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HomeMy Public PortalAboutVan Horn_1 FEDERAL EMERGENCY MANAGEMENT AGENCY 7 7 -007 O.M.B. No. 306 NATIONAL FLOOD INSURANCE PROGRAM Expires July u6 2002 ELEVATION CERTIFICATE Important: Read the instructions on pages 1 7. SECTION A - PROPERTY OWNER INFORMATION ) For Insurance Company Use: BUILDING OWNER'S NAME , -I-A.1 . 1 Policy Number 4h, VA /..1 1/ 4 N .&A2 / rL-lw BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and Bldg. No,) OR P.O. ROUTE AND BOX NO. I Company NAIC Number I VAov ,t rz". ► '3 �� 7 - --- / /P 0 35- CITY 1 STATE ZIP CODE 035 :. - Sr.....6 -A-t r) C -ire c,> A 3 Z a PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Z ` C.) c... Vi .e w9 va pit/ is; ®n./ BUILOAG USE (e.g., Residential, Non - residential, Addition, Accessory, etc. Use Comments section if necessary.) = Si I) Se./ - 1 -- •■ Ar L- LATITUDE/LONGITUDE (UI' I tONAL) HORIZONTAL DATUM: SOURCE: J,J GPS (Type): ( ##° - ##' - ##.##" or ##.##114I# JJ NAD 1927 L_I NAD 1983 1_1 USGS Quad Map '_( Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Bi, NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. UOUNI Y NAME l B3. STATE I C r rY OF TYe _[,. .sc�s..J v .. /35 / Co / H4- 4 i 1( 3. 9562 Co . , A. B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX 87. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding) ) 351(' - / 000 C-• ,Oro - 1 'T ° 3 Ca Xa - 1 1 -SC0 A.• 8 /5, j B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. J J FIS Profile j' FIRM J_J Community Determined j_J Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: j NGVD 1929 {_J NAVD 1988 L Other (Describe): B12, Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? J_J Yes j No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: j_jConstruction Drawings* J_,jBuilding Under Construction* 'Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 7 (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.) C3. Elevations - Zones A1 AE, AH, A (with BFE), VE, V1 - V30, V (with BFE), AR, AR /A, AR/AE, AR/A1 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 WA,1 2 3 Conversion /Comments Jot s Elevation reference mark used Does the elevation reference mark used appear on the FIRM? Li Yes ) No ❑ a) Top of bottom floor (including basement or enclosure) 6 8 . l ft.(m) ❑ b) Top of next higher floor m R'' " , t- D /Z ' 1 7 . 0 ft• (m) v � L� Q/ ❑ • c) Bottom of lowest horizontal structural member (V zones only) Al -A. , ft.(m) a �c & \STE, 9 CI d) Attached garage (top of slab) A/ `'' • —It(m) E CI e) Lowest elevation of machinery and /or equipment u, r No. 2743 servicing the building S . j ft.(m) l I '. '' a- ❑ f) Lowest adjacent grade (LAG) 7 . 7 ft.(m) z' . �2 . , ❑ g) Highest adjacent grade (HAG) '7 . S ft.(m) g � SUR`� , ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade FS M . \<. ❑ i) Total area of all permanent openings (flood vents) in C3h 0 sq. in. (sq. cm) Q 2 / Z I/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 law to certify elevation information. / 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. _ CERTIFIER'S NAME LICENSE NUMBER James M. Keaton, PT,S CA 274' _ T1TLE Land Surveyor Chatiffir i ' ing Services, Inc. _ ADDRESS CITY STATE ZIP CODE 'P. 0. Bo.-6--1 Savannah, Georgia 31420 _ SIGNATURE ,� yy DATE TELEPHONE GN' t— • \ PG S T 3 Z '. 20 0 3 (912) 303 -0302 FEM4 Form 81 -31, AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In these spaces, copy the corresponding information from Section A. I For Insurance Company Use: BUILDINg STREET.,DDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. I Policy Number vAm Ai Cfl Y lam ` s �� STATE ZIP CODE Company NAIC Number i C� z C�fA 3 1 3 Z8 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 .� C 3 Is s - n -f reo v,./ r) , tee . ©o rz , / r 's 2 rte �'TB id.�s.Co f•t r> / S Asti r 1-i -d.-€3 rTAB 43 t . T=.M 3 P r S sr � r 2 ST 3[-/ 3 /yA': d 1° FL-00 . {-g 2$ 4.-<- — r is A./ / 7 4, 7)4 5_ U r.e o c G b d 2 ,6..1 E c_ ro S .1 , G' / 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 E3. if the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR -F, Section C must be completed. E1. 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.) E2. The top of the bottom floor (including basement or enclosure) of the building is L1_1 ft.(m) LL{in.(cm) ( I above or L4 below (check one) the highest adjacent grade. E3. 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? ( _i Yes ( No 1_,_-1 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. PROPERTY OWNER'S OR OWNERS AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS II 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, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. 01. 1_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.) G2. 1_I 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. L) The following information (Items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. I DATE CERTIFICATE OF COMPLIANCEJOCCUPANCY 67. This permit has been issued for: LJ New Construction L) Substantial Improvement GB. Elevation of as -built lowest floor (including 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 1 J Check here if attachments =EMA Form 81 -31, AUG 99 REPLACES ALL PREVIOUS EDITIONS