 , 31t(m) 0 V ; 0 O • o f) Lowest adjacent (finished) grade (LAG) 6.411.(m) z' �► R o g) Highest ad)acent (finished) grade (HAG) 7. 3_ft.(m) � I i r ye! j ? o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 5 .2 i o ) Tota area of all pennant openings (food vents) in C3.h 1685 sq. in. (sq. cm) / D • SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION 1 This certification 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 in Sections A B, and C 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. CERTIFIERS NAME J. Whitey Reynolds LICENSE NUMBER 2249 TITLE Land Surveyor COMPANY NAME ADDRESS yi CITY STATE ZIP CODE 636 STEP t.Y TE C ,, Savannah, GA GA 31405 SIGNA / / /// DATE T 52 ?tom / 4/211 9-3 1212 -0464 7 / / v ./ L.------ .., ...,.,..,,. +..w,wNyu,cw not riV veiioauuI'iiVIII ,11v11 „. rurirsurarueuwnp e j BUILDING STREET ADDRESS (Including Ap ., UnL Suite, an& n. Na) OR P.O. ROUTE AND BOX NO. Policy Number 203A FIFTH AVENUE CRY - STATE ZIP CODE I Company NAIC Number TYBEEISLAND, GA 31328 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. COMMENTS C3.e) = NC PAD ❑ Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete items El through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR -F, Section C must be completed. El. Bulk:Mg Diayrdn Number the buildng diagram most similar to the building for which this certificate is being completed —see pages 6 and 7. If no dram accurately represents the building, provide a sketch or photograph.) E2 The top of the bottom floor (ndudng basement or enclosure) of the buildng is _ ft (m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, 6 available). E3. For Building Diagrams 6-8 with openings (see page 7), the nett higher floor or elevated floor (elevation b) of the building is ft(m) _in.(cm) above the highest adjacent grade. Complete items C3.h and C3,i on front of form. E4. The top of the platform of machinery and/or equipment servicing the building is _ ft (m) ___in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if amiable). E5. For 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. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, C (Items C3. h and C3. i only), and E for Zone A (without a FEMA- issued or community - issued BFE) or Zone AO must sign here. The statements in Sedions A, B, C and E are correct to the best of my knowledge. PROPERTY OWNER'S OR OWNERS AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplan management ordnance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the appfcabfe item(s) and sign below. G1. ❑ The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or rchited who is authorized by state or local 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 bullring located in Zone A (without a FEMA-issued or conunur r - issued BFE) or Zone AO. G3. ❑ Thefo{owi g information (Items 04-G9) is pnovided fdr community tlooiplain management purposes. G4, PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPUANCEIOCCUPANCY ISSUED G7. This pem t has been issued for: ❑ New Coon ❑ Substantial Immanent G8. Elevation of as- bruit lowest floor (including basement) of the bilking is: . ft. (m) Datum: G9. BFE or (n Zone AO) depth offlodng at the biking site s: , T(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS ❑ Check here if attachments