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Home My Public Portal AboutJones Av_202 0 /76 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067 - 0077 Expires July 31, 2002 ELEVATION CERTIFICATE Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION I For Insurance Company Use: BUILDING OWNERS NAME 1 Policy Number J. WAYNE DISHER BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and /or Bldg. No.) OR P.O. ROUTE AND BOX NO. i Company NAIC Number 202 JONES AVENUE CITY STATE ZIP CODE TYBEE ISLAND GA 31328 PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 63 B, WARD 1 BUILDING USE (e.g., Residential, Non - residential, Addition, Accessory, etc. Use Comments section if necessary.) RESIDENTIAL LATITUDE /LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): ( ##° - ##' - ##.##" or ##.##### °) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other: SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1, NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME 83. STATE TYBEE ISLAND 135164 I CHATHAM 1 GEORGIA 1 1 • B4. MAP AND PANEL B5. SUFFi.X B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding) 135164 001 C 6/17/86 6/17/86 A8 13 110. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe); 11. Indicate the elevation datum used for the BFE in B9: ►1 NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe): 12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes 0 No Designation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) 1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* ►1 Finished Construction `A new Elevation Certificate will be required when construction of the building is complete. 2. Building Diagram Number 6 (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) 3. Elevations — Zones A1-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, ARIAE, AR/A1 -A30, AR /AH, AR /AO Complete Items C3a -i below according 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 datum conversion calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum Conversion /Comments Elevation reference mark used SDBM Does the elevation reference mark used appear on the FIRM? ❑ Yes ►1 No o a) Top of bottom floor (including basement or enclosure) 11.4 ft.(m) Ti o b) Top of next higher floor 19 .4 ft.(m) o c) Bottom of lowest horizontal structural member (V zones only) NA . _ft.(m) m d r o d) Attached garage (top of slab) 11. Oft.(m) E ° E o e) Lowest elevation of machinery and /or equipment w 1° !�/ servicing the building 14. 1ft.(m) 8 = /4./ ' Z b l o f) Lowest adjacent grade (LAG) 10 .5ft.(m) z m \ C) G�_ o g) Highest adjacent grade (HAG) 10. 6ft.(m) N o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 6 5 o i) Total area of all permanent openings (flood vents) in C3h 1296 sq. in. (sq. cm) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION 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. understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ';ERT1FIER'S NAME WRIGHT C. POWERS, JR. LICENSE NUMBER 2612 TITLE REGISTERED LAND SURVEYOR COMPANY NAME CONNOR & ASSOCIATES, INC A DDRESS // CITY STATE ZIP CODE =' 0 60X 10091 - SAVANNAH (A 31417 SIGNATURE � % DATE TELEPHONE /9 R R /O2 1- 919- R97 -54Rn i =MA Form 81 -31, AUG 9 SEE REVERSE SiDE FOR CONTINUATI'' REPLACES ALL PREVIOUS EDITIONS IPORTANT: In these spaces, copy the corresponding information from Section A. 6 For Insurance Company Use: JILDING STREET ADDRESS (Including Apt., Unit, Suite, and /or Bldg. No.) OR P.O. ROUTE AND BOX NO. , i Policy Number J2 JONES AVENUE TY STATE ZIP CODE I Company NAtC Number fBEE ISLAND GA 31328 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) opy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. DMMENTS JOB No.GA02655 F.B. (506 -52) REVISE ADDRESS & C3h & C3i 9/13/02 ❑ Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) r Zone AO and Zone A (without BFE), complete Items El through E4. If the Elevation Certificate is intended for use as supporting - ormation fora LOMA or LOMR -F, Section C must be completed. (. Building Diagram Number _(Select the building diagram most similar to the building for which this certificate is being completed — see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) ?. The top of the bottom floor (including basement or enclosure) of the building Is ft.(m) _in.(cm) ❑ above or 0 below (check one) the highest adjacent grade. 3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is _ ft.(m) in.(cm) above the highest adjacent grade. 4. 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 he property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA- issued or :ommunity- issued BFE) or Zone AO must sign here. 'ROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVES NAME -kDDRESS CITY STATE ZiP CODE SIGNATURE DATE TELEPHONE DOMMENTS ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) he local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete ections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. 1. ❑ 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 state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) 2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA- issued or community - issued BFE) or Zone AO. 73. ❑ The following information (items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER I G5. DATE PERMIT ISSUED I G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED ;7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement 38. Elevation of as -built lowest floor (including basement) of the building is: _ft.(m) Datum: 139. BFE or (in Zone AO) depth of flooding at the building site is: ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS ❑ Check here if attachments - EMA Form 81 -31, AUG 99 REPLACES ALL PREVIOUS EDITIONS