FEMA-EC970114O.M.B..O. 30 7-0077
ELEVATION CERTIFICATE ' l~xpiresMoy 3t, 1996
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does not provide a waiver ol the flood insurance purchase requiremenl. This torm is'used only to
provide elevation information necessary lo ensure compliance wilh applicable community floodplain management ordinances, to
determine the proper insurance premium rate, and/or to support a requesl for a Letler of Map Amendment or Revision (LOMA or LOMR).
Instructions for completing this form can be found on the following pages.
SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE
POLICY NUMBERBUILDINGOWNER'S NAME
Perr s
STREET ADDRESS (Including Apl,, Unil, SMile and/or Bldg, Number) OR PO, ROUTE AND BOX NUMBER
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
Lc, T I __ 6lock- A
O,T¥
C,.,ep II
SECTION B
STATE
FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
COMPANY NAIC NUMBER
ZIP
Provide the following from the proper FIRM (See Instructions):
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ~"NGVD '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 this building site, Indicale
the community's BFE: I _L. J__J_J_ j .~_J feel NGVD (or other FIRM dalum-see Section B, Item 7).
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Cerlificale Inslruclions, indicate the diagram number from lhe diagrams found on Pages 5 and 6 lhal best
describes the subject building's reference level ._( _ .
2(a). FIRM Zones A1-A30, AE, AH, and A (wilh BFE). The lop of the reference level floor from the selecled diagram is al an elevation
of {_ l _J_VLS'J_~'I .JS'~feel NGVD (or olher FIRM datum-see Sea:lion B, Item 7).
b). FIRM Zones V1-V30, VE, and V (with BFE). The botlom of the lowest horizon!al slruclural member of the reference level from
the selected diagram, is at an elevation of J._ !_ ! !. ! . ! .J..1 feel NGVD (or olher FIRM dalum-see Section B, Item 7).
c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is J J J.[__l feet above ~_] or
below [_~] (check one) the highest grade adjacent lo the building.
d). FIRM Zone AD. The floor used as the reference level from lhe selecled diagram is [_ J J.L_J feet above [_:J or below U (check
one) the highesl grade adjacent Io the building. If no flood deplh number is available, is the building's Iowesl floor (reference
level) elevated in accordance with lhe community's floodplain management ordinance? [~ Yes ~ No [] Unknown
3. Indicale the elevation datum system used in determining the above reference level elevations: [-~NGVD '29 ~] 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 ~-~'No (See Instructions on Page 4)
5. The reference level elevation is based on: ~'/r"actual construction ~ construclion 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 immedialely adjacent to the building is: L_[ J~J~__J .~J .feet NGVD (or olher FIRM datum-see
Section El, Item 7).
SECTION D COMMUNITY INFORMATION
t. If lhe communily official responsible for verifying building elevations specifies that the reference level indicaled in Section C, Item f
is nol lhe "lowest floor" as defined in lhe communily's floodplain managemenl ordinance, lhe elevation of lhe building's "lowesl
lloor" as defined by the ordinance is: L_L_L_L_!. ~.l.I ~1 feet NGVD (or olher FIRM datum-see seCtion B, Ilem 7).
2. Date of the slarl of construction or subslanlial improvement
FEMA Form 81-31, MAY 93 REPLACES All PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUA11ON