FEMA-EC050701 (2)FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
ELEVATION CERTIFICATE
BUILDING STREET ADDRESS (including Apt., Unit Suite, andlor Bldg. No.) OR P.O. ROUTE AND BOX NO.
XULONUN UUE(oPTIUMAL). NUKILVNI AL VA i UM: SOURCE: UGPS (Type):
4#'- ##.W or #k:AWp,:ri°) U NAD 1927 U: NAD 1983
U USOS Quad Map U 011ier
SECTION B -FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. rtFIP COMMUNITY NAME 8 COMMUNITY NUMBER
/PELG_ 1 O
B2. COUN �y
e//
B3. STATE
TLAI
84. MAP AND PANEL
85. SUFFIX
Be: FIRM INDEX
87. FIRM PANEL
88. FLOOD
S9. BASE FLOOD ELEVATION(S)
NUMBERTE
i1d0170 00 /U
1 i� ,r441
EFFECT VERSED DATE
-All5lew
ZONE(S)
.4C
(Zone AO, use depth of flooding)
'1,/.<d
810. Indicate the source of the ase Flood Elevation (BFE)date or base flood depth entered In B9:
I I FIS Profile FIRM LJ Community Determined L_,j Other (Describe):
B11. Indicate Die elevation datum used for the BFE In 89: LJ NGVD 1929 NAVD 1988 u Other (Describe):
812. Is the building located in a Coastal Barrier Resources System (CSRS) area or Otherwise Protected Area (OPA)7 LJ Yea I-011co
Designation Date:
C1. Building elevations are based on: L_IConstrucfion Drawings' j_4•(Bullding Under Construction" L✓IFlnlshed Construction
•A new Elevation Certificate will be required when construction of the building IS complete.
C2. 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,)
C3. Elevations –Zones Al -A30, AE, AH, A (with BFE), VE, V1430, V (with BFE), AR, ARIA, ARAE, ARIA11-A30, AR/AH, ARIAO
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 _h Conversion/Comments
t avation reference mark used ,e/i1,r yh Does the a rice M�me�tc used a ar on )he FIRM? es LJ No
* a) Top of bottom floor (including basement or enclosure)
❑ b) Top of next higher floor ft.(m) , - 0 !F yty
O c) Bottom of lowest horizontal structural member (V zones only) i(% A ft.(m)
G d) Attached garege (lop of slab) ft.(m)
O 0 Lowest elevation of machinery and/or equipment
servicing the building (Describe In a Comments area.) YG ft.(m)
❑ til Lowest adjacent (finished) grade (LAG) 41q6 ft.(m) i. DONALD S, P' r 0
O g) Highest adjacent (finished) grade (HAG) --=ems �—. ft.(m)
❑ h) No, of permanent openings (flood vents) within 1 ft. above adjacentgrade '0 f„ `S G 2437 0..
..
i]1) Total area of all permanent openings (flood vents) InC3.h Alk sq. In. (sq. an) A` 1
This certification Is to be signed and sealed by land surveyor, engineer, or architect authorized by
I car* that the information in Sections A, 8, and C on this certificate represents my best efforts to I
I understand that any false statement may be Dunishable by fine or imorbonment under 18 U.S. Ca
FEMA Forth 81-31, January 2003 See reverse side for continuation. Replaces all previous editions
In
rata
Coot both sides of this Elevation Certificate for (1) community offlcial, (2) insurance agentfoOmpsny, and (3) building owner.
For Zone AO and Zone A (without SIFE), complete items E1. through ES. If the Elevation Certificate Is intended for use as supporong
Information fora LAMA or LOMR-F, Section C must be completed.
E1. Building Diagram Number_ (Salad the building diagram most similar to the building for which this certificate is being completed —
see pages 8 and 7. If no diagram accurately represents the building, provide saketch or photograph.. shove or U belowE2. The top of the bottom floor (including basement or enclosure) of the building is I I I ft. (m) LL.I (cm) L�
(check one) the highest adjacent grade. (Use naturalgrade, if available.)
E3. For Building Diagrams 6-8 with openings (see page 7), the nezt higher floor or elevated ft= (elevation b) of the building Is
I I I ft. (m) )JJln. (cm) above the highest adjacent grade. Complete Items C3A and C3.1 on front of form.
E4. The op of the platform or machinery and/or equipment servicing the building Is I I I ft. (m) I I I In. (cin) LJ stove or LI below
(check one) the highest f ejecont grade. (Use natural grade, If available.),
c5. for Zone A0 only: It no flood de ptb nu rnlbe la available, is the top of the bottom floor elevated in accordance with the ooRlmunity's
. . _. :_ •-_w —..e#, fie, o j. infnrtneNnn In Section G.
or owners authorized representative who completes Sections A, B. C (Items C3.h and C3.1 only), and E for Zone A
ued or community -issued BFE) or Zone AO must sigh here. The statements in Sections A, B, C, and E are correct to
PROPERTYOWNER'S OROWNER'SAUiMUKIG Urtcrncac,ann.'-'—"-
ADDRESS CITY STATE ZIP CODE
SIGNATURE DfTE TELEPHONE
The local oflldai 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 Elevabgn Ceniflcatg. "Complete the applicable item(s) and sign below.
Thg Woration in Section C was *06 from a #er documentation *,has been signW;I1nd,embossed by a gee(rigdsurveyor,
engineer, or erohltect vDho Is authodidd by state or local few to cerlffy elevation information. (Indicate the source and date of the
elevation data In the Comments ares below.)
G2. IJun4 official compip(edtSectionE for a building located In Zone (without a FEMA-Iasued or community -)saved SFE) or
he i40: ' '
G3. LI The following Information (items G4 -G9) is provided for community floodplain management purposes.
G4. PERMIT NUMSEK I uv. v.., «..,.,.., . •-----
L—
G7. This permit has been Issued for: L 1 New Construction
G8. Elevation of es-bullt lowest floor (including basement) of the
G9. SFE or (in Zone AO) depth of flooding at the building site is:
Improvement
ft. (m) Datum:
ft.(m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
FEMA Form 81.31, January 2003 Replaces all previous editions