6-9-009:003 - Laserfiche WebLink

Home

IMPORTANT: In these spaces, copy the corresponding information from Section A. ) For Insurance Company Use: i h CITY '0 OR ARCHITECT Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1. through E5. If the Elevation Certificate is Intended for use as supporting Information for a LOMA or LOMR-F, Section C must be completed. E1. 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.) E2. The top of the bottom floor (including basement or enclosure) of the building is III R. (m) LLI in. (cm) LI above or LI below (check one) the highest adjacent grade. (Use natural grade, if available.) E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is L—IJ ft. (m) 1_I_1in. (cm) above the highest adjacent grade. Complete Items C3.h and C3.1 on front of form. E4. The top of the platform of machinery and/or equipment servicing the building is LLI R• (in) LIJ in. (cm) 1_J above or LI below (check one) the highest adjacent grade. (Use natural grade, if available.) E5. For Zone AO only: If no good depth number is available, is the top of the bottom floor elevated in accordance with the community's property owner or o out a FEMA -issued SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION 'esentative who completes Sections A, B. C (Items C3.h and C3.i only), and E for Zone A BFE) or Zone AO must sign here. The statements In Sections A, B, C, and E are correct to REPRESENTATIVE'S NAME SIGNATURE j // DATE 6, -r( TELEPHONE �i,� � .7C COMMENTS SECTION G - here if The local official who is authorized bylaw or ordinance to administer the community's floodplain management ordinance can complete Sections A, B. C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. IJ 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 inthe,Comments area below.) G2. LI A community official completed Section.E for a building located In Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. G3. 1_I,The following info mtation (Items G4-Gg) is provided for community floodplain management purposes. G4. PERMIT PERMIT 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 TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE —ft. (m) Datum: —ft. (m) Datum: L I Check here if attachments FEMA Form 81-31, January 2003 Replaces all previous editions