FEMA-EC050701 (4)BUILDING STREET ADDRESS
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FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
W
ROUTE AND BOX NO.
area,
LM�pl
B. No. 3067-0077
December 31, 2005
1_11401, Z)_J NAD 1983 SOURCE: U GPS (Type):
U USGS Quad Map L -_I Other
B4. MAP AND PANEL I
B5. SUFFIX
B8. FIRM INDEX
B7. FIRM PANEL
88. FLOOD
89. BASE FLOOD ELEVATION(§)
NUMBER
�/dO17,0001411
TE
lavai�/!S/4U
EFFECT)VF�vISED DATE
ZONE(S)
(Zone A0, use depth of flooding)
70 00 /U
I
.4C
v+I s L
S1 U. Indicate the source of the ase Flood Elevation (BFE) data or base flood depth entered in B9.
LI FIS Profile FIRM LI Community Determined U er (Descdbe):
B11. Indicate the elevation datum used for the BFE in B9: LI NGVD 1929 i�VD 1988 U Other (Describe):
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? i—I Yea I An o
Designation. Date:
C1. Building elevations are based on: I_IConstruction Drawings" j_ uIlding Under Construction" I—(Finished 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, AR/Al-A30, AR/AH, AR/AO
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. I Ise the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion.
Datum _, Coy ; srsion/Comments
F. avation reference mark used AAf I f A Does the elevation reference mark used appear on the No
0 a) Top of bottom floor (including basement or enclosure) 'y�%g ( )
❑ b) Top of next higher floor
❑ c) Bottom of lowest horizontal structural member (V zones only) (l . ft'(m)
C. d) Attached garage (top of slab) i7N 7 [ ft.(m) •' V,
❑ e) Lowest elevation of machine and/or --����"-•
machinery equipment DONALD S. PE ESL ES 2
servicing the building (Describe Ina Comments area.) d%i7 . ft.(m) $$ .•.•.t.�. F.- •.« -------- V - 1
O 0 Lowest adjacent (finished) grade (LAG) 7 .2, ft.(m) i.se `•O 2437 y:
O g) Highest adjacent (finished) grade (HAG) !1 y7 ft.(m) m 9OA
{ 8 $ 9 A t Q
O h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade _0_
❑ 1) Total area of all permanent openings (flood vents) in C3.h—I%A--sq. in. (sq. cm) S U RV
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
I certify that the information in Sections A, B, and C on this certificate represents my best efforts to Interpret the darts available.
I understand that any false statement may be punishable by fine or impdaonment under 18 u. S. Gulp_ Sa .tion inns
S
FEMA Form 81-31, January 2003 See reverse side for continuation. Replaces all previouseditions
Copy both ;;Ides of this. Falesadon Certificate for (1) community official, (2) lRoUra" agepVcbmpbhy,-tftCJ) DwIglDgawner.
COMMENTS
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT KEUUIKtU) rOKtno cv~ n W ante w tnn nvu I orcr
For Zone AO and Zone A (without BFE), complete Items E1. through ftthe Elevation Certificate is intended for use as supporting
information for a LOMA or LOMR-F, Section C must be completed.
Et. Building Diagram Number _ (Select the building diagram most similar to't*bulf*g for which this certificate is being completed
see pages 6 and 7. If no diagram accurately represents the building, provids'dakatc3.or photograph.)
E2. The top of the bottom floor (Including basement or enclosure) of the building $- LLIA (m) I_LI in. (cm) Lj above or L-1below
(check one) the highest adjacent grade. (Use natural grade, if available.)
E3. For Building Diagrams 6-8 with openings (see page 7), the next higher fleb(ar p)evarW floor (elevation b) of the building Is
I I ft. (m) LJ—Jin. (cm) above the highest adjacent grade. Complete Item&G3JT$nd C3.1 on front of form.
E4. The top of the platform of machinery and/or equipment servicing the building is L14J ft. (m) I I I in. (cm)"above or U below
(check onel the highest az'jacent grade. (Use natural grade, If available./ •�
c6 For Zone AO only: if no flood depth number Is available,: is the top of the 6dttor0oof a evated In accordance with the ooQrmunity's
Thn property owner or owners authorized. representative who Completes Sections A, 13, C (Items L::3.n ano ta.r oniy), anti c mr toner m
(w::hout a FEMA -Issued or communityAssued BFE) or Zone AO must so here. The statements in Sections A, B, C, and E are correct to
ADDRESS CITY STATE ZIP CODE
SIGNATURE DfTE TELEPHONE
The local offldal 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 Elevation Certificatp.' Complets the applicable item(s) and sign below.
4}; `.SIS IhfoSmatlon in Section C was W@6 from et(ler docunientetipn apt has been signetlbntl,embossed by a RCep{ed surveyor,
engineer, or arohileot Vvho is authorized by state or local law to certify elevation information. (indicate the source and date of the
elevation data in the Comments area below.)
G2. 1J RuPity offlclal oompdetpd Section E for a building located in Zone (without a FEMA -Issued or community4sayed BFE) or
200: " _
G3. LJ The following information (Items G4 -G9) is provided for community floodplain management purposes.
G4. PERMIT NUMBER O6. DATE PERMIT ISSUED O6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY
i ISSUED
G7. This permit has been Issued for: La New Construction U Substantial Improvement
G6. Elevation pf sq-bIt 19y4palfloor OcLoluding basement) of the building is: _ ft. (m) Datum:
G9. BFE or (in Zbne Ab) deptli oftkxidng at the building site is: _ ft. (m) Datum:
LOCAL OFFICIAt'SNAME - TITLE
COMMUNITY NAME' • • TELEPHONE .
SIGNATURE DATE
Form 81-31, January 2003 Replaces all previous editions