FEMA-EC980122ELEVATION CERTIFICATE ,993
o-,.
FFr)ERAL EMERGENCY MANAGEIV!FNT A~EHCY
NATIONAL FLOOD INSURANCE PROGRAM
r'r~l',;ITION: Use of this certificat~ does not provide a waiver of the flood insurance purrh,3~;~ requirement. This form is used only tovideelevationinformahonnecessarytoensurecompliancewithapplicablecommur~W floodplain management ordinances, toorminetheproperinsurancepremiumrate, and/or to support a request for a Letter of ~Vlap Amendment or Revision (LOMA or LOMR).Inslrucllons for completing this form can be found on the following pa! es,
SECTION A PROPERTY INFORMATION
lt~,lG OWNER'S NAME
ADDRESS (including Apt., Unit, Sud. and~or Bldg. Number) OR PO. t:lOIJ I'E AND BOX NUMBER
2o __/,u' RZE'.5'._ 'cu, e 7'
SECTION B
s IA]E ZIP CODE
FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
vide the following from the propc, r FIRM (See Instructions):
COMMUNITY NUMBER I 2. PANEL NUMIt[ ~ I 3. SUFFIX
j4.
DATE OF t:l~r{M ,t]l )~:X [ 5. FI~IM ZONE ~ 6. BASE FLOO[) ELEVATION
in Ad Zones, use del)Ih)
i.dicate the elevation datum system used on the FIRM for Base Flood Elevations fREE): ! i NGVD '29 I itOther (describe on back)Zones A or V, where no BFE is provided on the FIRM, and the community ha~ e,~tnbl shed a BFE for this building site, Indicate
feet NGVD (or other FIRM datum-see ~ectirm R, Item 7).communily's BFE:i t I I t ;.
SECTION C BUILDING ELEVATION INFORMATION
ising the Elevation Certificate Instructions, ndicate the diagram number from the diaarams found on Pages 5 and 6 that best
describes the subject building's reference level ~._/__.
a). FIRM 7ones Al-A30, AE, AH. and A (with BFE). The lop of the reference level floor from the selected diagram is at an elevalion
feet NGVD (or other FIRM datum-see Section B, Item 7).
3 ih). FIRM Zones VI-V30, VE and V (with BFE). The bottom of the lowest hot zontal structural member of the reference Iflv~l from
the selected diagram, is at an elevation of i J ..j ...J._ J .J.J J feet NGVD (or other FIRM datum-see Section B, Item 7).
F1RM Zone A (without BFE). The floor used as the reference level from the ~etected diagram is ~ ~ .}.k J feet above ~'~_~ or
below ~ , (check one) the highest grade adjacent to the building.
as the reference level from the selected diagram is ~ ~ ;.~ ~ feet above ~-] or below ~ (check
FIRM Zone Ad.The floor used
one) the highest grade adjacent to the building. If no flood depth number is aVailable, is the building's lowest floor (reference
level) elevated in accordance with the community's floodplain management ordinance? ~ ] Yes [ { No ( ~ Unknown
ndicat~ the e!evRfion d~tum sTst,?m used in dotermining th. ~bove referencc I~vel el~v~tioqs: ~ ~ HGVD '29 ] ] Othgr (describe
t~¢ FIRM [see Section B Item 7/ then conve~ the elevations to the datum system used on the FIRM and show the conve~ion
under Comments on Page 2). (NOTE: If the elevation datum used in measudn~ the elevations is different than that used on
equation under Comments on Page 2.)
levation reference mark used appears on FIRM: [~-~ Yes ~ No (See Instructions on Pa.qe 4)
5 Th~ reference level elevation is ba~ed on: ~ actual construction ~ '~ construction drawings
NOTE: Use of construction drawings is only vafid if the buildinq does not yet have the reference level floor in place, in which
case this ce~ificate will only be valid for the building during the course of construction. A post-construction Elevation Cedificate
w/lt be requir~ once construction is complete.)
r'; The elevation of the lowest grade immediately adjacent to th~ building is: ~__J ~ J ] ;.~ I feet NGVD (or other FIRM datum-see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
1. if the community official responsible for verifying building elevations specifies that the referc~nce level indicated in Section C, Item 1
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: ! J J 5_J.~_l.[_.J feet NGVD (or other FIRM datum-see Section
Dale of the start of construction or substantial improvement . ....................."~"" ' ~'"' T,c'-~7'~
1 LE ~ J ~COMPANYNAMF
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