FEMA-EC09072408/97/2009 013::39 1i11ZblZtsl7
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
A2.
%;Jr_ ILF 1 M
ELEVATION CERTIFICATE
Important Read the instructions on pages 1-9.
SECTION A - PROPERTY INFORMA710H
or P.O. Roble and Box No.
OMB N;�ch
60-0008
Expkes 311.20
A4. Building Use (e g., Residential Non -Residential, Addition, Acoesaory. etc.) �t
�2d �"T' 2t `t Q Long. - aAG'd tag' •d4r," W Horizontal Datum: ❑NAD 1927 l81 lVAO 1683
A5. Latituden-ongitude: Lat , MWvMU-S&K3 1AaNM4Igt > C7PS
A8. Attach at least 2 photographs of ft b6Mdirig if the Certificate is being used to obtain flood InsurAme.
A7. Building Diagram Number A9. For a building with an attached garage:
A8. For a building with a crawlspace orendosurstay O sq h
a) Square footage of crawispace orendosure(s) sq it
a) Sure footage of attached garage
b No. of permanent hood openings in to attached garage
b) en of permanent 11oor1 openings eh ire ant grade
or ) within 1.0 foot above adjacent grade
enclosure(s) ne area of ithin
flood
foot above adjacent grade c) Total net -area of flood openings in A9.b sq in
c) Total net area of flood openings in AB.b sq lo
d) Erglheered flood openings? []Yes �] No d) Engineered flood opens gs? ❑ Yes ❑ No
SECTION B - FLOOD INSURANCE RATE MP TJMP 11 OKMMION _
lr%MDat nwo+c f _\ . A use
be- flOOd
Date E Ised Date Zo`e(5)
B10. Indicate ttw source of the Base Flood Elevation (BMdata or base flood depth encored in Item B9.
❑ FIS Profile X FIRM Comnunky Determined ❑ Other (Describe)
B11. Indicate elevation datum used for BFE in Bern 99: H NGVD 1929 ❑ NAVD 1988 [] Other (Describe)
Yes No
B12. is Etre budding located at a Coastal 68nier Reeourcres System (CORS) area or Otherwise Protected Area (EPA)?
Designation Date CBRS ❑ OPA
SECTION C -BUILDING ELEVATION INFOMMT ION (SI,TRVEY {RMIREDj
C1. Building elevations are based on: ❑ Construction Drewkgs. ❑ Budding UnderComtructiffr Finished Construction
'A new El m*M Certificate will be re0red when construction of the budding is compiels.
C2. Elevations -Zones At -A30, AE, Alf. A (with BFE), VE, V1 V30, V (With BFE), AR, ARIA, ARAE, ARIA1*M, ARIAH, AR/AO. ComPlets Menu C2.a-h
below according to the budding diagram specified in Nam A7. Use the the datum as the BF -E.
Bendowk UWzed CAV dF CtNPPEIA GV!rAVPT_ E. �J Verticai ►w��J 84s
ConversioNComrnents vNt S •
Check the°measurement used.
Top bottom floor (including basement, cnawispace, or enclosure Moor) l -
Ieet
H
meters (Puerto Rico only)
a) of
:�
fest
malars (Puerto Rico only)
b) Top of the next higher Moor
c) Bottom of the lowest horizontal structural member (V Zones only)
"- a feet
4 ftt feet
❑ mews (Puerto Rico only)
❑ meters (Puerto Rico only)
d) Attached garage (top of 61811)
e) Lowest elevation of machinery or equipment servicing the building
)
•� �
❑ rrheters (Puerto Rico only)
(Deseribe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to budding (LAO)
1"t 1�t feet
�t ZBE
❑ meters (Puerto Rico only)
g) Highest adjacent (finished) grade next to budding (HAG)
L• ieet
feet
metras (Puerto Rico only)
meters (Puerto Rico only)
h) Lowest adjacent grade at lowest elovallon of deck or stales, ehcludirg
D - SURVEYOR, ENGINEER, OR
HS/H7/YNby f7ti::i3 t31/Lb1Lr3f7 `-'�"+"'"' ----•– -- --
Copy both sides of (his Elevation CsrtHimts for (1) ca(rmhedty offKW, (2) lMurant a aganvcomparmy, anu tau UUsuary .,77-
Comments _ G CL
L
ttf�F.Y R.v vtt, G
3vtY 24 2000
Signature tete
. - ❑ Check trate If attachments
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE11(WITHOUT BFE)
For Zones AO and A (without BFE), complete items E1 -E5. If the Cute N intended to support a LOMAor
LOMB-Fnter re uest. complete Sections A, B.
