FEMA-EC960822INSPECTION CARD Water Meter Number
uetanea information Regarding Inspections Located on Back
Job Address Legal Description Permit Number
L-.2 q 1 ULA j
Builder Phone Number Type of Occupancy
POW / 7� Zs
Electrical Contractor Plumbing Contractor B;fecbdnical Con actor
T -Pole Mechanical Rough Water Utility Belly Steel
AM 19 OCT 15 1 __DEC_0 4
7 10
Flatwork
Pool Plumbing
Plumbing Rough Plumbing Top -Out Building Final Deck Steel
2 1 DEC 1 1995
V WT 15 1996
ow 13 199E AVItoW.T 17 �
2
1 191 DEQ 1 11996
P-Trap/Gas Line
c
Foundation Electrical Rough Releases Pool Final
E' 15 1996
T 15 T -Pole
W -0-4-V96 7 NV'
TT
21 Gas
Electrics %L
/ �d
Framing Ele trical Fin i cellaneous Miscellaneous
OCT 15 1996
20
17
1
BIR 2 sivo
O.M.B. NO. 3067-0077
CERTIFICATE EXplresMcry31, 1996
ELEVATI J��
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to
provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to
determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR).
Instructions for completing this form can be found on the following pages.
SECTION A PROPERTY INFORMATION
BUILDING OWNER'S NAME 'l
--hao r r -y-- Q m e ---- — __
STREET ADDRESS (Including Apt., Unit, Suite and/or Bldg. Number) OR PO. ROUTE AND BOX NUMBER
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
FOR INSURANCE COMPANY USE
POLICY NUMBER
COMPANY NAIC NUMBER
CITYjope
e l' STATEo 6D
ZIP CODE
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions):
I. COMMUNITY NUMBER
X01
;2.ANEL NUMBER
p (o
1 SUFFIX
I
4. DATE OF FIRM INDEX --
q-ts-9y
5. FIRM ZONE
X
6. BASE FLOOD ELEVATION
(in AO Zones, use depth)
I ys3,o
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): (_1JGVD '29 ❑Other (describe on back)
8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate
the community's BFE: I___LL_ L -L] . U feet NGVD (or other FIRM datum—see Section B, Item 7).
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level
2(a). FIRM Zones Al -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
of L_1_ 1 -!A5171 .171 feet NGVD (or other FIRM datum—see Section B, Item 7).
(b). FIRM Zones V1 -V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from
the selected diagram, is at an elevation of LJ_L11I -_I .I --1 feet NGVD (or other FIRM datum—see Section B, Item 7).
(c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is L1 I. LJ feet above ❑ or
below ❑ (check one) the highest grade adjacent to the building.
(d). FIRM Zone AO. The floor used as the reference level from the selected diagram is L1J.LJ feet above ❑ or below ❑ (check
one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference
level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown
3. Indicate the elevation datum system used in determining the above reference level elevations: [?"NGVD'29 ❑ Other (describe
under Comments on Page 2). (NOTE: It the elevation datum used in measuring the elevations is different than that used on
the FIRM [see Section B, Item 7], then convert the elevations to the datum system used on the FIRM and show the conversion
equation under Comments on Page 2.)
4. Elevation referenc2 mark used appears on rFIRM: El Yes 0 No (See Instructions on Page 4)
5. The reference level elevation is based on: L�_IIRactual construction ❑ construction drawings
(NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which
case this certificate will only be valid for the building during the course of construction. A post -construction Elevation Certificate
will be required once construction is complete.)
6. The elevation of the lowest grade immediately adjacent to the building is: 1 1 1 �I SJ . U .feet NGVD (or other FIRM datum -see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
1. 11 the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest
floor" as defined by the ordinance is: L_l.1-1 1. [ ! feet NGVD (or other FIRM datum—see Section B, Item 7).
2. Date of the start of construction or substantial improvement
FEMA Form 81-31, MAY 93 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION
SEC'NO v E - CERTIFICATION
This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation
information when the elevation information for Zones Al -A30, AE, AH, A (with BFE),V1-V30,VE, and V (with BFE) is required.
Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the
certification. In the case of Zones AO and A (without a FEMA or community issued BFE), a building official, a property owner, or an
owner's representative may also sign the certification.
Reference level diagrams 6, 7 and 8 - Distinguishing Features—If the certifier is unable to certify to breakaway/non-breakaway wall,
enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not
included in the certification under Comments below. The diagram number, Section C, Item 1, must still be entered.
l certify that the information in Sections 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 line or imprisonment under 18 U.S. Code, Section 1001.
/ro..i A�l'evt t�oo,o IZPC.S � SrY/
CERTIFIE S NAME LICENSE NUMBER for Affix Seal)
u�-_v_ `1- CANQ iA F IEcn SEPU(CES
TITLE COMPANY NAME
t - Ie w. T� 6280
ADDRF^ ERFO•Tv . ZZ STATE ZIP
g -9` z�y
SIGNA UR — - - Z3�-�/3sg
...... { DATE PHONE
Copies should be made of this Cert kid
y official, 2) Insurance agent/company, and 3) building owner.
COMMENTS:- I A rr 5 �/e va_ 7�/ o L , e It1 > i�7`i 1641Lo ' S f� 1- 4
e e -e 2 S 00 CC f 7 `z / ✓� //"dG �v/ � �.0/S fi n % t /�-hej%
6q t -`1
ON WITH ON PILES,
SLAB BASEMENT PIERS, OR COLUMNS
A v A A v
ZONES ZONES ZONES ZONES ZONES
REFERENCE , REFERENCE
LEVEL BASE LEVELREFERENCE
FLOOD
LEVEL
ELEVATION
BASEFLOOD ADJACENT :`,Z:. REFERENCE
BASEFLOOD
ELEVATION?°'
REFERENCE ADJACENT GRADE _ IEVEI
E
LEVATION
LEVEL GRADE
:.'i::.': i.::;',.`•ii:5:.:..:I:;'.. .:y:!
ADJACENT...
... �.'�'}�'::�•..:'.:... �..:..!:'.�`'..".i:�.�.':;i'.
GRADE
The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones.
Elevations for all A Zones should be measured at the top of the level
reference floor.
Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member.
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