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Home My Public Portal AboutMeddin Dr_30 U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660 -0008 Federal Emergency Management Agency Expires March 31, 2012 National Flood Insurance Program Important; Read the instructions on pages 1 -9. SECTION A - PROPERTY INFORMATION ( For Insurance Company Use: A1. Building Owner's Name ! Policy Number !_Y BEE . 1_5_.1-A.1 1-11 S' °Qp 1C..6,. . oC./ e Y /AJC. A2. Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route w Box No. Company NAIC Number - - ice Iii) / 1712.1V /G.® �`r E AZT S. E . - A/ ) _ � . City State ZIP - Code /3e, - t-L_` , Q _ C. ®2C. /A -313 A3. Property Description (Lot and Bidck Numbers, Tax Parcel Number, Legal Description, etc.) A.c-/z Cr /ir./ r-®/ZT 5e./2 E V EsAr "-L./A.4._ T) / P. /. N, a/- CO0 / °/,3 ®/o A4. Building Use (e.g., Residential, Non - Residential, Addition, Accessory, etc.) /1TTee /‹.6-1- F ( g4 /, i 7-- A5. Latitude /Longitude: Lat. /V 3Z'b Long.W a _5®' d-/Z . < r Horizontal Datum: ❑ NAD 1927 sit 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 (0 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) Z. L i $~ sq ft a) Square footage of attached garage sq ft b) No. of permanent flood openings in the crawlspace or b) No. of permanent flood openings in the attached garage enclosure(s) within 1.0 foot above adjacent grade s i within 1.0 foot above adjacent grade Al- A c) Total net area of flood openings in A8.b 3 COO sq in c) Total net area of flood openings in A9.b - A sq in d) Engineered flood openings? ❑ Yes T No d) Engineered flood openings? 9� 0 Yes ❑ Nom -4 SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 1 B1. NFIP Community Name & Community Number I B2. County Name B3. State ITV As* /V sa isc, rn 1351(01-1 IC. ,a,ai. � I 1 C� lr2e0.i . B4. Map /Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8, Flood B9. Base Flood Elevation(s) (Zone Date Effective /Revised Date Zone(s) AO, use base flood depth) 13651C-.07-1 3 € P ° 01- ZCG -OS (a9) _ 2 ,- a 04 .®.e 1 '2. B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile I, FIRM ❑ Community Determined ❑ Other (Describe) B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 rg. NAVD 1988 ❑ Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes No Designation Date ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: 0 Construction Drawings* ❑ Building Under Construction* 2' Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations -Zones Al A30, AE, AN, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1 -A30, AR/AH, AR/AO. Complete Items C2.a -h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized USCVS - ri DAL C ST'A I Vertical Datum fat 41.\( 1 9 ZS Conversion /Comments d�8 ".t i- Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 9 , ® ►- feet ❑ meters (Puerto Rico only) b) Top of the next higher floor 1.1 . ® feet ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) /... v.& ❑ feet ❑ meters (Puerto Rico only) d) Attached garage (top of slab) X41 -8, ❑ feet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building _j_32_. 1 gj feet ❑ meters (Puerto Rico only) (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) . - 7 Ea. feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade next to building (HAG) A - 4 3 ► feet ❑ meters (Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs, including 8, . Fi p feet ❑ meters (Puerto Rico only) structural support 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, 1 certify that the information on this Certificate represents my best efforts to interpret the data avaiiable.l r T "�:� understand that any false statement may be punishable by fine or Imprisonment under 18 U.S. Code, Section 9009. ID � � s 1 �_ -1, - > Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a 7 '),S1- 4- licensed land surveyor? ® Yes ❑ No ; j � <C t ; Certifier's Name JAMES M. KEATON, RLS License Number GEORGIA #2743 >' " .f E N 0.27 2743 Title LAND SURVEYOR Company Name CHATHAM SURVEYING SERVICES, INC. Address P. 0. BOX 61649 City SAVANNAH State GA ZIP Code 31420 Sig ature .-- Date Telephone 912 - 303 -0302 �' , // Al. �.�3 ... u 2_0 >' ID IMPORTANT: In these spaces, copy the corresponding information from Section A. I For Insurance Company Use: Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number 30 . — .PDIA! byeu ��0 ice- 4.s 5� �® ®o/Soc.- City State ZIP Code d Company NAIC Number °! /5t-A"- - (.0eol .Cp t ?; 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 Z M cc-E) /Zoom g, 0 wt E coaoc./A./ r L o° ' 3 & A'3'rA Cd-/a C®) - TI-LE ®c- r r T-' rE rd, a e i s.2 toL1 A L. L. 1 S .d.D = C,A V.� i G Y V 0 pd. 7 = p a r^L C. 2 • /4-.� • - 04E v ■ s a .› A c a ® ® our -rats 0.4 5 . fir , C. 2e is .&'J .G 4u ®s P aL . rir ge,.4 C 2k is .° ..r 57E4'5. Sig ature A � Date «,, /Z G S w.I E Ogg Z / / fia Check here if attachments §CTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT RE(IUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete items E1 -E5. If the Certificate is intended to support a LOMA or LOMR -F request, complete Sections A, B, and C. For Items E1 -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. El . Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is _ ❑ feet 0 meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet 0 meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and /or 9 (see pages 8-9 of Instructions), the t her floor (elevation C2.b in the diagrams) of the building is _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is El feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and /or equipment servicing the building is ., ❑ feet ❑ meters ❑ above or ❑ below t E5_ 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, and E for Zone A (without a FEMA - issued or community- issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments fl Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, 8, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8 and G9. 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 G4 -G9) is provided for community floodplain management purposes- . - -- - _ __ ... - ------- - - -.._ G4. Permit Number I G5_ Date Permit Issued G6- Date Certificate Of Compliance /Occupancy Issued G7. This permit has been issued for: 0 New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: ❑ feet 0 meters (PR) Datum - G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters (PR) Datum G10. Community's design flood elevation ❑ feet ❑ meters (PR) Datum Local Official's Name Title Community Name Telephone \� Signature Date Comments n Check here if attachments