FEMA-EC940120ELEVATION CERTIFICATE o.,.,. ~o oo,,
L ~pnes M,~¥ $ I, t 993FEDEFIALEMERGENCYMANAGEMENTAGENCYNATIONALFLOODINSURANCEPROGRAMATTENTION: Use of this cerlificale does not provide a waiver of the flood Insurance purci)ase requirement. This form is used only loprovideelevationinformationnecessarytoensurecompliancewithapplicablecommunityfloodplainmanalementordinances, todeterminetheproperinsurancepremiumrate, and/or to support a request for a Letter of Map Amendmen or Revision (LOMA or LOMR).Instructions for completing this form can be found on the following pa! ~es.
SECTION A PROPERTY INFORMATION
BUILDING OWNER'S NAME
STREET ADDRESS (Includin0 Apl., Ullll. SUJll~ ilntJ.,or 131d0 Numlmr) O[-I PO. ROIJTE AND B~X NIJMBER ...........
OTHE~ DESO~IPTION (Lol and Block Numbers, elc.) - .......
m
Y STATE
0. 'NSORANCE COM.AN~ USE
CO,,.^N¥ .^,c
ZIP CODE
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions):
X 0n Ad Zones, use aeplh) ,
dc:, c::, -t::, - Oe_-r. IA .4q o.
7. Indicate the elevation datum system used on lhe FIRM for Base 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 this building site, indicatelhecommunity's BFE:i i : i i . . feet NGVD (or other FIRM dalum-see Section B, Ilem 7).
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams lound on Pages 5 and 6 that bestdescribesthesubjectbuilding's reference level
2(a). FIRM Zones Al-A30, AE, AH, and A (with BFE). The top of the reference level Iloor. trom the selected diagram is at an elevationfeetNGVD (or other FIRM dalum-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 fromtheselecteddiagram, is at an elevation of. :... 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 lhe selected diagram is :___!.-_. feet above ~.i orbelow ~ (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 ........... _: feet above ~i or below ~ (checkone) the highest grade adjacent to the building. If no flood depth number is available, is the builc~ing's lowest floor (referencelevel) elevated in accordance with the community's floodplain management ordinance? i-- Yes ~_': No ii '_'.'i Unknown3. 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 lhe elevations to the datum system used on the FIRM and show the conversionequationunderCommentsonPage2.)
4. Elevation reference mark used appears on FIRM: ~/.' Yes L...-"~ No (See Instructions on Page 4)
5. The reference level elevation is ba~ed on: !~ctual construction ' - i construction drawings ..NOTE: Use of construction draWings is only valid if the building does not yet have the reference level floor in p/ace, in whichcasethiscertificatewi//only be valid for the building during the course of construction. A post-construction Elevation Certificatewi//be required once construction is complete.)
6. The elevation of the lowest grade immediately adjac, ent to the building is:. _~ ._~. ~.:~_.'.,~j feet NGVD (or other FIRM datum-seeSectionB, Item 7).
i ! SECTION D COMMUNITY INFORMATION
1. If the community official responsible*'for verifying building elevations specifies tlqat the reference level indicated in Section Cl Item 1isnotthe "lowest floor" as defined in th~ :communily's floodplain managemenl ordinance, the elevation of the building's "lowestfloor" as defined by the ordinance is: :..~.~ ........ ~. feet NGVD (or other FIRM datum-see Section B, Item 7).2. Date ot the start of cons. t. rucl on or substantial improvement
FEMA Form 81.31s MAY 90 ItEPI AC. L5 Al I I'ltl: VIOHS'LI,)III()N5 SEE REVERSE SIDE FOR CONTINUATION