Loading...
FEMA-EC010912FEDERAL ~MERGENCY MANAGEMENT AGENCY ~ O~.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 ELEVATION CERTIFICATE.;. ,., Important: Read the in~tra~tronS:,on" pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION BUILDING OWNER'S NAME BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. 70 ! CITY STATE PROPERTY DESCRIPTION (Lot and Block Numbers, Ta~( Parcel Number, Leg_~Description, etc.) . , BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments s~cti'on if necessary.) ZIP CODE LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: I_1 GPS (Type): or ~.;; ;; ;; ;;....:o) I_t NAD 1927 L__I NAD 1983 I_1 USGS Quad Map SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION I_1 Other: B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME I B3. STATE B4. MAP AND PANEL B5. SUFFIX I B6. FIRM INDEX I B7. FIRM PANEL I B8. FLOOD NUMBER I_ DATE J EFFECTIVE/REVISED DATEI Z~E(S) B10. Indicate the source o~f t~e Base Flood Elevation (BFE) data or base flood depth entered in B9. I_1 FIS Profile J~CJ,~IRM I~1 Community Determined ! I_1 Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: J~NGVD 1929 I~1 NAVD 1988 I~1 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: B9. BASE FLOOD ELEVATION(S) Zone AO, use depth of flooding) SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: I__lConstruction Drawings* ~Building Under Construction* I__lFinished Construction A new Elevation Certificate will be required when construction of the bu31ding is complete. C2. Building Diagram Number I (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, AR, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, AR/A, AR/AR, 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 calculation. Use the space provided or the Comments area of Sectiod D or Section G, as appropriate, to document the datum conversion. Datum Conversion/Comments j,,Yes I~1 NoElevationreferencemarkused '~, [ O) ~ Does the eleVation reference mark used appe~ar on theFIRI~ .~ 3 a) Top of bottom floor (including basement or enclosure) ~C~'"~ .~'~ ft.(m) -~ 3 b)Topofnexthigherfloor I~ . ft.(m)(~ O c) Bottom of lowest horizontal structural member (V zones only) 'lk[~ . ft.(m) ~~ ~' 3 d) Attached garage (top of slab) J~J~' . ff.(m) ~ 3 e) Lowest elevation of machinery and/or equipment ~ ~1~[servicing the building ~lt~' . ~ft.(m) _=E [3 0 Lowest adjacent grade (LAG) ~ .4~ft.(l~ ~ml ~03g) Highest adjacent grade (HAG) 4-~(~ ."~_. ft.(~) 3 h) No. of permanent openings (flood vents) within I ft. above adjaCent grade I~Je ._8, 3 i) Total area of all permanent openings (flood vents) in C3h ~ s~ n (sq cm) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION 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 orimp#sonment under 18 U.S. Code, Section 1001. LICENSE NUMBER DATE ' TELEPHONE - SEE REVERSE SIDE FoR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In thes~ spaces, copy the corresponding information from Section A. BUIL~DING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. CITY 1~[ . ~~...~ ZIP CODE SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT 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 INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), ~mplete Items E1 through E4. If the Elevation Ce~ificate is intended for use as supposing info~ation for a LOMA or LOMR-F, Section C must be completed. El. Building Diagram Number (Sele~ the building diagram most similar to the building for which this ce~ifi~te is being ~mpleted - see pages 6 and 7. If no diagram a~urately represents the building, proVide a sketch or photograph.) E2. The top of the boffom floor (including basement or enclosure) of the building is I~1~1 fl.(m) I_l_lin.(cm) I~1 above or L-I below E3. For Building Diagrams 6-8 with openings (see page 7), the next higher flOor or elevated floor (elevation b),of the building is I_1_1 ~.(m) I~l~lin.(cm) above the highest adja~nt grade. floodplain management ordinance? ~ Yes I~1 No I~1 Unknown. The Io~1 official must ceRi~ this information in Se~ion G. SECTION F - PROPER~ OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICA~I~ The property owner or owner's authorized representative who completes SeCtio,ns A, B, and E for Zone A (without a FEMA-issued or community,issued BFE) or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS 'C TY I STATE ZIP CODE SIGNATURE DATEI TELEPHONE COMMENTS I__1 Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the'comh~unity's floodplain management ordinance can complete Sections A, B, C (0r E), and G of this Elevation Certificate. Complete the applicable item(s~ and. sign Gl. I_1 The information in Section C was ta~n fr .off?ther documentation that has been sighed and'em~3(~ssed by a licensed surveyor, engineer, or architect who is authorized by state Or local law to certi~ elevation information. (Indicate the source and date of the elevation datajn the Comments area below.) ~"~ G2. I~1 A community official completed Section E for a b~c~ing located n zOne A (without a FEMA-issued or community-issued BFE) or Zone AO. G3. I~1 The following information (Items G4-G9) is provided ~for commun ty floodplain management purposes. G7. Thi~ per4~Jt ha~ been issued for: I_1 New Const'.m...:.ction I~1 Substantial Improvement GS. Elevati0~of as-built lowest floor (including basement) of the buildii~%: ft.(m) Datum: G9. BFE or (~ Zone AO) depth of flooding at the building site is: ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS Check here if attachments FEMA Form 81-31, AUG 99 REPLACES ALL PREVIOUS EDITIONS