6-9-003:007 - Laserfiche WebLink

Home

IMPORTANT: In Section A. or State SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) Insurance agent/company. and (3) building owner. Comments Garage wall are not mmnlete (seehn otos) Lowest Electrical Equipment is bottom of hot water heater which is 0.2 foot from concrete slab (see photo). 1014 -7 4 Off signature Dale March 2, 2009 Check here if attachments SECTION - BUILDING ELEVA ORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items Et -E5. If the Certificate is Intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items El -E4, use natural grade, If available. Check the measurement used. In Puerto Rico only, enter meters. El. 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). a) Top of bottom floor (including basement, crawl space, or enclosure) is _ _ El feet El meters 11 above or El below the HAG. b) Top of bottom floor (including basement, crawl space, or enclosure) is _ _ ❑ feel ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided In SectigiLP Items 8 n /or 9 (see �a a 8 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is _ [:]feet �j meters above or (_I 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 community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown, The local official must certify 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 community -Issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are coned to the best of my knowfedge. Property Owner's or Owner's Authorized Representative's Name - ress City State ZIP Code Signature Date Telephone Comments ❑ 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, 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 architect who M is authorized by law to certify elevation Information. (Indicate the source and date of the elevation data In the Comments area below.) qac. " n wunnunu7 mnuai wmpmtoa oa(.11iun c mr a uusumg iuualeu in Lune A twimom a rtmm-Issues or communityissuee oht) or Lone AV. G3. ❑ The following Information (Items G4. -G9.) Is provided for community floodplain management purposes. G5. Date Permit Issued I G8. Date 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 Date FEMA form 81-31, Replaces all previous