FEMA-EC970318O.M.B. NO. 3067-0077
ELEVATION CERTIFICATE t996.
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does not provide a waiver ot 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 lo support a request for a Letter of Map Amendmenl 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
STRi.~ ..... ADDRESS_.~ ~___'~_ .e_ ~'Il''' ~ ~ '/1- e' ¢''~--(IncludingApt., Unit. Suite and/or BIdg.(o ¢ ~"' "'~Number) OR PO ROUTE AND BOX NUMBER
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
7_ ...... ......... TAr_
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide tile following from the proper FIRM (See Instructions):
7. Indicate lhe elevation datum system used on the FIRM for Sase Flood Elevations (BFE): [_._~NGVD '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 lhis building site, indicate
the community's BFE:t I [ 1_ ! !.l_j feet NGVD (or other FIRM datum-see Section B, Item 7).
SECTION C BUILDING ELEVATION INFORMATION
1. Using Ihe 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 A1-A30, AE, AH, and A (with BFE). The top of the reference level floor from the selecled diagram is at an elevation
of l I J¥1~j~'1.1°_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 al an elevation of [ ! ! I ! !.1 I 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 LJ_J .I _J feel above [-_~ or
below [-'~ (check one) the highest grade adjacent to tile building. --
d). FIRM Zone AD. The floor used as the reference level from lhe selected diagram is I._h_l. [_ ! feet above Ii~l 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 communily's floodplain management ordinance? F~ Yes [~ No [~ Unknown
3. Indicale the elevation datum syslem used in delermining the above reference level elevations: I~f"'NGVD '29 I~] 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 fo the datum system used dn the FIRM and'show the conversion
equation under Comments on Page 2.)
4. Elevation reference mark used appears on FIRM: [.] Yes r No (See Instructions on Page 4)
5. The reference level elevation is based 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 during the course of construction. A post-construction Elevation Certificate
will be required once construction is complete.)
6. The elevation of lhe lowest grade immediately adjacent lo lhe building is: L_ll_ I¥1~_lY .1~1 .feet NGVD (or other FIRM dalum-see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
1. If Ihe community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Ilem
is Roi the "lowest floor" as defined in the communily's floodplain management ordinance, Ihe elevation of the building's "lowest
floor" as defined by the ordinance is: I__ J_..! ~_ ~,.~1, .t feet NGVD (or other FIRM datum-see Section B, Item 7).
2. Date of the start of construction or substantial improvement
FEMA Form B1 ~31, MAY 93 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONtiNUATION