FEMA-EC981124ELEVATION CERTIFICATE
o.,.,.s. ~o
Expires May 31,' !
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATI'ENTION: Use el 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 s~pport a request for a Letter of Map Amendment or Revision (LOMA or LOMR).
Instructions for completing this form can be found on the following pages.
SECTION A PROPERTY INFORMATION
BUILDING OWNER'S NAME
STREET ADDRESS (including Apt., Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
CITY
COppi;['T,T.
SECTION B
IFOR
INSURANCE COMPANY USE
POLICY NUMBER
COMPANY NAIC NUMBER
STATE ZiP CODE
r~.¥ & .c: "/R fll q
FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the lollowing from the proper FIRM (See Instructions):
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): Ix--J NGVD '29 L_~ 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.L_J feet NGVD (or other FIRM datum-see Section B, Item 7).
SECTION C BUILDING ELEVATION INFORMATION
t. Using the Elevation Certificate Instructions, indicate the diagram number trom 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 reterence level floor trom the selected diagram is at an elevation
et I [ 141515 I.L,qJ feet NGVD (or other FIRM datum-see Section B, Item 7).
b). FIRM Zones Vl-V30, YE, and V (with BFE). The bottom et the lowest horizontal structural member el the reference level trom
the selected diagram, is at an elevation otl I [ I._J__J .L_J 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 I I I.LJ feet above ~ or
below [] (check one) the highest grade adjacent to the building.
d). FIRM Zone AD. The floor used as the reference level from the selected diagram is t I I.[ J feet above ~[~--~ or below Ill (check
one) the highest grade adjacent to the building. It no flood depth number is available, is the building's lowest lloor (reference
level) elevated in accordance with the community's floodplain management ordinance? [~] Yes [] No [] Unknown
3. Indicate the elevation datum system used in determining the above reference level elevations: [] NGVD '29 [] 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 relerence mark used appears on FIRM: [] Yes [] No (See Instructions on Page 4)
5. The reference level elevation is b~sed on: [] actual 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 dering 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:[ ..[ .J 4~ ,5.14]. L~ feet NGVD (or other, FIRM datum-see
Section B, Item 7).
ECTION D COMMUNITY INFORMATION
1. I1 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: [ I I I I J.L_J leer NGVD (or other FIRM datum-see Section B, Item 7).
2. Date of the start of construction or substantial improvement
FEMA Form 81-31~ MAY 90 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATIOH