FEMA-EC940615ELEVATION CERTIFICATE o, e
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
A~ENTION: Use of II,is certificate does not provide a waiver of II~e Ilood insurance purchase requirement. This form is used only toproviaeelevalioninformationnecessarytoensurecompliancewithapplicablecommuniiyIloodplainmaria, ement ordinances, todeterminetheproperinsurancepremiumrate, and/or iD suppo~ a request for a Letter of Map Amendmen or Revision (LOMA or LOMR).Instructions for completing this form~n be found on the following pa es.
SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE
BUILDING OWNER'S NAME ......
STREET ADDRESS Ilndud,,~ Apl.. Un.I. Suilu and, or B~g N.""..,~ 0~ r;o nOUTE AND abX NUM~. .......... ~8~-~X~,~ ~ ~ .....
OTHER DESCRIPTION (Lot and Block Numbers. etc.)
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the followihg from the Proper FIRM (See i'nstructions):
I
1. COMMUNITY NUMBER 2. PANEL NUMeER I ' 3. SUFFIX 4. DATE OF FIRM INDEX I 5 FIRM ZONE 6. BASE FLOOD ELEVATION
E in AD Zones. use depth}
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): J~GVD '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
lhe community's BFE:i i : i . leel NGVD (or other FIRM dalum-see Section B, Ilem 7).
SECTION C BUILDING ELEVATION INFORMATION
1. Using lhe Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that bestdescribesthesubjectbuilding's relerence level
2(a). FIRM Zones Al-A30, AE, AH, and A (with BFE). Tile top of the reference level floor trom the selected diagram is at an elevation
of ....... ~-~;~-~.~ feet NGVD (or other FIRM datum-see Seclion B, Ilem 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. : .. i . J.: i leer NGVD (or other FIRM datum-see Section B, Item 7).c). FIRM Zone_.~ A (wilhout BFE). The floor used as the reference level from the selected diagram is ;___j, ~.: feet above i~.i or
below '~ (check one) the highest grade adjacent lo the building.
d). FIRM Zone AD. The floor used as the reference level from the selected diagram is ....... ;.~-" feet above ~] or below ~ (checkone) the highest grade adjacent to thebuilding. If no flood depth number is available, is the builcling's lowest floor (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 (describeunderCommentsonPage2). (NOTE: If the elevation datum used in measuring the elevations is different than that used ontheFIRM [see Section B, Item 7], then convert the elevations to the datum system used on the FIRM and show the conversionequationunderCommentsonPage2.)
4. Elevation reference mark used appears on FIRM: ~.f'~ Yes L_~.i 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 valid for the building during the course of construct/on. A post-construction Elevation Certificatewillberequiredonceconstructioniscomplete.)
6. The elevation of the lowest grade immediately adjacent to the building is:, _~ ~'~' ~r feet NGVD (or other FIRM datum-seeSectionB, Item 7). - .............
SECTION D COMMUNITY INFORMATION
1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1isnotthe "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowesl
floor" as defined by the ordinance is: _~. ! i._~ .~.__: feet NGVD (or other FIRM datum-see Section B, Item 7).2. Date of the start of construction or substantial improvement ..................
FEMA Form 61-3 tj MAY 90 NI. Pi ACL 5 Al I IH{I: VIOl ~ L DII I()N5 SEE REVERSE SIDE FOR CONTINUATION