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FEMA-EC970101O.M.B. NO. 3067-0077 ELEVATION CERTIFICATE Expires May 31,.1996 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. Thi, 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 LOMB). Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE BUILDING OWNER'S NAME//o l ePOLICY NUMBER - -- --parry / --/omS_----___ - STREET ADDRESS (Including Apt., Unit, Suite and/or Bldg. Number) OR PO. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER OTHER DESCRIPTION (Lot and Block Numbers, etc ----TA e --'e h i ,I'v /a -o CITY f Com p e f STATE ZIP CODE „ p P e I I- ---- —---�-_� SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM (See Instructions): 1. COMMUNITY NUMBER '480 1 2. PANEL NUMBER 3 SUFFIX E 4. DATE OF FIRM INDEX 5. FIRM ZONE X 6. BASE FLOOD ELEVATION (in AO Zones, use depth) I do to ys3.o 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): -�_GVD '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_ I_ _).i_J feet NGVD (or other FIRM datum -see Section B, Item 7). SECTION C BUILDING ELEVATION INFORMATION 1. Using file 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 _i - . 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 oil I 151.5171-31 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 LI- 1 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 [L.LJ feet above U or below F1 (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 [_IJ U feet above [) or below U (check one) the highest grade adjacent to the building. It no flood depth number is available, is the building's lowest floor (reference level) elevated in accordance with the community's floodplain management ordinance? U Yes U No U Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations: LINGVD '29 L-1 Other (describe under Comments on Page 2). (NOTE: If 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 reference mark used appears on FIRM: [_I Yes VT No (See Instructions on Page 4) 5. The reference level elevation is based on: Z`actual construction F- I 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.) A 1 6. The elevation of the lowest grade immediately adjacent to the building is: U-1.5L51J .0 .feet NGVD (or other FIRM datum -see Section B, Item 7). SECTION D COMMUNITY INFORMATION 1. If 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 .i 1 _ ! ' . ' ! feet NGVD (or other FIRM datum -see Section B, Item 7). 2. Date of the start of construction or substantial improvement FEMA Foran 81-31, MAY 93 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION SECTION E CERTIFICATION This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or locaa law to -certify elevation information when the elevation information for Zones At—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. / 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 fine or imprisonment under 18 U.S. Code, Section 1001. l ro.j Alie VX 12oc30O CERTIFIE 'S NAME LICENSE NUMBER (or Affix Seal) _01 NQA _TA F LELLZ 5E12U(CES ----------- -- TITLE �7 ZVPOMPANY NAME ---Z--—PJ3t-t e e ("C'10 �.� `%0 ADDRF� �i �• ARE STATE ZIP 31 SIGNAT RE 1-•• g' .••"'s DATE PHONE �'' • Vim• � �?� Copies should be made of this Certiil i'i ficial, 2) Insurance agent/company, and 3) building owner. COMMENTS: --/ A;5 eJe va- ca /e SLAB BASEMENT PIERS, OR COLUMNS G4AZ s 070_ a C - _&,Q s1ryc.1wen eis 111.i4 7 X lP fT'P T`t^e rr!_ P�F �/11�� y. tircy . lIQ �A7C�I� e,;7c' �1 �— c � / 1 t Y-06-10_5-i`I --f S �' eti v I S /l© r,�! CD Ca ✓m00% t -"7 ON WITH ON PILES, SLAB BASEMENT PIERS, OR COLUMNS A v A A v ZONES ZONES ZONES ZONES ZONES REFERENCE REFERENCELEVEL REFERENCE LEVEL FLOOD LEVEL ELEVATION ,A3 ,• BASE 't�! '"'`-' ADJACENT :'- ':�}'. REFERENCE FLOOD -4'S. BASE FLOOD ELEVATION REFERENCE ADJACENT GRADE :?'F„ LEVEL ELEVATION LEVEL GRADE '4'::': •: • •'t': :::j. t; n: :'.c:•r::%.:.'f.: .i: ADJACENT ARADE r.. 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 reference level floor. Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member. Page 2