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IMPORTANT: In those spaces, copy the corresponding Information from Section A. For Insurance Company Use: Building Street p dress (including Apt., A O L6 r Blep.�,j P.O. Route and Box Z- -o ; Ob'a Pala Number city -41 L.p - i� State ) q6 Z p ZIP Code Company NAIL Number Allis, SECTION D -SURVEYOR ENGINEER OR ARCHITECT CERTIFICATION (CONTINUED) MW Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenVcompany, and (3) building owner. Comments `fir I nh If•r-r nniuhrs-.%T r'n w.u..... �, _ .-.... - - —• _ - ks I `r- — SECTION - E •BUILDING ELEVATION N (SURVEY NOT REQUIRED) FOR ZONE AO AND 20NE A 11MTNOtn' 9FEh For Zones AO and A (without BFE), complete Items E7 -E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, S. and C. For Items E7 -E4, use natural grade, H available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation Information for the following and check the appropriate boxes to show whether the elevation Is above or below fie highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement crawl space, or enclosure) M _ feet El meters 11 above or ®Debw the FLAG. b) Top of bottom floor (Including basement, crawl space, or enclosure) is __ _ ❑ feet ❑ meters ❑ above w below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provider/ in Secllgp,A Items 8 V*or g (see pale 8 of Instructions), the next higher floor (elevation C2b in the diagrams) of the building is ❑feet LJ meters UJ above or U below the HAG. E3. Attached garage (top of slab) Is __ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is _ ❑ feel ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated In accordance with the commuNtys floodplain management ordinance? ❑ Yea ❑ No ❑ Unknown. The local official must car* this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A. B. and E for Zone A (without a FEMA issued or communhydasued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name 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. B. —C(" E), and G of this Elevation Cenifimte. Complete the applicable hem(s) and sign below. Check the measurement used In Items G8. and GO. G1. The Information In Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to cenify elevation information. (Indicate the source and date of the elevation data In the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMAdssued or commituri issued BFE) or Zone AO. G3. ❑ The following Information (Items 04.-Gg.) Is provided for community.floodptsln management purposes. G4. Permit Number G5. Date Permit Issued GB. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been Issued for: ❑ New Construction ❑ Substantial Improvement G6. Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building she: ❑ feet ❑ meters (PR) Datum Official's Name Community Name Telephone Signature Date ❑ Check hereif attachment, FEMA Form 81-31, February 2006 Replaces all previous editions