HomeMy Public PortalAboutJones Av_105 FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067 -0077
NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1- 7.
SECTION A - PROPERTY OWNER INFORMATION I For Insurance Company Use:
BUILDING OWNER'S NAME I Policy Number
KEITH GAY
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. I Company NAIC Number
105 JONES AVENUE
CITY STATE ZIP CODE
TYBEE ISLAND GA 31328
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 93, WARD NO. 1
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 ##.####/e) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other.
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE
TYBEE ISLAND 135164 CHATHAM GA
B4. MAP AND PANEL B7. FIRM PANEL B9. BASE FLOOD ELEVATION(S)
NUMBER B5. SUFFIX B6. FIRM INDEX DATE EFFECTIVE/REVISED DATE B8, FLOOD ZONE(S) (Zone AO, use depth of flooding)
135164 0001 C 6/17/86 6/17/86 A8 12
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe):
B11. Indicate the elevation datum used for the BFE in B9: ® NGVD 1929 ❑ 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
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1, Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* 0 Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number 5 (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-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1 -A30, AR/AH, AR/A0
Complete 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
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 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 (inducting basement or enclosure) 20. 2 ft.(m) m G 0 r '
o b) Top of next higher floor NA . _ft.(m) co rw
o c) Bottom of lowest horizontal structural member (V zones only) NA . _ft.(m)
o o i v t �
o d) Attached garage (top of slab) N. _ft.(m) e B t
o e) Lowest elevation of machinery and/or equipment W 4 4.4. servicing the building (Describe in a Comments area) NA , _ft.(m) E ti - d • 6 ill
o f) Lowest adjacent (finished) grade (LAG) 10.1 ft.(m) z 7 • SURD y
o g) Highest adjacent (finished) grade (HAG) 10. 9 ft.(m) 4 yf PL EY ,
o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 0 / �-, - Q
o i) Total area of all permanent openings (flood vents) in C3,h sq. in. (sq. cm) ( `/ 'Z) 1' "
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION 7
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation informMion.
I 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 J. Whitley Reynolds LICENSE NUMBER2249
TITLE Land Surveyor COMPANY NAME
ADDRESS 5 �C CITY V GA 31405
636 STEPH SON NU ITE C SAVANNAH GA 31405
SIGNATSJE //:,-.:Z , 8 /19/01% 912-352-0464
7
� / / / i-
FEMA Fpi 81 -31, Jan6ry 2003 ■' See reverse side for continuation. Replaces all previous editions