FEMA-EC030830re sTsOJO
BUILDING OWNER'S NAME
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
Important: Read the instr,__,~_ons on pages I - 7.
SECTION A - PROP,-KT¥ OW~ INFORMATION
BUILD~I~8;~-I~)DRESS (Including Ap~ ~lnit, Suite, a~ Bldg. No.) OR P.O. ROU~ ~D BOX NO.
P~'~R~ ~ESC~IQN (Lo~ BI~ ~-s, T~ Par~m~, Le~l ~pM~, '
O:id;B. h~). 3067-0077
Expires December 31, 2005
ZIP CODE
etc.)
BUILDING USE (e.g., R~,~identiel, NoFce~a}, ~tion, Accessory, etc. Use a Comments area, If neoesse~/.)
LAT:TUDEJLONGITUDE (OPTIONAL) HORIZONTAL DATUM:
f;'-fffi'-~t.~' or ~.~) L..J NAD1927 L.JNAD1983 SOURCE: L_JGPS(Type):
I I US(3S Quad Map L_J Other
SECTION B- FLOODINSURANCERATE ,AI~, (FIRM) I,'FORMAT~INI" B1. ~I~IPCOMMU~'r~ NAME & COMMUNITYI~UMBERB2. COUE ' B3.B4. MAPANDPANELNUMBERIB0:F'"M'"DEXIB7. F'RM"^NEL { "0. F'OODDB5. SUFFIXBg. BASEFLOODELEVATION(S)FEMAForm81-31, January2003Seereversesidefor continuation. ~ReplacesallpreviouseditionsB10. IndicatethesourceoftheBaseFloodElevation (BFE) dataorbaseflooddepthenteredinBg.IIFISProfileIIFIRML_JCommunityDeterminedIIOther (Describe):Bll. IndicatetheelevationdatumusedfortheBFEinBg: IINGVD1929IINAVD1988IIOther (Describe):.B12. IsthebuildinglocatedInaCoastalBarrierResourcesSystem (CBRS) areaorOtherwiseProtectedAma (OPA)? L_lYes [miNoDesignationDate:SECTIONC - BUILDI GELEVATIONINR:)~IATION (SURVEYI~_I=_~JlRED)C1. Buildingelevationsarebasedon: L._JConstrucfionDrawings* LL~'BuildingUnderConstructOn*
iMPORTANT: In t-h--~-~- _%n_~c_~_, copy the corresponding information from Section ~
crrY STATE Z~P COD~ l:;~~' ~?~':i:i~.:!ii!'~'~?i:;::~::]
SECTION D ' SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Ce~tificata for (1) community official, (2) insurance agent~oompany, and (3) building owner.
COMMENTS.
I~ Check here if ~tmChme~ts
SECTION E - BUILDING Fr~VATION iNFORMATION ($,URVEY NOT REGUI,RED) ,FOR ZONE A
For Zone ^0 and Zone ^ (without BFE), complete Items El. through ES. If the E~evatlon Cerflficete is intended for use es suppor~ng
information for e LO~L~ or LOMR-F, Section C must be completed.
El. Building Di~mm Number ~ (Se~eot the building diagram most similar I~ the building for which this certificete is beinG compisted -
see pages 6 and 7. tf 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 L_II ft. (m) I__L_,I in. (cm) L_.J above or L._.I below
check one) t~e highest adjacent grade. (Use natural grade, if available.)
E3. For Building Diagrams 6-8 with openings (see page 7), the next. higher fmor or elevated floor (elevation b) of the building Is
L_L._I fl. (m) L..J_.._Jin. (..cra) above the I~ghest adjacent grass. CompiMe items C3.h and C3.i on front, of
4. rne top of the platf~rm ~,t machinery and/or equipment servicing the bullding is I__L_i.ft.(m)l I IIn.(cm)L--JaboveorL-Jbelow
check one) the highest adjacent grade. (Use natural grade, if available.)
ES, For Zone AO only: if no flood depth number is available, is the top of the bott~)m floor elevated In accordance with the community's
floodplain manacflement ordinance? I . I Yes I.._..I No I .. J Unknown. The local official must certJf)~ this information in Section,G..
SECTION F - PROPERTY OWNER (OR OWNER'8 RE~ PRESENT ,ATIVE) CP-Kt~u'iCATION
The property owner or owner's authorized representative wh° comPletes Sections A, B, C (Items C3.h a~d C3.i only), ~,nd E'for ~.~ne A
without a FEldA-Issued or community-issued BFE) or Zone AO must sign here, The statements in Sections A,
the best of my knmM..=dge.
PROPERTY OWNE;'S OR OWNER'S ^UTHOR~.ED REPRESENT^T;VE'S NAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
1~ Check here if attachments
SECTION G - COMMUNITY INIK~M~TION (OPTIONAL) ,,,
The local offidel wh~) is authorized by law or ordinance to administer the c~munity's floodplain management ordinance can complete '"
Sections A, B, C (or E), and G of this Elevation Certificate. '-Complete the applicable item(s) and sign below.
Gl. I I The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor,
engineer, or amhitect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.)
G2. [_.1A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or
Zone AO.
l___[ Th~ ~ol!owi.'.ng information (Items G4-G9} is provided for community floodplain management pu~.
lG4. PERMIT NUMBER. IG5. DATE PERMIT ISSUED tG6. DATE cERTIFICATE OF cOMPLIANcE/OccUPANCYISSUED
G?. This permit Ires been issued for: I I New Construction I I Substantial Improvement
Ge. '~evation of es-built lowest floor (including basement) of the building is: __ ft. (m) Datum:
Gg. ~F£ or (in Zone ^O) depth of flooding at the building site is: __ ft. (m) Datum: ,,.
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
I_1 ~ here if attachments
FEMA Form 81-31, January 2003 Replaces all previous editions