FEMA-EC990305 (3)ELEVATION CERTIFICATE . O.M.B. No. 306Z-007
FEDERAL EMERGENCY MANAGEMENT AGENCY · Expires July 31, 1997
NATIONAL FLOOD INSURANCE PROGRAI~,k ~
A'I-rENTION: USe of this certificate does not provide a Waiver of the flood insurance pufchas, e req,Uirement. This form is used only to pro-
vide elevation information necessary to ensure compliance with applicable community floodplain ~a~nagement' ordi.nances, to determine
the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (EOMA or LC)MR). You are not
required to respond.to this collection of information unless a valid OMB control number is displayed in the upper right corner of thi~ term
Instructions for completing this form can be found on the following pages.
SECTION A PROPERTY INFORMATION
IFOR
INSORANCE COMPANY USE
POLI~Y NUMBER
o
COMPANY NAIO NUMBER
BUILDING OWNER'S NAME
STREET ADDRESS (Inc,ucling A~t., Unit, Suiie and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER
OTHER DESCRIPTION (Lot and Bi~ck Numbers, etc.)
STATE ZIP CODECITY
SECTION B FLOOD INS~JRANCE RATE MAP (FIRM)' INFORMATION'- -
Provide the [ollowing from the proper FIRM (See Instructions):
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: i ' feet NGVD (or other FIRM datum-see Section B, Item 7).
SECTION C BUILDING ELEVATION INFORMATION
1. Using 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 !
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 /"//!'~,/ ~ feet I~GVD (or other FIRM datum-see Section B, Item 7)..
30 VE ;art~l~il~ BEE). The bottom of the lowest horizontal structural member of the reference level fromb). FIRM Zones V1 ,
r~ ' ' ~ ' ~ ~ ~
J
the selected diagram, is ~t,an'elev~tion of ' i .~_~ feet NGVD (or other FIRM datum-see Section B, Item 7).
c). FIRM Zone A (w thout BFI~),..T.h~?~?,r,,i~ed as the reference level from the selected diagram is '. i. ~ feet above _ or
below --- the':tl~j~ grade'~djacent to the building.check one)
d). FIRM Zone AD. The fl6or'~seCt'.a~'the r~ference level from the selected diagram is I [feet above i__2 or below (check
one) the h ghest grade adjacenf~t'Q,t~e 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
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/n 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.)
4. Elevation reference mark used appears on FIRM: Yes ~-~ (See Instructions on Page 4)
5. 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
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'alliance is: ~ 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 REI:~.ACES ALL PREV1OUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION