FEMA-EC960301 (3)ELEVATION CERTIFICATE Mwf996
FEDERAL EMERGENCY' MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of lhis cerlilicale does nol provide a waiver of the flood insurance purchase requirement. This form is used only lo
provide elevation informalion necessary to ensure compliance wilh applicable community floodplain managemenl ordinances, to
determine the proper insurance premium tale, and/or to supporl a request for a Letler ot Map Amendmenl or Revision (LOMA or LOMR).
Instructions for completing lhis form can be found on lhe following pages.
SECTION A PROPERTY INFORMATION
BUILDING OWNER'S NAME
s
STREET ADDRESS (Including Apl., Unit, Suite and/or Bldg. Number) OR PO. ROUTE AND BOX NUMBER
T/,IFO~RINSURANCECOMPANYUSEPOLICYNUMBERS?ATEZIPCODESECTIONBFLOODINSURANCERATEMAP (FIRM) INFORMATIONProvidethefollowingfromtheproperFIRM (SeeInstructions):g01'7o :: F.__ X7. IndicaletheelevationdatumsystemusedontheFIRMforBaseFloodElevations (BFE): [] NGVD '29E_~ Other {describeonback)8. ForZonesAorV, wherenoBFEisprovidedontheFIRM, andthecommunityhaseslablishedaBFEforthisbuildingsile, indicatelhecommunity'sBFE: ! ~_ L_J_~_._~.I_~ leelNGVD (orotherFIRMdalum-seeSectionB, Item7).SECTION
C BUILDINGELEVATIONINFORMATION 1. UsingtheElevationCertificateInstructions, indicate thediagramnumberfromthediagramsfoundonPages5and6thalbesldescribeslhesubjectbuilding'sreferencelevel .~'_ _.2(a). FIRM ZonesAl-A30, AE, AH, and A (with BFE). The topofthereferencelevelfloorfromtheselecteddiagramisatanelevationofLIIVI~-~_1.1~1feelNGVD (or otherFIRMdatum-see Section B, Ilem7).b). FIRM ZonesV1-V30, VE, andV (withBFE). ThebottomoflheIoweslhorizontalstructuralmemberotlhereferencelevelfromtheselecteddiagram, isatanelevationoflI ~__~__~ .!__! feet NGVD (or otherFIRMdalum-see SectionB, Item7).c). FIRM ZoneA (wilhoulBFE). Thefloorusedasthereferencelevelfromtheselecteddiagramis ~_~.[~ feetabove [] orbelow [] (checkone) thehighestgradeadjacenttothebuilding.d). FIRMZoneAO. The floorusedasthereferencelevelfromtheselecteddiagramis ~_~.1.~ feelabove [] orbelow [] (checkone) lhehigheslgradeadjacenttothebuilding. If noflooddepthnumberisavailable, isthebuilding's IoweslIloor (referencelevel) elevatedinaccordancewiththecommunity'sfloodplainmanagementordinance? [] Yes [] No [] Unknown3. Indicatetheelevationdatumsystemusedindelerminingtheaboverelerencelevelelevations: [__~NGVD '29 [] Other (describeunderCommentsonPage2). (NOTE: If theelevationdatumusedinmeasuringtheelevationsisdifferentthanthatusedontheFIRM [seeSectionB, Item 7], then converttheelevationstothedatumsystemusedontheFIRMandshowtheconversionequationunderCommentsonPage2.)4. ElevationreferencemarkusedappearsonFIRM: [] Yes [~No (See InstructionsonPage4)5. The referencelevelelevationisbasedon: ~'actualconslruction ~ conslrucliondrawingsNOTE: Use ofconstructiondrawingsisonlyvalidifthebuildingdoesnotyethavethereferencelevelfloorinplace, in whichcasethiscertificatewillonlybevalidforthebuildingduringthecourseofconstruction. Apost-constructionElevationC~rtificate willberequiredonceconstructioniscomplete.)6. Theelevationoflhelowestgradeimmedialelyadjacenttothebuildingis:lII~I~.L~ .feet NGVD (or otherFIRMdalum-see SectionB, Item7).SECTIONOCOMMUNITYINFORMATION1. If lhecommunityofficialresponsibleforverifyingbuildingelevationsspecifiesthatlhereferencelevelindicaledinSectionC, Item 1isnotthe "loweslfloor" asdefinedinthecommunily's floodplainmanagemenlordinance, lhe elevationofthebuilding's "lowesl floor" as definedbytheordinanceis: ~__! ~ ~ ~1 .I ! feet NGVD (or olherFIRMdatum-see SectionB, Item7).2. Dale oflhestartofconslructionorsubstantialimprovemenlFEMAForm81-31, MAY93