Carter-RS021001
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FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
a.M.B. No. 3067-0077
Expires July 31, 2002
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ELEVATION CERTIFICATE
ImDortant: Read the instructions on paaes 1 - 7.
SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use:
BU~INq OWNER'S~METh Policy Number
r \ an 0 e
B5~ING STeET AD~ESS (In~ f,pt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number
0\ Qr er '\Ie
CIl(:o ( \ 4lxE I 53 ~E
PROPE~l ~SCRIPTION (lot and Block Numbe[S~IT.ax.P,arcel Number,~!ilal Descriptio~.)
LoT 1 Celt-fer Aaa 'T'l~n - r-'hase ...J..L
BUJLPING U.S~(e.g., Re,siQentiaJ, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.)
Ke5luenTIO 1
LATITUDElLONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: LI GPS (Type):
( #If - ##' - ##.##" or ##:#####") I_I NAD 1927 I_I NAD 1983 LI USGS Quad Map LI Other:__
B3.STATE
IX
84, MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S)
NUMBER E DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding)
480170 -OOlO 4-(s..q4 4-IS-Q4 X 46q.2.
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. f? 6 -r.~4 p
L-I FIS Profile I_I FIRM 1--1 Community Determined IXI Other (Describe): J:._Or~~:L~ ~_Q__=__~_____
B 11. Indicate the elevation datum used for the BFE in B9: Il(I NGVD 1929 I_I NA VD 1988 L-I Other (Describe): _______________
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? I_I Yes I~I No
Designation Date:
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: 1_IConstruction Drawings. 1~.IBuilding Under Construction. I-I Finished Construction
. A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number ~ (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 A1-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, ARiA, ARiAE, ARiA1-A30, ARiAH, ARiAO
Complete Items C3.a-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....s.Eace provided or the Comments area of Section D or Section G, as appropriate. to document the datum conversion.
Datum NGVD lq:zt.fConversion/Comm~ts
Elevation reference mark used C i:h:,.._~~O.J'~IlDoes the elevation reference mark used appear on the FIRM? L-I Yes ~I No
o a) Top of bottom floor (including basement or enclosure) ___~_"I.~___ .90ft.(m) m
o b) Top of next higher floor ___________ . ___ ft.(m) ~
o c) Bottom of lowest horizontal structural member (V zones only) _____________' ___ ft.(m) ~ ~
o d) Attached garage (top of slab) ___________ . ___ ft.(m) ~-g
o e) Lowest elevation of machinery and/or equipment ~ :
CD ~
servicing the building (Describe in a Comments area.) ____________ . ___ ft.(m) ~ ~
o f) Lowest adjacent (finished) grade (LAG) _________ . ___ ft.(m) ~ ~
o g) Highest adjacent (finished) grade (HAG) _________ . ___ ft.(m) ~
CD
o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade _______ :3
o i) Total area of all permanent openings (flood vents) in C3.h _____ sq. in. (sq. cm)
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION -Oz
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.
/ understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
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FEMA Form 81-31, JUL 00 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
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1M PO ANT: In these spaces, copy the corresponding information from Section A.
IlliJLQING ~T ADDRESS Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
~I rter- r'lVe
. CITY STATE ZIP CODE Company NAIC Number
Co It -'-X -, ,
SECTION D. SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
For Insurance Company Use:
Policy Number
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenUcompany, and (3) building owner.
COMMENTS B~ E ,'nf'orl'V"\at\on obfo"V\ed -Fn:>rY" LOHR qq -06 -7.34- P
STATE
ZIP CODE
TELEPHONE
COMMENTS
I_I Check here if attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Sections A, 8, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below.
G1. I_I The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor,
engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.)
G2. I_I A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued 8FE) or
Zone AO,
G3. L-I The following information (Items G4-G9) is provided for community floodplain management purposes.
G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY
ISSUED
G7. This permit has been issued for: I_I New Construction L-I Substantial Improvement
G8. Elevation of as-built lowest floor (including basement) of the building is:
G9. BFE or (in Zone AO) depth of flooding at the building site is:
LOCAL OFFICIAL'S NAME
. ___ ft.(m)Datum: ____________
______ . ___ ft.(m) Datum: _____________
TITLE
COMMUNITY NAME
TELEPHONE
SIGNATURE
DATE
.OMMENTS
I Check here if attachments
FEMA Form 81-31, JUL 00
REPLACES ALL PREVIOUS EDITIONS