FEMA-EC970709o 7-oo77
ELEVATION CERTIFICATE t99,
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does not provide a waiver of lhe flood insurance purchase requirement. This' form is'used only Io
provide elevation information necessary to ensure compliance with applicable cornmunity floodplain management ordinances, to
determine the proper insurance premium rate, and/or lo support a request for a Letter of Map Amendment or Revision (LOMA or LOMR).
Inslruclions for completing lhls form can be found on the following pages.
SECTION A PROPERTY INFORMATION ~OR INSURANCE COMPANY USE
BUILDING~OWNER'S NAME ~,/ POLICY NUMBER
STREET ADDRESS (Including Apl., Unit, Suite and/of Bldg. Number) OR PO. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
OTHER DESCRIPTION (Lot and Block Numbers, elc.)
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions):
7. Indicate lhe elevation datum syslem used on the FIRM for Base Flood Elevations (BFE): E_.'r.- eve '2g [ _1 Other (describe on back)
8. For Zones A or V, where no BFE is provided on the FIRM, and the community has eslablished a BFE for this building sile, indicate
tile community's BFE:! l I .!.1_~ feel NGVD (or other FIRM dalum-see Section B, Ilem 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 J _ .
2(a). FIRM Zones A1-A30, AE, AH, and A (with BFE). The top of the reference level floor from lhe selected diagram is at an elevation
of ! I lz//[~l .l~1 feet NGVD (or other FIRM dalum-see Section B, Item 7).
b). FIRM Zones V1-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.I I feet NGVD (or other FIRM dalum-see Section B, Item 7).
c). FIRM Zone A '(wilhout BFE). The floor used as lhe reference level from the selected diagram is [_ I~__f .L_! 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 lhe selecled diagram is L I L_J feet above [~] or below [~J (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? Ejq Yes [_-_] No I~_~] 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 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 ,_i~ No (See Instructions on Page 4)
5. The reference level elevation is based on: _[~'"~ aclua construction _[_~_ conslruction drawings
NOTE: Use of construction drawings is only valid if the building does not yet h~ve 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 the building is: [_[___I_Y_. _~_J ~. L~~ .feet NGVD (or other FIRM datum-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 Section C, Item 1
is not the "lowesl floor" as defined in the community's floodplain management ordinance, the elevation of the building's."lowest
floor" as defined by lhe ordinance is: L t.. !__J ! I.! ! feet NGVD (or other FIRM dalum-see Section B, Item 7).
2. Date of the start of construction or subslanlial improvement
FEMA Fon~ 81-31, MAY 93 REPLACES AU. PREVIOUS EDItiONS SEE REVERSE SIDE FOR CONtiNUAtiON