FEMA-EC960326 (3)o.M.,.,o. 3o 7.0o 7
ELEVATION CERTIFICATE E ,,,M31,1996
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use ol Ihis c~rtific~le' does' not provide a waiver ol Ihe flood insurance purchase requiremedl. This'form is used only Io
provide elevation information necessary Io ensure compliance wilh applicable community floodplain managemenl ordinances, to
delermine the proper insurance premium rate, and/or Io supporl a request for a Lelter of Map Amendmenl or Revision (LOMA or LOMR).
Instructions for complethlg lhis form can be found on the following pages.
SECTION A PROPERTY INFORMATION
BUILDING OWNER'S NAME IFOR
INSURANCE COMPANY USE
POLICY NUMBER
STREET ADDRESS (Including Apt.. Unil, SMile and/or Bidg, Number) OR P.O. ROUTE AND BOX NUMBER
OTHER DESCRIPTION (Lol and BI~ Numbers, elc.)
TATE ZIP CODE
t l
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions):
7. Indicate the elevalion datum system used on lhe FIRM for Base Flood Elevalions (BFE): L~NGVD '29 [] Olher (describe on back)
8. For Zones A or V, where no BFE is provided on the FIRM, and Ihe community has eslablished a BFE for this building sile, indicale
Ihe communily's BFE: L~L_J_J_J.I-_J feet NGVD (or other FIRM datum-see Section B, Item 7).
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions, indicale Ihe diagram number from lhe diagrams found on Pages 5 and 6 thai best
describes lhe subjecl building's reference level _~_._.
2(a). FIRM Zones Al-A30, AE, AH, and A (wilh BFE). The lop of the reference level lloor from the selected diagram is at an elevation
of L I 1~t/~_5'~_'5'~'.[~ leer NGVD (or other FIRM datum-see Section B, Item 7).
b). FIRM Zones V1-V30, VE, and V (wilh BFE). The botlom of the Iowesl horizonlal structural member ot the reference level from
Ihe selecled diagram, is at an elevation oil I t t !_J .!_J feet NGVD (or olher FIRM dalum-see Section B, Item 7).
c). FII~M Zone A (without BFE). The floor used as the reference level from the selected diagram is I I I ,~..I feet above [] or
below [-~ (check one) the highest grade adjacenl to the building.
d). FIRM Zone AD. The floor used as lhe relerence level from the selecled diagram is L~_~ .L~ feel above ~_~ or below [] (check
one) the highest grade adjacent to lhe building. If no flood depth number is available, is the building's lowest tloor (reterence
level) elevated in accordance with lhe community's floodplain managemenl ordinance? [] Yes [] No [] Unknown
3. Indicate the elevation datum syslem used in determining the above reference level elevations: ~"'NGVD '29 [] Olher (describe
under Comments 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 [~'No (See Instructions on Page 4)
5. The reference level elevation is based on: ~-~actual construction ~ 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 Ihe lowest grade immediately adjacenl !o lhe building is:l I I '/151¥1 .L_~.feel NGVD (or other FIRM dalum-see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Seclion C, Ilem
is nol lhe "lowest floor" as delined in the communily's floodplain management ordinance, Ihe elevation of the building's "lowest
floor" as defined by the ordinance is: L_L_I I ! .~ .1_~ feel NGVD (or olher FIRM dalum-see Section B, Item 7).
2. Date ot the start of construction or substanlial improvement
FEMA Form 81-31, MAY 93 REPLACES AU. PREVIOUS EDItiONS SEE REVERSE SIDE FOR CONTINUAllON