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DR8601-CS 890614 INSURANCE PROGRAM : FEDERAL EMERGENC~Y MANAGEMENT AGENCY NATIONAL FLOOD instructions for completing Ibis lorm can be found on the reverse BUILDING OWNER'S NAME 4/4, /-/ STREET ADDRESS POLICY NUMBER BOX NUMBER ' 'R~)uTE Apt.-A/Unit-U Suite-SIBIdg.-B / NO. OTHER DESCRIPTION (Block and lot numbers, etc.) .IC""~ ~..--~, STATE ZIP CODE CITY corn leted b a land surveyor engineer or architect who is authorized by state law to certify elevation information when the elevation lThis form is to be p y ..- ,,:- ...... ;,% ,,~- ~...~ ~// ,~, ~c~ a, ,-o~,,ir,~,'f In the case of zone AO the building official the property r nas A1A30 AE AH A w'rn cwo) vf-vou v~ ,=,u -t"'"' ~-~/ .... w ....... . .' - linformatior~.fo zo , - ' - :' '~ ( ...... "--.~ o~.~ ;%¢~r~ation in Section I and may also complete the certification. Commumty off/ctals who are owner, or me owner s represenrartve snoulu c'umH~u~ -~ ,,,,,-, -. - lauthorized by local law or ordinance to provide floodplain management information may also complete tins form. -~FCTION I BUILDING ELEVATION INFORMATION 1. Using the Flood Insurance Manual or the NFIP Flood Insurance Application--Part 2 Worksheet, indicate the proper diagram number__ 2. 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 ~'l · ::~ 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 I I I 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, a post-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: [ [{ I feet []above []below (check one) the highest grade. I [ I I feet []above []below (check one) the highest grade. I I )lfeet J~above []below (check one) the lowest grade. I l~lfeet [] 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: (In A0 Zone, use depth)ELEVATION ESTABLISHED FOR ZONE A OR ZONE V, IF AVAILABLE Elevation reference mark used appears on FIRM []Yes [~ No (See reverse side for details) SECTION III C~-R¥iFICATION sL ned b a land surveyor engineer or architect who is authorized by state law to certify elevation information when the I Th'iSe,evauonC'~rtif!ca'ti°nmrormauon !~ t°~e--?n-s[o~ zu ~ AlY-~30- , AE, AH, A/~vith, BFE),'V1-V30, VE, and V(with BEE) is required. In the case .of zo.n.e AO, the.. bulld~n.g' ' offic{aJ; ' the n r's re resentative can sign the certification. Community officials who are authorized by/ocai ~aw or orainance [o provtae Ip..rop,ert? ow~_e_r,_o_r_th_e_.o~e~. .... ~ m~v also sion the certification I certify that the information on this c,ertificate_rep_res, ent,.s my, be~ef, forts to ,nterpret I tr~hC~d°Paitaa~navmaial;ablgff/~uu~n~d;Urs~i;~;Ut~h';t"~· ~-al-s-e st~atement may be l~unishable by fine or imprisonment unoer 18 U.,..w. (Jooe, ,~ecrton CERTIFIER'S NAME TITLE SIGN The naurence agent should ettech the originel copy of the completed form to the flood Insurance policy eppllclation. The sec~,,,,~ copy should be supplied to the policyholder end the Ih rd copy retained by the egent. The tourth copy la for the Iocel community permit office, if required. THIS FORM MAY BE REPRODUCED. COMPANY NAME CITY ZIP c.. DATE PHONE 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. FEMA FORM 81-31 (10187) 593-117 (6/87) l~s form ~s to be used for PRINTED St THE STANDARD ~SGISTER COMpANY U S A OMB 3067-007 ELEVATION CERTIFICATE Exp,.Es .u. 3o,.9o FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM 1 POst-FIRM ccqstructlon ORly wnen the Dasd flood nformatlon s ava ladle for the bLiiIdlng sire al3O 2'~ Pre-FIRM buildings re. teo using Post-FIRM rules ir3structloos for oomp~etm9 this form can be fOUnD on lne reverse s~de. ~MBER t LIILDING oWN E--~-~-~A M E ~REET ADDRESS ~--~UTE ~R -pt.-AlUmt-U Suite-S/BIdg-B ~..~_..~ _ NO.