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Home My Public Portal AboutJones Av_603 r p•VVI VN\VL I Iw.21,-MM I Expires December 31, 200, ELEVATION CERTIFICATE J Important: Read the instructions on pages 1- 7. . SECTION A - PROPERTY OWNER INFORMATION I For Insurance Company Use: BUILDING OWNER'S NAME 1 Policy Number �l S R. - Ai r, a A 20i- /3 • C H 4 "1 __ I BUILDING STREET ADDRESS (Including Apt_, Unit, Suite, and/or Bldg. No) OR P.O. ROUTE AND BOX N0. . , 1 Company NAIC Number , Ca j2a►..i15 -..« "/ v . CITY �— STATE -iii -CODE y k'/ E -T'SL_.,.6.t..tr> �O /eG'® /A _3 / 3 Z 8 PR r'ERTY DES TION (Lot and Block Numbers, Tax Parcel Number, Legal Description, eta) T C �� a Id _f) 2 BUILDA1,9 USE (e.g., Residential, Non - residential, Addition, Accessory, eta Use a Comments area, if necessary.) LATITUDE/LONGITUDE (OPTIONAL) • HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): ' ( ##° - IN' - ice,##" or ##.>AltAlg) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑Other; • SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NF]P COMMUNITY ME &COMMUNITY NUMBER f COUNTY NAME 83. STATE C ► TY 0 c I Yt1 rsi_a1•a 0 1351 64 I C, d- 1.rA:n -14 vt - -- - l Co c o ✓z 0.0/ 4\ . &t. MADAM) PANEL di. HifiM PANEL -- 89. BASE f•L00D ELEVATION(S) NUMBER 95. SUFFIX B6. FIRM INDEX DATE EFFECTIVE/REVISED DATE 88. FL00D ZONE(S) (Zone AO, use depth of flooding) 13,16) 0001 G plc - i7 - ac Q (0�°r A. (Z.o B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered In 89. ❑ FIS Profile FIRM ❑ Community Determined ❑ Other (Desk); 911. lndcale the elevation datum used for the BFE in 89: R NGVD 1929 0 NAVD 1988 ❑ Other (Describe): 812. Is Lhs building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (CPA)? ❑ Yes tii. No Designation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Bu" rng elevations are based on: ❑ Construction Drawings* ❑ Bullding Under Construction* N.Finished Construction 'A new Elevation Certificate will be required when construction of the building Is complete. C2, Buh^ding 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.) t C °A1 e C3, 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 Ccn plele Items C3. -a-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 S eiion B, convert the datum to That used for the BFE. Show field measurements and datum conversld n calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Dah.rm 2i Conversion /Comments 1 E - Elevation reference mark used Does the elevation reference mark used appear on the FIRM? Q Yes No � O D o a) Top of atom floor (including basement or enclosure) LO . Qf .(m) . r / o b) Top of next higher floor N — A_. _(t,(m) i7 C? GAS T q / o c) Bottom of lowest horizontal structural member (V zones only) ®I - A. , _il.(m) • N g Q� 6.,() o d) Attached garage (top of slab) 1 - . _MI) i • No. 2 43 4 . o a) Lowest elevation of machinery and/or equipment t ,r 8 ervidng the building (Describe in a Comments area) 1 q , I fi,(m) a � \I � y 0 o f) Lowest adjacent (finished) grade (LAG) _.ift(m) z 4,Zi vQ S U R \I 0 o g) Highest adjacent (finished) grade (HAG) _9_. .(m) c FS M KIP o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade Q - o f) Total area of all permanent openings (flood vents) in C3.h Qsq. in. (sq. cm) CAeo - 0 - 03 SECTION D • SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification Is to be signed and sealed by a Land surveyor, engineer, or architect authorized by taw to certify elevation Information, i certify that the information in Sections A, B, and C on fhls 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, CERTIFiER'S NAME LICENSE NUMBER ?A M _E S ..212____LC A.Q GA 7743 _ __ _ 'ME COMPANY NAME Registered Land Surveyor Chatham Surveying Services, Inc. ADDRESS CiT'Y STATE ZIP CODE p. CL R rx eih 49 Savannah, Georgia 31420 SIGNATURE 1 / ..., 1 -1. c DATE TELEPHONE � -�-- N rime- 9— 4:17PM - 73 ' 4e — a`OA .Z4"®3 ( 91 2 303 -0302 J L)i v ri etJet.D 8. I D G STREET ADDRESS (Indudng Apt, Uncj Suits, arc 'g. No OR P.O. ROUTE AND BOX NO. Policy Number �A(�� G . . t ®� /3 . ZN C®i-i Ai►1 CITY r STATE ZIP CODE Company NAIC Number / P te r 5 .� CV/Z. G10,/ 3/ 3 2-'$ I 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) bulding owner. • COMMENTS r /5 1-104/5 _4 Ls/ AS /4/., /,"/ /97/ -4 ii. r pR6 F7 12/14. �t l� 0 to - 0 -- o - ❑ 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 fora LOMA or LOMR -F, Elevation Section C must be completed. El. Building Diagram Number _(Select the build diagram most similar to the building for which this certificate Is being Completed- see pages 6 and 7. If no diagram a=rately represents the building, provide a sketch or photograph.) E2, The lop of the bottom floor (Including basement or enclosure) of the building is _ ft_(m) _in.(an) d above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if available). E3, For Building Diagrams 6-8 with openings (see page 7), the next higher floor a elevated floor (elevation b) of theb ding Is ft.(m)_in,(an) above the highest adjacent grade. Complete Items C3.h and C3.i on front of form, E4. The top of the platform of machinery andor equipment setvIdng the building Is _ fl,(m) _In.(an) ❑ above a ❑ below (check one) the highest adjacent grade, (Use natural grade, if available). 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 Of owner's authorized representative who completes Sections A, 8, C (Items C3.h and C3a only), and E fa Zone A (without a FEMA- issued or community - issued BFE) or Zone AO must Sign here. The statements in Sections A, 8 C, end E ere collect to the best of my knowledge. PROPERTY OWNERS OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME N— ADDRESS 1 CITY STATE ZIP CODE SIGNATURE ( DATE TFI FPHONE COMMENTS ❑ Check here if attachments . SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by taw or ordinance to administer the communitys tloodplain management ordinance can complete Sections A, 8, C (or E), and G of this Elevation Certificate, Complete the applicable Item(s) and sign below. GI, ❑ The information In Section C was taken from other documentation that has been signed and embossed by a frcensed surveyor, engineer, a architect who is authorized by state or It 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 build located in Zone A (without a FEMA-tssued a community-issued BFE) a Zone AO. G3. ❑ The following information (Items G4-G9) Is provided for community floodplain management purposes. G4. PERMIT NUMBER GS. DATE PERMIT ISSUED G6, DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been issued for. ❑ New CansUvdion ❑ Substantial improvement G8. Elevation of as -built lowest floor (Inducting basement) of the building is: fl(m) Datum: • G9. BFE or (in Zone AO) depth of flooding at the building site is: �d p / A s�-, _ ft. ' Datum: LOCAL OFFICIAL'S NAME ( TITLE COMMUNITY NAME • ) TELEPHONE SIGNATURE l ) • DATE COMMENTS Received Time—Jun. 9._ 4:17PM TOTAL P.03