and C. For Items E1 -E4, use natural grade, If available. Check the measurement used. In Puerto Rico only,
E1. Provide elevation krfcrm dM for tree fdbwing and check the appropriate bores lo show whether ere elevation Is above or below the highest adjacent
grade (NAG) and the lowest adjacet tgrade (LAG). ❑Leet ❑meters []above or ❑below the HAG.
a) Tbp of bottom floor (Including basement, crawispace, or enclosure) is
b) Top of bottom row (including basement, crawispaae, or enclosure) Is [3ml E]matem ❑above or []below the LAG.
E-2. For Building Diagrams 6-9 with permanent flood openings provided in Sectim A items 8 anwor 9 (see 8-9 of Instructions), the next higher floor
_ Leet meters above or below time HAG.
(elevation C2.b in the diagrams) of the bullfirr9 LS ❑ ❑
E3. Attached garage imp of slab) is ❑ feet ❑ meters ❑ above or. Q below the HAG.
feet meters above or below the HAG.
E4. Top of piatfomh of machinery andfor equipment servicing fete tiuliding is • _ ❑ ❑ ❑ ❑
ES. Zone AO only. If no flood depth number is ava llabW is the top of the bottom floor elevated in accordance with the community's tloodpiain management
ordinance? L] Yes ❑ No ❑ Wmown. The local official mist cerd/y this Inlomreton in Seceosh G. -
SECTION F - PROPERTY b1AfNet (dR OY 'Is �A 9CAT"N
The prupdrty owner or ownWs auth6rized mpr+esertfafive who compieies Sections A, B. and E br Ione A (wMftd a FEMA• ssuad or carmmundydssued BFE)
or Zone Ab must sign there. The sfafenre lis lo Sections A, A and E are conad to the best ormy lbuowfedge•
Property Owner's or 0wrWs Audwrized tlepresemadve"s Name
Address. City State ZIP Code
Signature Def Telephone
Comments
The local official who Is authorized by law or orrflneoce 1D administer the commun" eoodplefn *6WO thent "mance can compow oec aom ,% o, tut ch
and G of this Etevalon Certificate. Complete the aPPN-bb items) and sign below. Chack the madsure*Wl used in items 08 and G9.
G1. ❑ The Information in Section C was taken from otter documentation that has been signed and sealed by a licensed surveyor, engineer. or architect who
is authorized by taw to certify elevation Mtormadort• (Indicate the source and date of the elevation data in erg Conowft area below.)
(32. ❑ A corarraanity official Completed Section E for a bu#CWV located Ii Zane A (wfltwut a FEMA4ssued or comramityassued BFE) or Zone A0.
G3. ❑ The fdbwkng information (Items G4 -G% is provided for community floodplain management purposO.
G4. Perhilti Number G5. Dam Perrot teased G6. Date CetciRCats Of tarred
°GT This permit has been issued for: ❑ New Construction ❑ Substantial Improvement
W. Elevation of as4xAt lowest floor (mcluding basement) of the building C] fee ❑meters (PR} Daum
G9. OFE or rat Zone AO) depth or flooding at the building site [:]W ❑ meters (PR) Oakxm
G14 Community's design fibod elevation ❑ feet ❑meters (PR) Datum
Local Official's Name- Two
Community Name, Telephwne
Signature Date
s ❑ atecic trete 9 atlach meats
FEMA Form 81-31, Mar 09 tld ions