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Home My Public Portal AboutMILLER AV_1202 ELEVATION CERTIFICATE 1 1 • important: Read the instructions on pages 1- 7. SECTION A- PROPERTY OWNER INFORMATION 1 For Insurance Company Use: BUILDING OWNER'S NAME I Policy Number ARCHIE MARTIN BUILDING STREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. I Company NAIC Number 1202 MILLER AVENUE CITY STATE ZIP CODE TYBEE ISLAND, GA 31328 PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 133, WARD NO, 4 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 #!#.#####") ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP COMMUNITY NAME & COMMUNITY NUMBER 82. COUNTY NAME B3. STATE TYBEE ISLAND 135164 CHATHAM GA 64. MAP AND PANEL 87. FiRM PANEL ' 89. BASE FLOOD ELEVATIONS) NUMBER 65. SUFFIX 66. FiRM INDEX DATE EFFECTiVE REViSED DATE B8. FLOOD ZONE(S) (ZoneAO, use depth of tooding) 1351640002 C 6/17/86 6/17186 A8 12 810. Indicate the source of the Base Rood Elevation (BFE) data or base flood depth entered 10 39. ❑ FIS Profile ►1 FIRM ❑ Community Determined ❑ Other (Describe): 811. Indicate the elevation datum used for the BFE in B9: ►1 NGVD 1929 ❑ NAVD 1988 0 Other (Describe): B12. is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ►Z No Designation Date. ,� SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) 01. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* ►Z1 Finished Construction *A new Elevation Certificate wit be required when construction of the building is complete. C2. Building Diagram Number 1(Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no dagram accurately represents the building, provide a sketch or photograph.) C3. Elevations —Zones A1-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR ARJA, AR/AE, AR/A1 A30, AR/AH, AR/AO Complete Items C3.-a-1 below according to the building diagram specified in Item 02. 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 forthe 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 NGVD 29 Conversion/Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? ❑ Yes ® No o a) Top of bottom floor (induding basement or endosure) 8. 5 ft.(m) m o b) Top of next higher floor NA ..ft.(m) w 1 tG ' o c) Bottom of lowest horizontal structural member (V zones only) NA . _ft.(m) o o �G�S 7 o d) Attained garage (top of slab) NA. _ft.(m) E 2 A A it o e) Lowest elevation of machinery and/or equipment w * y 1 G serridng the building (Describe in a Comments area) 8.1 ff.(m) c / oQ v o f) Lowest adjacent (finished) grade (LAG) 7.7 ft.(m) z .cm . ,t,� � 4 to o g) Highest a�acent (finished) grade (HAG) 8. 2 ft.(m) ,, UF1 F, " I I ' o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 5 1` . ITI.E'� 44 o 0 Total area of all permanent openings (flood v s) in C3.h 518 sq. in. (sq. cm) . a • t` SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION / t . This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation infom ition. 1 certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001, CERTIFIER'S NAME J. Whitley Reynolds LICENSE NUMBER 2249 TITLE Land Surveyor COMPANY NAME ADDRESS CITY STATE ZIP CODE 636 STEPHENS9 y;UI E C"7 SAVANNAH GA 31405 SIGNATU ' //� DATE TELEPHONE �/ — 9/24/04 912-352-0464 / FEMA Perim 81 -31, J nary 2003 See reverse side for continuation. Replaces all previous editions • BUILDING STREET ADDRESS (Induding Apt, Unit, Suite, andl r Bldg. No.) OR P.O. ROUTE AND BOX NO. Poky Number 1202 MILLER AVENUE CITY STATE ZIP CODE I Company NAICNumber T(BEE ISLAND 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 0 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. 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 buildng, provide a sketch or photograph.) E2. The top of the bottom floor (including basement or endosure) of the building is ft.(m) _ in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if available). E3. For Bung 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. Complete items C3.h and C3.i on front of form. E4. The top of the platform of machinery and/or equipment servidng the building is ft.(m) _in.(cm) 0 above or ❑ 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 commuois 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 Sections A, B, C, and E are correct to the best of my knowledge. PROPERTY OWNERS OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The loaf offidal who's authorized by law or ordnance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicabbe 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 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.) G2. ❑ A community official completed Section E fora building located in Zone A (without a FEMA- issued orcommunity4issued BFE) or Zone AO. G3. ❑ The following information (Items G4-G9) is provid4 for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT' ISSUED 08. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (nduding basement) of the building is: — ft.(m) Datum: G9. 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 FEMA Form 81 -31, January 2003 Replaces all previous editions