FEMA-EC950731 (5)ELEVATION CERTIFICATE Expires May fl~l, 1993
FEDERAL EMERGENCY MANAGEMENT AGENCY ' '
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to
r ovide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to
termine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR).Inslructions for completing this form can be found on the following pages.
SECTIO~N A PROPERT~Y INFORMATIO~N FO. ,NSURANCE CpM~N__y.
lNG OWNER'S NAME PO{ ICY NUMBER
R~ ~T~DoR~S-~-;ln~lu~i~g A~t.,~it. Suite and,or B,dg.-"umber~-~ P~-ROUTE ANO BOX ~UMBER .... COMPANY NAIC NUM~
f iFR DESCRIPTION (Lot and Block Numbers, etc.)
STATE
SECTION El FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
ziP CODE
ovide the following from the proper FIRM (See Instructions):
i. COMMUNITY NUMBER 2 PANEL NUMBER 3. SUFFIX 4. DATE OF FIRM INDEX I 5 FIRM ZONE I 6. BASE FLOOD ELEVATION
J (
in AO Zones. use depth)
Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ~¢NGVD '29 { }Other (describe on back)
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._~[ [ ! .!.~ ! feet NGVD (or other FIRM datum-see Section B, Item 7).
SECTION C BUILDING ELEVATION INFORMATION
sing the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level_._ / .
re'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
ofl J~ ;4t I?l~ [.tC2t feet NGVD (or other FIRM datum-see Section B, Item 7). 'b). -V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level fromFIRMZonesV1
the selected diagram, is at an elevation of [ I J J__J.! t feet NGVD (or other FIRM datum-see Section B, Item 7).
c). FIRM Zone A fwithout BFE). The floor used as the reference level from the selected diagram is J I I.I I feet above [~J or
below t i.i J (check one) the highest grade adjacent to the building.
rd) FIRM Zone AO. The floor used as the reference level from the selected diagram is I I !.! treat above ~-] or below I'~! (check
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? I~ J Yes [ 1 No [~.J Unknown
Indicate the elevation datum system used in determining the above reference level elevations: ~ ! NGVD '29 ~' 1 Other (describe
under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than that 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.)
Elevation reference mark used appears on FIRM: ~-'1 Yes i~"No (See Instructions on Page 4)
The reference level elevation is based on: ~ actual construction ~-_] construction drawings
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 valid for the building during the course of construction. A post-construction Elevation Certificate
W~ll be required once construction is complete.)
The elevation of the lowest grade immediately adjacent to the building is: [ _~ _ .~_ 1¢~! .~'I feet NGVD (or other FIRM datum-see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
s 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 I I ~.b_i feet NGVD (or other FIRM datum-see Section B, Item 7).
Date of the start of construction or substantial improvement
U_l~r~t:~'(or Affix S@al)
CITY ~¢1~S HARRy"~'A;';' ' ":,/;' STATE ZIP