FEMA-EC020830FEDERAL EMERGENCY MANAGEMENT AGENCY,
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE ""
rtant: Read the in,s~r,~i.rO~ns.on pages 1 - 7.
S~TION A- PROPERTY (::J~/~N[='R INFORMATION
E).M.B. ~No. 3067-0077
Expires July, 31; 2002
BUILDING OWNER'S NAME
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
CITY STATE
oPpa,c
ZIP CODE
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.)
LATITUDE/LONGITUDE (OPTIONAL)
o. ~, _ f/~.f/~ or ~=lk;;;;;;;;;:~)
HORIZONTAL DATUM:
I~..~AD 1927 L-I NAD 1983
SOURCE: I IGPS (Type):
I I USGS Quad Map [~1 Other:
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
lB1. NFIP COMMUNITY NAME & COMMUNITY NUMBER I
B4. MAP AND PANEL Bf. SUFF X B6. FIRM INDEX B7. FIRM PANEL BS. FLOOD
NUMBER I DATE EFFECTIVE/REVISED DATE ZONE(S)
B10~ Ir~dicate th'e source of the Base Flood EleVation (B~EE) data or base flood depth entered in B9.
I_1 FIS Profile I~t~IRM I---~ Community. D~ermined L_J Other (Describe):
B11. Indicate the elevation datum used for the BFE in Bg:~i;~NGVD 1929 [~1NAVD 1988 U Other (Describe):
B12. Is the building located in a Coastal_Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? I_1 Yes
Designation Date:
I
B9. BASE FLOOD ELEVATION(S)
Zon~,~se depth of flooding)
L~io
SECTION C - BUILDING ELEVATION INFO~RMATION (SURVEY REQUIRED)
C1. Building elevations are based on: L_lConstruction Drawings* Jg~Building Under Construction* I~Finished Construction
A new Elevation Certificate ~vill 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 Al-A30, AE, AH, A (with BFE), VE, VI-V30, V (with BFE), AR, AR/A, AR/AE, AR/Al-A30, AR/AH, AR/AO
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
calculatipn. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion.
Datum ~ Co nversio~p./Co_m m_er~t.s' ~NElevationreferencemarkused ~ IP___~I~.~_~ Does the elevation reference mark used appear on)n thethe F~,~I I Yes I o
a) Top of bottom floor (including basement or enclosure) ~ · .1~.. ff.(~)
i3b) Top of next higher floor ff.(m) ~j ........... '~'
C} c) Bottom of lowest horizontal structural member (V zones only) fl.(m) ~ ...;~<~s '..
d) Attached garage (top of slab) ~t~fl-(m) E~ ....: .......... '.
3 e)Lowest elevation of machinery and/or equipment ;- ;- BAR '"~"1~ ..... ~'
servicing the building ~J~' . ·fi(m)
3 t) Lowest adjacent grade (LAG) ~ .~,¢~ ff-(~) ~= ~
O g) Highest adjacent grade (HAG) ~t~l~ , .~_ ff.(m) ~
3 h) No. of permanent openings (flood vents) within 1 ft. above adjace.n.t grade iU~'~
O i) Total area of all permanent openings (flood vents) in C3h JJ ~,' s~l~ in. (sq. cra)
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
CERTIFIER'S NAME
TITCE
L~
ADDRESS '"'"~'
SIG~TUR~ X
FEMA Form ~1, AUG 99
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine orimpdsonment under 18 U.S. Code, Section 1001.
r z,,co
DATE TELEPHONE
SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
IMPORTANT: In these spa~es, copy the corresponding information from Section A.
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
JY~'~JT ~'*-~-'-'"~-
STATE ZlPCODE ! ~l~Y'NAi~i~i
SECTION D - SURVEYOR, ENGINEER, OR ~.RCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
COMMENTS
SECTION E- BUILDING ELEVATION INFOR~ON (SURLY NOT REQUIRED) FOR ZONE AO AND ~N~
For Zone AO and Zone A (wi~o~ BFE), ~mplete Items E1 through E4. Ift~ ElevaU~ Ce~cate is ~~ru~ as su~
info~aUon ~r a L OMA or L OMR-F, Section C mu~ be ~pleted.
El. Building Di~ram Numar__ (Sel~ the building diagram m~t similar to the building for whi~ ~is ~ifi~te is ~ing ~mplet~ -
see pages 6 and 7. If no diagram a~umtely repre~n~ the building, provide a sket~ or ph~mph.)
E2. The top of the b~om floor (including basement or enclosure) ~ ~ building is ~l fl.(m) ~in.(~) ~l a~ve or ~J ~1~
check one) the h~e~t.. . , ~nt grade. -~.~ ' ~, .: * :~',~,.'x;'" : .;~..: '
E3. For Building Diagrams ~8 ~th openings (s~ page ~, the n~ higher fl~r or elevated fl~r (elevation b) ~ ~e building is
1 ff.(m) I~n.(cm) above the highest adja~nt grade.
E4. For Zone AO onl~'~f ~e flo~ depth n~er is available, ie~ t~ ~ ~'~om ~r ~}~ ~rd~ with the ~u~*
floodplain management o~inan~? ~J ~es ~J No ~ Onkn~n. ~he I~J o~1 mUst ~i~ ~is i~n in S~n G.
SECTION F - PROPER~ OWNER (OR O~ER'S REPRESENTATI~) CERTiFICATI~
The prope~ owner or owne(s authoHz~ repm~nta~e who ~mpl~es S~ionsA, B, and E for Zone A (~o~ a FEMA-iesu~ or
mmuni~-issu~ BFE) or Zone AO must sign hem.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS .- CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
J J Check here if attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinan~.~
Section.s A, B, C (or E), and G of this Elevation Certificate. Complete the applicable
Gl. I--i The information in Section C was tarn fm.~ other ~entation that has been ~[l~n~l and embo'Ssed by a licensed su .weyor.,.
engineer, or architect who is authorized by ~tate or local law to certify elevation information. (Indicate the source and date of me
elevation data in the Comments area below.) .;,* ~
G2. [__l A community official completed Section E ~ a buil¢ .~. :~,iocated in Zone A (without a FEMA-issued or community-issued BFE) or
Zone AO.
G3. [__-I The following information (Items G4-Gg) is provid~l~ for community floodplain management purposes.
i~l'~ERMITNUI~BER, ..~ ID'a~T~ PE~IT ' 'SI~' -~D...,, /,:. ~ ~, IG6'ISSUEDDATE CEH',TiFICATE OF COMPLIANCFJOCCUPANCY
GT. 'l~is ~p:ermit has been issued for: [_.1 New Constriijction ~ Substantial Improvement
G8. Elevation of as-built lowest floor (including basement) of the bailCljng is: lt.(m) Datum:
G9. BFE or (in Zone AO) depth of flooding at the building site is: lt.(m) Datum:
LOCAL OFFICIAL'S NAME i iJLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
FEMA Form 81-31, AUG 99
I__1 Check here if affachments
REPLACES ALL PREVlOLJS EDITIONS