FEMA-EC960627ELEVATION.CERTIFICATE : . 3t, t996
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does nol provide a waiver ol 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 lhe proper insurance premium rate, and/or Io support a request for a Letl~r ot Map Amendmenl or Revision (LOMA or LOMR).
Inslructlons for completing this form can be found on the following pages.
SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE
POLICY NUMeERBUILDING~OWNER'S NAME
STREET ADDRESS (Including Apt., Unil, Suite and/or Bldg, Number) OR PO. ROUTE AND BOX NUMBER
OTHER DESCRIPTION (Lot and Block Numbers, elc,)
COMPANY NAIC NUMBER
ZIP CODE
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from lhe proper FIRM (See Instructions):
7. Indicate the elevalion datum system used on Ihe FIRM for Base Flood Elevations (BFE): r_~"I~'NGVD '29 [~'.~ Other (describe on back)
8. For Zones A or V, where no BFE is provided on the FIRM, and the community has establisl)ed a BFE for lhis building site, indicale
the community's BFE:I L._J ! [ !.1__! 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 lhe diagrams found on Pages 5 and 6 that best
describes lhe subjecl building's reference level ~ _.
2(a). FIRM Zones A1-A30, AE, AH, and A (with BFE). The top of the reference level floor from the selecled diagram is at an elevation
of I.. ] J"/15'J~1.1~ 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 structural member of the reference level from
the selected diagram, is at an elevation of _1 I _ [__!_._1.1_ ! feet NGVD (or other FIRM dalum-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 J .1_~ feet above [~ or
below [_~ (check one) the highest grade adjacent to the building.
d). FIRM Zone AG. The floor used as the reference level from lhe selecled diagram is [_ [_ I leal above [_] or below I[~i] (check
one) the highest grade adjacent to the building. If no flood deplh number is available, is the building's lowest floor (reference
level) elevaled in accordance with the communily's floodplain management ordinance? [] Yes ~ No [] Unknown
3. Indicale the elevation datum syslem used in delermining the above reference level elevations: [_~""NGVD '29 I_~] Olher (describe
under Commenls on Page 2). (NCTE: 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 FIRM: I~._~ Yes [__;;~_ No (See Instructions on Page 4)
5. The reference level elevation is based on: ~actual conslruction _~-~ 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 vafid 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 lhe building is: I_! .feet NGVD (or olher FIRM dalum-see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
1. If the community official responsible for verifying building elevations specifies lhat the reference level indicaled in Section C, Item 1
is nol lhe "lowesl floor" as defined in the community's floodplain management ordinance, lhe elevation of lhe building's "lowesl
floor" as defined by the ordinance is: ~__ ~_ [ _J _ii !.! _! feel NGVD (or olher FIRM dalum-see Section B, Ilem 7).
2. Date of the start of construction or substantial improvement
FEMA Form 81-31, MAY 93 REPLACES ALL PREVIOUS EDI11ONS SEE REVERSE SIDE FOR CONTINUATION