FEMA-EC020508 (2)Fll.RAL EMERGENCY MANAGEMENT AGA;y
NATIONAL FLOOD INSURANCE PROGRlt"
ELEVATION CERTIFICATE'
Q,M,8, No. 3067-0077
Expires July 31,. 2002
1m ortant: Read the instruction, on a es 1 - 7.
SECTION A - PROPERTY OWNER INFORMATION For'"surance:CompanyUse:
Policy NumberBUilDINGOWNER'S NAME
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
I '~GOO
CITY STATE
c::.o1'?e:t..L .,-e:l(As
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) ..-'
II.. I
I.-CT" ~\ "i3Loc:..k:... A- AMeSDlrJ6I "t\..A-i 1"Ze'5=. lNCc.a<:-
BUilDING USE (e.g., Residential, Non.residential, Addition, Accessory, etc. Use Comments sedion if necessary.)
O~M.-
LATITUDE/lONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: I_I GPS (Type):
or ##._') WAD 1927 LI NAD 1983 LIUSGSQuadMap
CompanyNAIC Number
ZIP CODE
Sol"
I~her: 'A2.J\I\....
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER
010
B5. SUFFIX B6. FIRM INDEX B8. FLOOD
DATE ZONE(S)
I ~ "-' V. 1./:b 'ZIlb1 X
Bl0. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
I_I FIS Profile I~FIRM 1-1 Community Determined I_I Other (Describe):
Bll, Indicate the elevation datum used for the BFE in B9: I~GVD 1929 I_I NAVD 1988 1-1 Other (Describe):
B12, Is the building located in a Coastal. Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)?
Designation Date:
B3. STATE
B9. BASE FLOOD ElEVATION(S)
Zone A:J~ depth of flooding)
I_I Yes KJ..No
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: I_I Construction Drawings' ~uilding Under Construction' I_I Finished Construction
A new Elevation Certificate will be required when construction of the building is complete.
C2, Building Diagram Number ---!- (Select the building diagram most similar to the building for which this certificate is being completed - see
pages 6 and 7, If no diagram accurately represents the building, provide a sketch or photograph.)
C3, Elevations - Zones A1-A30, AE. AH, A (with BFE), VE, V1-V3D, V (with BFE), AR, ARIA. ARlAE. ARlA1-A30. ARlAH. ARlAO
Complete Items C3a-i below according to the building diagram specified in Item C2. State the datum used, If the datum is different from
the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion
calculation. Use the space provided or the Comments area of Section 0 or Section G. as appropriate, to document the datum conversion,
Datumb/#rp ~ Conversion/Comments ~ ()P ~ 61~c.... Ul~L
Elevation reference mark used ~rJ ~ Does the elevation reference mark used appear on the FIRM? I_I Yes No
o a) Top of bottom floor (induding basement or enclosure) 496 .~ft.(Mt.. '1.\;
o b) Top of next higher floor ==l=._ft.(m) ,
jJ
OF
o c) Bottom of lowest horizontal structural member ry zones only) . _ ft,(m) ~ ~ 1I.,,":"i!aiSTEii~4..!
o d) Attached garage (top of slab) , _ ft.(m) ~ -g ".,q..~ ~<>"~'
o e) Lowest elevation of machinery and/orequipment ~: \: ...:...IIA. Bj;; .... ....... .....
servicing the building NPr". fl.(m) E ~ RH
o f) Lowest adjacent grade (LAG) 4-55 . ~ft.<-l ~ ~
o g) Highest adjacent grade (HAG) 4-S'7 .-:Mft.(-l ~
o h) No, of permanent openings (flood vents) within 1 fl. above adjacent grade Nt.- ~
o i) Total area of all permanent openings (flood vents) in C3h tJA- sq. in. (sq. em)
SECTION 0 - SURVEYOR, ENGINEER. OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor. engineer, or architect authorized by law to certify elevation information.
certify that the infonnation in Sections A. 8, and C on this certificate represents my best efforts to intelpret the data availab/e,
understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code. Section 1001.
CER~hHO~ LICENSE NUMBER ~
I
CoAJN~ ..... oc=o
ADDRESS
t:.)fk-....e:-
ZIP CO.!2f~
FEMA Fo AUG 9 .SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
for Insurance GOmpany U~;
Policy Number
Company NAIC Number
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
COMMENTS
1' '. '
1' I Checkh'ete if attachments
SECTION E _ BUILDING ELEVATION INFORMATION (SURVEV NOT REQUIRED) FOR ZONE AO AND ~ONEA IW,ITHOIlT"BFE)
For Zone Ap and Zone A (without BFE), complete Items EI through E4, If the Elevation Certificate is intended for use as supporting
infonnation fa" a lOMA or LOMR-F, Section C must be completed.
EI. Building Diagram Number _ (Select the building diagram most similar to the building for which this certificate is being completed -
see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
E2. The top of the bottom floor (including basement or enclosure) of the building is LLI It.(m) LI-1in.(cm) LI above or LI below
check one) thMligJ;1estadjacent grade, '
E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is
1_1_1 It,(m) LLlin.(cm) above the highest adjacent grade.
E4, For Zone AO onlY'" If no flood depth nurJl~er is availablll: is the iop 01 \he bottom fl"'elr eteyate,finaccordanc.. with the cQmmunilS':S
I ' .. '.
floodplain management ordinance? LI Ves I I No I 1 Unknown, The local official must certify this information in Section G.
SECTION F _ PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA.issued or
community:issued BFE) or Zone AO must sign here.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS
SIGNATURE
CITY STATE ZIP CODE
DATE TELEPHONE
COMMENTS
I Check here if attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official who is authQ.rized by law or .ordinan"" to admi~ij!t"thepommunity',s flpodplain management ordinance I"'n,complate
Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(6) and sign be~, .
o.
GI. LIThe information in Section C was tl\kjln from other.,d,acumentation that has been signed and embOssed by a licensed surveyor,
engineer, or architect who is authorized by state or loc;allaw to certify elevation information, (Indicate the source and date of the
elevation data in the Comments area below.)
G2. I_I A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or
Zone AO, .
G3. 1--1 The following information (Items G4-G9) is provided for community floodplain management purposes,
G4. PERMIT NUMBER G6, DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY
l' . ISSUED
G7. This permit has been issued for: I_I New Coni;tfl,Jction LI Substantial Improvement
G8. Elevation of as-built lowest floor (including basement) of the buiidi~g is:
G9. BFE or (in Zone AO) depth of flooding at the building site is:
LOCAL OFFICIAL'S NAME
It.(m) Datum:
It.(m) Datum:
TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
0,
COMMENTS
I
FEMA Form 81-31, AUG 99
I_I Check here if attachments
REPLACES ALL PREVIOUS EDITIONS