FEMA-EC950731 (4)ELEVATION CERTIFICATE O.M.B. No 30~7-0077
FEDERAl. EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
A"I-rENTION: Use of this certif catn does not provide a waiver of the flood insurance purchase requirement. This form is used only toprowdeelevationinformationnecessarytoensurecompliancewithapplicablecommunflvfloodplainmanagementordinances, tod,~'termine the proper insurance prer].um 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 pa! es.
SECTION A PROPER fY INFORMATION FOb INSURANCE COMPANY USE
lNG OWNER'S NAML
POUCY NUMBER
tHEE f ADDRESS (Includ,ng Apl. Uml. Su,le ,~M,'or Bidg Nu~ ~h,~l L;~q P O ROU ! E AND BOX NUMiJL i~
HER DESCRIPTION (Lot and Bilk Numbers. elc)
SECIION B
JMPAN¥ NAK.. NUMBER
SIAIE ZIP CODE
FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Prowde the following from the proper FIRM (See Instructions):
7. ~ndicate tho elevation datum system used on the FIRM lor Base Flood Elevations (BFE): L~NGVD '29 b~] 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: .. J_[ J i i i I feet NGVD (or other FIRM datum-see Section B, Item 7).
SECTION C BUILDING ELEVATION INFORMATION
1. [)sing the Elevation Certificate Instrljctions. indicate the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject buflding's reference level /
2(a). FIRM Zones Al-A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
of [. J ~t_~j .[¢,! feet NGVD (or other FIRM datum-see Section B, Item 7).
b). FIRM Zones Vl-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 of bb._l I J J.b.~ feet NGVD (or other FIRM datum-see Section B, Item 7).
c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is [ I I.b_J feet above [] or
below _~-j (check one) the highest grade adjacent to the building.
rd) FIRM Zone AD Tho floor used as the reference level from the selected diagram is L%J.LJ feet above ~ or below [] (check
one) the highest grade adjacent to lhe building. If no flood depth number is available, is the building's lowest floor (ref,~rence
level) elevated in accordance with the community's floodplain management ordinance? [--J Yes ['~_] No [:'j] Unknown
Indicate the elevation datum system used in determining the above referenc~ level olcvations: ~-I NGVD '29 ~ Other (describe
under Comments on F'nge 2) (NO I E: If the elevation datum used tn measunng the elevations is different than that used on
lt~e FIRM Isee Sectton B, Item 7], then convert the elevations to the datum system used on the FIRM and show the conversion
equal[on t¢nd¢r Comrnents on P,3.qe 2.)
Flora[ion reference mart, used appears on FIRM: F_-] Yes [~/No (See Instructions on Page 4)
The reference level elevation is basc, d on: r~actual construction ~ construction drawings
NOTE: Use of construction drawtnqs ~s only valid ¢f the buildtng does not yet have the reference level floor in place, in which
case this certificate w/ll only be vahd lot the building during the course of construction. A post-construction Elevation Certificate
wtll be requtred once construction m complete.)
The elevation of the lowest grade immediately adjacent to the building is: ! ! ~!~' !~! .!O! feet NGVD (or other FIRM datum-see
5ect~on B, Item 7).