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Parkwood-CS 890614FEDERAL EMERGENCLY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM 9 4 . This town a fo be used for 1 i Post-FIRM construction dhen the base flood information is available fog the buildmy ~ nd 21 Pre-FIRM uil ra usi ~q'Ft-1=1 r s. ~;vuctions for completing this form can be found on the reverse si BUILDING OWNER'S NAME POLICY NUMBER STREET ADDRESS Apt.-A/Unit-U Suite-S/Bldg.-B NO ROUTE BOX NUMBER OTHER DESCRIPTION (Block and lot numbers. eic l ~~°~ ~x CITY STATE ZIP CODE This form is to be completed by a land surveyor, engineer or architect who is authorized by state law to certify elevation information when the elevation in/ormation for zones Al-A30, AE, AH, A(with BFE), Vl-V30 VE and V(with BFE) is required. In the case of zone AO, the building official the property owner or the owner's representative should complete the in/ormation in Section I and may also complete the certification Community officials who are authorized by local law or ordinance to provide floodplain management information may also complete this corm SECTION I 6UILDING tLtVi4l fvly lnrvnmw I fvn 1 Using the Flood Insurance Manual or the NFIP Flood Insurance Application-Part 2 Worksheet, indicate the proper diagram number- 2 FIRM Zones A,11'-A~30,..AE, AH, and A (with BFE) The top of the reference level floor from the selected diagram is at an elevation ofd-!feet NGVD (or other datum-see #5) 3 FIRM Zones V1-V30, VE, and V (with BFE) The bottom of the lowest horizontal structural member of the reference level floor from the selected diagram is at an elevation of feet NGVD (or other datum-see #5) 4 FIRM Zone AO The floor used as the reference level from the selected diagram is L~ feet above highest natural grade next to the building (also enter in line 8) This value must be equal to or greater than the AO Zone flood depth number listed below If no flood depth number is available, is the building's lowest floor (or reference level) elevated in accordance with the community's floodplain management ordinances? ^ Yes ^ No ^ Unknown 5 Indicate the elevation datum system used in determining the above reference level elevations:~ NGVD ^ Other (describe on back) 6 Indicate the elevation datum system used on the FIRM for base flood elevations: NGVD ^Other (describe on back) (ATTENTION If the elevation datum used in measuring the elevations is different than that used on the FIRM, then the elevations provided must be converted to the datum system used on the FIRM ) 7 Is the reference level based on actual construction? Yes ^ No` ' A "No" answer is only valid if the building does not have the reference level floor in place Fill in the elevation based on construc- tion drawings and do not complete question #8 If "No" is checked, this certification will be valid only for buildings in the course of construction After construction of the reference level floor is completed, apost-construction elevation certificate will be required for continued flood insurance coverage 8. Provide the following measurements using the natural grade next to the building (round to the nearest foot) a. The reference level is' b The garage floor (if applicable) is: L~ feet ®above ^ below (check one) the highest grade L~ feet ®above ^ below (check one) the highest grade L~ feet ~ above ^ below (check one) the lowest grade L~ feet ©above ^ below (check one) the lowest grade SECTION II FLOOD INSURANCE RATE MAP INFORMATION Provide the following from the proper FIRM (see Instructions on back-Date of FIRM) and accompanying insurance application COMMUNITY NO PANEL NO SUFFIX DATE OF FIRM FIRM ZONE BA E FLOOD ELEV (In AO Zone, use depth) MMUNITV E TIMATED BASE FL000 ELEVATION ESTABLISHED FOR ZONE A OR ZONE V IF AVAILABLE Elevation reference mark used appears on FIRM U Yes l~ No (see reverse sloe ror aetallst SECTION III CERTIFICATION This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state law to certify elevation information when the elevation information for zones Al-A30, AE, AH, A(with BFE), Vf-V30, VE, and V(with BFE) is required In the case of zone AO, the building of/icial the property owner, or the owner s representative can sign the certification. Community officials who are authorized by focal law or ordinance to provide floodplain management information, may also sign the certification. I certify that the information on this certificate represents my best efforts to interpret the data available. I understand that any false statement ma be unishab/e by fine or imprisonment under 18 U.S Code, Section 1001 ~Jf~ TITLE COMPANY NAME SIGNATUR DATE PHONE The insurance agent should attach the original copy of the completed form to the flood insursntx policy application. The second copy should be supplied to the policyholder end the third copy retained by the agent. The fourth copy is for the local community permit office, If required. TYIC fWY YAV AF riFp nrfl l[`Fn FOR OPTIONAL COMMUNITY USE. Is the reference level also the lowest floor under the community's floodplain management ordinances? ^YES ^NO If NO the elevation of the lowest floor is feet NGVD 593-117 (6/871 FEMA FOAM B1 31 (10187)