FEMA-EC960318 (2)ELEVATION CERTIFICATE . ..
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM '~
ATTENTION: Use o! Ihis cerlificale does not provide a waiver of the flood insurance purchase requiremenl. This Iorm is used only lo
provide elevation information necessary to ensure compliance w/Ih applicable communily floodplain managemenl ordinances, Io
delermine lhe proper insurance premium rate, and/or to support a request for a Letler of Map Amendment or Revision (LOMA or LOMR).
Instructions for completing lhis form can be found on the following pages.
SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE
POLICY NUMBERBUILDINGOWNER'S NAME
STREET ADDRESS (Including Apt., Unit, Suile and/or B~ldg. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
SECTION B
STATE
FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
ZIP CODE
Provide the following from the proper FIRM (See Inslruclions):
7. Indicale the elevation datum system used on Ihe FIRM lot Base Flood Elevalions (BFE): J-~J~'GVD '29 J~J Olher (describe on back)
8. For Zones A or V, where no BFE is provided on the FIRM, and lhe community has established a BFE for this building sile, indicale
the community's BFE: I__~_[_ I J J .l__J feel NGVD (or other FIRM datum-see Section B, Item 7).
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Cerlificate Inslruclions, indicale the diagram number from the diagrams found on Pages 5 and 6 thai besl
describes lhe subject building's reference level _L_.
2(a). FIRM Zones At-A30, AR, AH, and A (wilh BFE). The top of the reference level floor from Ihe selecled diagram is al an elevation
of J_ J J~_JS'J~,].[9 feel NGVD (or other FIRM datum-see Se~llon B, Item 7).
b). FIRM Zones V1-V30, VE, and V (with BFE). The bottom o! lhe lowest horizontal structural member of the reference level from
the selected diagram, is al an elevation of l ! J J ! !.J__.J feet NGVD (or olher FIRM dalum-see Section B, Ilem 7).
c). FIRM Zone A (wilhout BFE). The floor used as the reference level from Ihe selecled diagram is J J I.J__J feel above [] or
below [] (check one) the highesl grade adjacent to the building.
d). FIRM Zone AD. The floor used as the reference level from Ihe selecled diagram is J_~__J .J_] teal above [__q or below [] (check
one) lhe highesl grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference
level) elevated in accordance with the communily's Iloodplain management ordinance? [] Yes [] No [] Unknown
3. Indicale Ihe elevation dalum syslem used in delermining lhe above reference level elevations: J~NGVD '29 [] Olher (describe
under Commenls on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than that used on
the FIRM [see Section B, Item 7], then convert the elevations to the datum system used on the FIRM and show the conversion
equation under Comments on Page 2.)
4. Elevation reference mark used appears on FIRM: [] Yes J-~No (See Inslruclions on Page 4)
5. The reference level elevalion is based on: ~'"aclual conslruclion ~ 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 construction. A post-construction Elevation Certificate
will be required once construction is complete.)
6. The elevation of the lowest grade immediately adjacent lo Ihe building is:J I I~ ~-q".l~/.feet NGVD (or other FIRM dalum-see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
1. If the communily official responsible lot var/lying building elevations specifies/hal the reference level indicated in Section C, Item
is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowesl
Iloor" as defined by lhe ordinance is: J J _! J ! _J .~_! leal NGVD (or other FIRM datum-see Section B, Item 7).
2. Dale ut the start of construction or substantial improvement
FEMA Form 81-31, MAY 93 REPLACES All PREVIOUS EDItiONS SEE REVERSE SIDE FOR CON11NUA11CIN