FEMA-EC961125o.,.,.,o. 3o 7.oo.
ELEVATION CERTIFICATE Mw 3t. t,96
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
A'I-rENTION: Use of this cedificate do{~ not provide a waiver of the flood insurance purchase requirement. This form Is used only to
provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to
determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR).
Instructions for completing this form can be found on the following pagee.
IFOR
INSURANCE cOMPANY USE
POUCY NUMBER
COMPANY NAIC NUMSER
SECTIoN*A PROPERTY INFORMATION
BUILDING OWNER'S NAME
STREET ADDRESS (Including Apt., Unil, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
CITY STATE
co~PEL.L, T~.
ZIP CODE
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
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, Indicate
the community's BFE:! t I I I I,I 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 ~,Jmber 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 ~elected diagram Is at an elevati°n
oft ! IWI~I~ ]. ~l~__~ feet NGVD (or other FIRM datum-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 cfi ;~ ~ .... I ! I 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 ~evel from the selected diagram is I ! !.]__] feet above [] or
below ~ (check one) the highest grade adjacent to the building.
d). FIRM Zone AD. The floor used as the reference level from th~: selected diagram IS ; I I ! feet above [] or below C (check
one) the highest grade adjacent to the building. If no flood depth number Is available, Is the bulldlng's lowest floor (reference
level) elevated in accordance with the community's floodplain management ordinance? ~ Yes [] No [] Unknown
3. Indicate 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 u~ed in measuring the elevations is different than thef 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: I-~ Yes [] No (See Instructions on Page 4)
5. The reference level elevation is based on: [] actual construction [] construction drawlng~
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 vali~l for the building during the co~]rse 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:l ~ ''~ I~ ~Oi. ~ .feet NGVD (or other FIRM datum*see
Section B. Item 7). -
SECTION D COMI~UNITY INFORMATION
1. If the community official responsible for verifying building elevati,:qs specifies that the reference level Indicated In Section C, Item t
is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building'S "lowest
floor" as defined by the ordinance is: [ i i ! I.L_I feet NGVD (or other FIRM datum-see Section B, Item 7).
2. Date of the staff of construction or substantial Improvement
m, ,-cc , ,, nnc~.~., ,¢ c~'n?-~c cci: Or~:l~ .~lO~ FOI~ CONTINUATION