FEMA-EC990305ELEVATION CERTIFICATE ., O.M.B. No. 3067-00Z7
FEDERAL EMERGENCY MANAGEMENT AGENC.Y :.. Expires July 31, 1999'
NATIONAL FLOOD INSURANCE PROGRAM .!'
ATTENTION: Use of this certificate doeS not provide a waiver of the flood insurance purchase reqmrement. Th]s form ~s used dray to crc-
vi;de elevation information necessary to ensure compliance with al~piicable community floodpla n man~tgement ordinances, to d~[erm~r~e '
the proper insurance premium rate, and/or to sQpport a request for a Letter of Map Amendment:or Revision (LOMA or,LOMR). You are r3.,o~
required to respond to dins collection of information unless a valid OMB control number is displ~iyed in the upper ngnt coiner or this form
Instructions for completing this form can be found on the following pages.
SECTION A PROPERTY INFORMATION ~o~ INSURANCE COMPANY ~JSE
BUILDING OWNER'S NAME POUCY NUMBER
STREET ADDRESS (tncruding At2L, Umt, Suite and/or Bldg Number} OR P.O. ROUT~ AND BOX NUMBER COMPANY NAIC NUMBER
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
C!TY
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
STATE ZIP CODE
Provide the following from the proper FIRM (See Instructions):
1' COMMUNITY NUMBER
I
2' PANEL NUMBER'
I~''/~-''2 //'"~-~ ~0
3.
SUFFIXE
4 DATE OF FIRM INDEX ~/""-/"'~-- '~
Y
5. FIRM ZONE
J
6. BASE FLO~)D
ELEVATIONAE (in Ad Zones, use depth)
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): --~NGVD '29 '--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: .__ feet NGVD (or other FIRM datum-see Section B, Item 7).
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevatio,¢ ..Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
describes the.,s,~'~ng's reference level /
2fa). FIRM:~'r~[Ai~ i~10,_~[,k-4.,-,---.
7_ '- ~
and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
of _£L..~1¢..~,~.~ ~fj~J~?r other FIRM datum-see Sect,on B. Item 7).
J~,~ ~, ....
the sek~,...e~i~.~ _~~tlatlon of .... ~ feet NGVD (or other FIRM datum-see Section B, Item 7).
c). FIR~,Z~'~.A'~,[~_ZTh.~)/Ioor used as the reference level from the selected diagram is . feet above ~ or
e~ ¢1/ -- --
below.!.~'¢, (cbOe) ~ig~t grade adjacent to the building.
d). FIRM~j~~~s~ as the reference level from the selected diagram is~'"' ~ .~ feet above -- or below ~ (check
one~ the h~;~d~C~nt to the building· If no flood depth number is available, ~s th~ buildin~'s Iow?t floor (reference
level) elevated ~:~'~nce with the community's floodplain management ordinance? ~ Yes ~ No ~Unknown
3. Indicate the elevation datum system used in determining the above reference level elevations: ~ NGVD '29 ~ 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 conveR the elevations to the datum system used on the FIRM and show the conversion
equation under Comments on Page 2.)
4. Elevation reference mark used appears on FIRM: ~.~ Yes ~ (See Instructions on Page 4)
5. The reference level elevation is based on: ~tual 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 ceRificate wi// only be valid for the building dudng the course of construction. A post-construction Elevation CeRificate
will be required once construction is complete.)
6. The elevation of the lowest grade immediately adjacent to the building is: ¢¢~ . ~ 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 reference 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 or.d~nance is: ! i i. ~_ feet NGVD (or other FIRM datum-see Section B, Item 7).
2. Date of the start of construction or substantial improvement
FEMA Form 81-31, MAR 97 REPLACES ALL PREVIOUS EDIllONS SEE REVERSE SIDE FOR CONTINUATION