FEMA-EC050701 (3)FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2006
ELEVATION CERTIFICATE.
Important: Read the Irwtruottons onPaoea Y- T.
ADDRESS (including Apt.,
area,
wowrvvu uue tvnvrucvn i � uAI um: SOURCE: LI(iPS (Type):
!ip' • MNeY#" or Wf:AYlAwrf°) t_I NAD 1927 LJ. NAD 1983
(_( USOS Quad Map L Other
U FIS Profile Lvf FIRM Lj Community. Determined LI Other (Describe):
B11. Indicate the elevation datum used for the BFE in B9: U NGVD 1929 .g NAVD 1888 L_J Other (Describe):
012. Is the building located Ina Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? LJ Yes 1_ o
Designation. Date:
tie L ng - L�Finished Construction
Cl. Building elevations are based on: L�Constwctibn Drawings' Odi Under 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 8 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, AR/Al-A30, AR/AH,AR/AO
Complete Items C3.a•1 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 Con; ersicn/Comments
r'. avation reference mark used /�l /%e `Does the elavetlon reference mark used appear on the F( L No
0 a) Top of bottom floor (Including basement or enclosure) V7 . @[ft.(m)
0 b) Top of next higher floor � . & ft.(m) i41,
0 r,) Bottom of lowest horizontal structural member (V zones only)ft.(m)
L d) Attached garage (top of slab) ft:(m) Jr A.
0 e) Lowest elevation of machinery and/or equipment1ZI 07
s««« -w..+«,-.•.+.-........«.
servicing the building (Describe Ina Comments area.) ,4 �(m) ` DONALD S, PEF Bl•FS
O 4 Lowest adjacent (finished) grade (LAG) ZOn•(m) z.trw ° 2437
0 g) Highest adjacent (finished) grade (HAG) ft.(m) f 'f'p
0 h) No, of permanent openings (flood vents) within 1 ft. above adjacent grade �_ % %U g I;% ..
0 1) Total area of all permanent openings (flood vents) in C3.h A/A sq. In. (sq, cm) ~" y
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to Certify elevation Information.
I car* that the Information in Sections A. B, and C on this cefWcete represents my best efforts to Interpret the data available.
CITY
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agentloompany, and (3) building owner.
COMMENTS
For Zone AO and Zone A (without BFE), complete Items E1. through E5. If the Elevatlon Certfyt Is itklepded fpeL,e as supporting
Information for a LAMA or LOMR-F, Section C must be completed.
El. Building Diagram Number_ (Salad the building diagram most similar to the building for which this certificate Is being oomplated –
see pages 6 and T. 0 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 LLI ft. (m) LLQ in. (cm) Li above or LI below
(check one) the highest adjacent grade. (Use natural grade, Navailable.)
E3. For Building Diagrams &B with openings (see page 7), the nerd higher floor or elevated floor (elevation b) of the building Is
LLJ ft• (m) Lr. _* (rim gove the highest adjacent grade) fatt�R s C3.h and C3d'9liTrgrR fohn. =ti {
E4. The top of the platform of machinery and/or equipment servicing the bulkling is LLl ft. (m) IJ In. (cm) LJ, above or below
(check one) the highests,'jacent grade. (Use natural grade, If available.)
e5..=or Zane AOQniye,i[ &11goddepthnumMirvavallable i4.,Margobfo boftomflooge7evr ep,icr1`accordanceAtheeeompWriWe' 1 L,
T.
wnefs authorized representative who completes Sections A, B. C (items C3.h anot3.i only), anc r Tor cone„
or community -Issued BFE) or Zone AO mus( sign here. The statements in Sections A, B, C, and E are correct to
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
The local offldal who is authorized by law or ordinance to administer the community's floodplain management oruinancs can wnw um
Sections A, B. C (or E), and G of this Elevation Certificate.' -Complete the applicable item(s) and sign below. a licensed surveyor,
G1."The informatlonIn Section C was taken from other documentation that has been signed atul eh bt)asMtj by Y
engineer, or architect who Is authorized by stator IocaPqkUpetNY elevation Information. (Indleate the source and date of the
elevation data In the Comments area below.)
G2. U A community official completed Section E for a r dilig cstsd in Zone A (without a FEMA-lasued or community -Issued BFE) or
Zone A0. ° 1
G3."The following Information (Items G4 -G9) Is pro�Ad for rb mnity floodplain management purposes.
G7. This permit has been Issued for: LI New t:onst lonr L- j=ummiuuj unymvon,m,a
G0. Elevation of as -built lowest floor (Including basemen» &lLwilding is: —ft. (m) Datum:
Gg. BFE or (in Zone AO) depth of flooding at the building sR is; * ._ft. (m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
Form 81-31, Ano)ary`2003 " 4 J 1. 1 ' '