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the corresponding Information from Section A. I For Insurance Company Use: or State LZ Copy both sides of this Elevation Certificate for (1) community official, (2) Insurance agenUcemparly, and (3) building owner. • - - - r • 11 ' tii - - 1 - - - r - mlalslell February 21, 2007 Re] For Zones AO and A (without SFE), complete Items E1 -E5. If the Certificate is Intended to support a LOMA or LOMR-F request, complete Sections A, B. and C. For Items E1 -E4, use natural grade, If 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 the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). ❑ feet ❑ meters ❑ above or below ltx3 HAG. a) Top of bottom floor (Including basement, crawl space, or enclosure) Is b) Top of bottom floor (Including basement, crawl space, or enclosure) Is _ _ ❑ feet El meters ❑above or H below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided In SectIW Items 8 got 9 (see page 8 of Instructions), the next higher floor (elevation C2.b In the diagrams) of the building Is . _ ❑ feet U meters i above or U below the HAG. E3. Attached garage (lop of slab) is . _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building Is . _ ❑ feet ❑ 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 commuMtys floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. The property owner or owner's authorized representative who completes Sections A, B, ant E for Zone A (without a FEMA -Issued or community -Issued BFE) r Zone AO must sign here. The statements In Sections A, B, and E are eared to the best of my knowledge. onerly Owner's or Owner's Authorized Representative's Name Cfly State ZIP Code Signature Date Telephone SECTION G - COMMUNITY INFUHMA I IUM (vr n rvnN�l The local official who is authorized by law or ordinance to administer the communitys 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. Check the measurement used In Items G8. and G9. G1. ❑The Information In Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architectwho is authorized by law to certify 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 FEMA4ssued or community -Issued BFE) or Zone AO. G3. ❑ The following Information (items 64: G9.) is provided for community floodplain management purposes. G5. Date Certificate G7. This permit has been Issued for: ❑ New Construction ❑ Substantial Improvement G8. 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 site: ❑ feet ❑ meters (PR) Datum Local Official's Name - Title Community Name Telephone ❑ Check here If attachments FEMA Form 81-31, February 2006 Replaces all previous editions