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FEMA-EC030314FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE .:: 4mlalortant: Read the instructi0!~ on pallas I - 7. SECTION A - PROPERTY OWNER INFORMATION lO.MB No. 3067-0077 Expires July 31, 2002 I F°r InSurance companY Us~: IPolicY Number ICompany NAIC !Number BUILDING OWNER'S NAME BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. CITY STATE ZIP CODE PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.) LATITUDE/LONGITUDE (OPTIONAL) G° - f~' - ~.~' or ~.;;;~;;;.-';~) HORIZONTAL ~)ATUM: I__1 NAD 1927 ~J~NAD 1983 SOURCE: I~1GPS (Type): I USGS Quad Map L/flL.Qther: ~:'J ~.ll~A- SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER I B2. COUNTY NAME B4. MAP AND PANEL B5. SUFFIX ~ FIRM INDEX [ B7. FIRM PANEL I BS. FLoODNUMBERDATEEFFECTIVE/REVISED DATE Z (S) B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. I~l FIS Profile IX[ FIRM I~ Community Determined I~ Other (Describe): B9. BASE FLOOD ELEVATION(S) Zone AO, use_depth of flooding) B11. Indicate the elevation datum used for the BFE in B9: ~ NGVD 1929 I~ NAVD 1988 I_.1 Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? I~1 Yes I~No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: L~lConstruction Drawings* I~Building Under Construction* I__lFinished Construction A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number I (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations -,Zones Al-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, APJA, APJAE, AR/Al-A30, APJAH, APJAO Complete Items C3a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum ~J(~JO t~r~ Conversion/Comments Elevation r~ference r~ark used ~ _~,J.~_ ~_ Does the elevation reference mark used appear on the FIRM? L_l Yes ~ No 3 a) Top of bottom floor (including basement or enclosure) ~ .~1'{ ft.(i~) Q b) Top of next higher floor ~-O'~f · .4'~ ft.('m')~ ~, I 3 c) Bottom of lowest horizontal structural member (V zones only) ~- . .. ff.(m) 3 d)Attached garage (top of slab) ~- . ft.(m) ~ ~l / ~ ~''' * x..~.'~._.~3 e) Lowest elevation of machinery and/or equipment .. servicing the building j~,l¥ . ft.(m) f)Lowest adjacent grade ((L~HAG)G ~-~--~ '~r- :'((mm))3 g)Highest adjacent grade ( ) ~ '~ ' ~ 1%~"_.O.~S.,~ 3 h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 3 i) Total area of all permanent openings (flood vents) in C3h kJ ~- sq: in. (sq. cm) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the informaUon in Sections A, B, and C on this certificate represents my best efforts to inteq~ret the data available. I understand that any false statement may be punishable by fine orimpdsonment under 18 U.S. Code, Section 1001. C E I~/I~ ~~ LICENSE NUMBER O PANY ADDRESS ~ -,-- _ SIGNATURE ~ ~ DAT%_ ,a~.,-O~ FEMA Form 81-~, AU~ - -'~ ~G 9~ T~~ ZIP CODE ELEPHONE SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In these spaces, copy the corresponding information from Section A. ~ For Insurance Company Use:' BUILDING STR_E_ET ADDRESS (Inciuding Apt., U,~nit, Suite, and/or Bldg. No.) OR P.O. R'OUTE ,~ND BOX NO. I Policy Number CITY STATE ZIP CODE Company NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. COMMENTS I_1*~ heck'~ere' f attachments SECTION E- BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A.0N. ITHOUTr. BF,,E) For Zone AO,a.nd .Zo.ne A (without BFE), complete Items E1 through E4. If the Elevption Certificate is intended for use as supporting information*for ~ £ OMA or LOMR-F, Section C must be completed. El. Building Diagram Number ~ (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2. The top of the bottom floor (including basement or enclosure) of the building is I_1_1 ff.(m) L_[~lin.(cm) [~1 above or L_.l below check one) the highest adjacent grade. *':' .; . * * : .... . E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is L_l~l ft.(m) I__l__lin:(cm) above the highest adjacent grade. E4. For Zone AO only:` If no flood depth number is available,'is~th.e tOp'of the ~bottom fll3ot, el .eyated in~ccordance with the corn. munfty'~* ' floodplain management ordinance? I_1 Yes I~l No I.=1 Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The properb~ owner or owner's authorized representative who completes Sections ,~, B, and E for Zone A (without a FEMA-issued or community-issued BFE) or Zone AO must sign here. PROPERTY OWNER'S OR OVVNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS I I Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable iterr~s,) ~nd sign b?,low... ' ' ** Gl. I'__1 The information in Section C was taken from other doc .~mentation that has been Sign~dan'd 'er~bossed by a licensed surveyor, engineer, or architect who is authorized by state orJocar law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. I.~1A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zone AO. G.3, I_1 .The following information (Items G4-G9) is provid .ed. for community floodplain management purposes. G4. PERMIT NUMBER I G5. DATE PERMIT ISSUED I G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED I I G7. This'permit has been issued for: L_I New Construction [_.1 Substantial Improvement G8. Elevation of as-built lowest floor (including basement) of the building is: ft.(m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS ! ' " ' " ' " I_1 Check 14ere if pttachments FEMA Form 81-31, AUG 99 REPLACES ALL PREVIOUS EDITIONS