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FEDERAL EMERGENCY MANAGEMENT AGENCY <br />NATIONAL FLOOD INSURANCE PROGRAM <br />ELEVATION CERTIFICATE <br />A - PROPERTY OWNER INFORMATION <br />O.M.B. No. 3067-0077 <br />Expires December 31, 2005 <br />For Insurance Company Use: <br />�, nuunraa pncruamg qpt, mt, Suite, and/or Bldg. No.) OR P. ROUTE AND BOX NO. Company NAIC Number <br />_ IVavinA(�Y► MA '7 <br />LA)AMo1gCA- <br />CITY , STATE <br />area, <br />or ##.###Wi IJ NAD 1927 . LI,NAD 1983 SOURCE: - LI GPS (Type): <br />Lj USGS Quad Map IJ geher <br />NUMBERDATE <br />5166 067 4/02/(1 <br />(tone AO us depth of Hooding) <br />B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. v lr cc7 <br />1-1 FIS Profile I j FIRM I_I Community Determined I_I Other (Describe): <br />B11. Indicate the elevation datum used for the BFE In B9:124j NGVD 1929 NAVD 1988 IJ Other (Describek <br />B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or OtherwiseProtected Area (OPA)? LYes No <br />Date: <br />SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) <br />Building elevaticnsrare based on: L_IConstruction Drawings* r <br />9 "Building Is Under Construction Finished Construction <br />'A new Elevation Certificate will be required when construction of the building is complete. <br />C2. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed - see <br />pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) <br />C3. Elevations -Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR-, AR/A, ARAE, AR/A1-A30, AR/AH, AR/AO <br />Complete Items C3.s-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from <br />the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion <br />calculation. Use the space provided or, the Comments area of Section D or Section G, as appropriate, to document the datum conversion. <br />Datum Converslon/Comgxents <br />Elevation reference mark use.Does the elevation reference mark used appear on the FIRM? I_I Yes I No <br />❑ a) Top of bottom floor (Including basement or enclosure) _ ft,( m) <br />❑ b) Top of next higher floor — N a,P6 G• PITT? <br />fl (m) <br />❑ c) Bottom of lowest horizontal structural member (V zones only)_� 1 q �0 <br />❑ d) Attached garage (top of slab) — _ ft (m) .8 ti LICENSED y <br />❑ e) Lowest elevation of machinery and/or equipment w PriOFESSIONAL <br />m* <br />servicing the building (Describe in a Comments area.) LAND <br />-- ft.(m) a � SLIR1/E`tOR <br />O Q Lowest adjacent (finished) grade (LAG) - ; 53ft.(m) i <br />❑tjf Na 10743 <br />g) Highest adjacent (finished) grade (HAG) SL ft.(m) <br />❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade - <br />❑ 1) Total area of all permanent openings (flood vents) in C3.h — sq. in. (sq. cm) wq I U 5 <br />ar <br />ARCHITECT - <br />This certification Is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. <br />l certify that the information in Sections A, B, and C on this Certificate represents my best efforts to interpret the data available. <br />I understand that any false statamant may ha k„ A-- <br />[ <br />.. <br />t (n 0 AA A� V I-'Aif /Su:� LIUbNSE NUMBER i�%O , 1 G 7 4� <br />MKE <br />SS Y/ <br />FEMA Form 81-31, <br />.: DATE TELE HONFi,;>,_-. <br />See reverse side for <br />all <br />