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FEMA-EC950330Th. City With A Beautiful°°'. BUILDING PERMIT APPLICATION wv > > 95 If7 Print or Type in a Clear, Legible Manner Job Address: � 3 _ Date. � -- Lot:a - Block: Subdivision: Phase or Section Number: Owner: N - Address: 2Z01 Phone #: 393,q0045 Contractor: �� \. Address: one #lC&1L M o. sZ�3"p V"% L Description of Work to be Done Class of Work: [H New ❑ Addition ❑ Alteration ❑ Repair ❑ Demolition ELEVATION CERTIFICATE °.M.BNo3061993 Expires May 31,, 1993 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 fora 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 Foh INSURANCE COMPANY USE BUILDING OWNER'S PAME POLICY NUMBER STREET ADDRESS (Including Apt—Unit. Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER OTHER DES RIPTION (Lot and Block N moers, etc.) CITY STATE ZIP CODE = SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM (See Instructions): ; 1. COMMUNITY NUMBER 2. PANEL NUMBER 3. SUFFIX 4. DATE F FIRM DEX 5. FIRM ZONE 6. BASE FLOOD ELEVATION _ - (in AO Zones, use depth) - 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): L�VD '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: J. 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 . LL1 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 stn ctural member of the reference level from the selected diagram, is at an elevation of I I I L I .I� 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 W . U 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 W .0 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? El -res ❑ No ❑ Unknown j 3. Indicate the elevation datum system used in determining the above reference level elevations: E NGVD '29 7 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 ;actual M: Yes. El No (See Instructions on Page 4) 5. The reference level elevation is based on: 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: feet NGVD (or other FIRM datum -see Section B, Item 7). a SECTION D COMMUNITY INFORMATION "4 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: 1 1 44 .6 feet NGVD (or other FIRM datum -see Section B, Item 7). Data of the start of construction or substantial improvement Iq FEMA Form 81-31, MAY 90 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 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. I 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 1 S. Code, Section 1001. - CERTIFI R'S NAME LICE E TITLE....... COP Y NAME JR - HARRY ROWEU.. % ADDRESS CIT��p STATE _ ZIP SIGNATURE �0 PON - Copies should be m e of this Certificate for: 1) community official, 2) Insurance agent/company, and 3) building owner. COMMENTS: 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 ON WITH ON PILES, SLAB BASEMENT PIERS, OR COLUMNS A V A V ZONES ZONES AT ZONES ZONES ZONES REFERENCE REFERENCEBASE LEVEL REFERENCE LEVEL FLOOD LEVEL ELEVATION �t4;•::. `H t_'rt;:.('t .. `•{t . L t{@k{�i ti(i;' 't �r::rAt'_•t�t •F t{+t �t!:tii��iJ 'S.}1.:, :`�3: : °,(t4; BASE FLOOD ( :;:, is:;.r.;:: • . ilk ADJACENT :'..: { REFERENCE BASE ELEVATION REFERENCEI ADJACENT �F;. GRADE LEVEL FLOOD ELEVATION LEVEL 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 reference level floor. Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member. Page 2 i i 1 S S_ 7',.47"1 00 6-..-, i 20' i � � I Y. 01 REVIEWED F( 1L OF SINGLE SIDENCE ONL' EPIC" TIONS OR ON PLOT PLA 3EEN REVIEW] IIOT APPROVE] Length: 303' NGTH SHOWN IS MAX. !IFY EXISTING FENCES. �! �--;A ;;.. i;;•'775; •---03/09/95 3236.00 ELEV A RIGHT 12141 713-8404