FEMA-EC9706113 7. 77
ELEVATION CERTIFICATE t996
FEDERAL EMERGENCY MANAGEMENT AGENCY ,
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of lhis certificate does not provide a waiver of lhe flood insurance purchase requirement, l'his form is used only to
provide elevation information necessary to ensure compliance wilh applicable community floodplain managemenl ordinances, to
determine the proper insurance premium tale, and/or to support a request tora Letter of Map Amendmenl or Revision (LOMA or LOMR).
Instructions for completing this lorm can be found on the following pages.
SECTION A PROPERTY INFORMATION
BUILDINGv....3OWNERS NAME
STREEI ADDRESS (Including Apt.. Unit. Suile and/or Bldg. Number) OR PO. ROUTE AND BOX NUMBER
OTHER DESCRIPTION (Lot and Block Numbers, etc )
B .............. e
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
FOR INSURANCE COMPANY USE
POLICY NUMBER
COMPANY NAIC NUMBER
ppe /I
ZIP CODE
Provide the following from the proper FIRM (See Instructions):
1 COMMUNITY NUMBER 2. PANEL NUMBER 3 SUFFIX ~ 4 DATE OF FIRM INDEX 5. FIRM ZONE 6 eASE FLOOD ELEVATION
I
in AD Zones, use deplh~
7. Indicate the elevation datum syslem used on the FIRM for Base Flood Elevations (BFE): ~.N~VD '29 [_] Other (describe on back)
8. For Zones A or V, where no BFE is provided on the FIRM. and the community has established a BFE for Ibis building sile, indicale
the community's BFE:I ! J ]_ ~ t.I ] feet NGVD (or other FIRM datum-see Section B, Item 7).
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level _( _ .
2(a). FIRM Zones Al-A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
of {...I .l/'/'l"~'J~ .~1 feet NGVD (or other FIRM datum-see Section B, Item 7).
b). FIRM Zones VI-V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from
the selected diagram, is at an elevation of I~ ! ! ! _! ! .I ! feet NGVD (or other FIRM datum-see Section B, Item 7).
c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is L_J_.I.J_~ feet above ~.~ or
below [~] (check one) the highest grade adjacent to the building.
d). FIRM Zone AC. The floor used as the reference level from the selected diagram is !_.L_J.J__~ feet above Ill or below [_~_} (check
one) the highest 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 community's floodplain management ordinance? ~J Yes [.~_-~J No [_'-] Unknown
3. Indicate the elevation datum system used in determining the above reference level elevations: (~_.~NGVD '29 I_-] Other (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 tire 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: [~J Yes (_~r_'No (See Instructions on Page 4)
5. The reference level elevation is based on: [__~"'actual construction ~-J 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 to the building is: I__J.__L?_J ~_~ .LJ~.feet NGVD (or other FIRM datum-see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
1. If the community official responsible for veri!ying building elevations specifies that the reference level indicaled irt Section C, Item 1
is nol the "lowest floor" as defined in the communily's floodplain management ordinance, lhe elevation of the building's "lowest
floor" as defined by the ordinance is: I___L_!__~_ ! t .I ! feet NGVD (or other FIRM dalum-see Section B, Item 7).
2. Date of the start of construction or substantial improvement ......................
FEMA Form 81-31, MAY 93 REPLACES ALL PREVIOUS EDItiONS SEE REVERSE SIDE FOR CONtiNUAtiON