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IMPORTANT: In these spaces, copy the corresponding Information from Section A. ) For Insurance Company Use: or State OR ARCHITECT Copy both sides of this Elevation Certificate for (1) community official, (2) Insurance agent/oomparry, and (3) building owner. Comments No Attached Garaqp One Stay Building„ Lowest Flactrural EDLinm nt — Washer /Dryer May 17, 2007 SECTION E -13UILDING ELEVATION (NFOyt'MATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT SIFE) 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 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). a) Top of bottom floor (Including basement, crawl space, or enclosure) Is _ ❑ feet ❑ meters ❑ above or❑ below the HAG. b) Top of bottom floor (including basement, crawl space, or enclosure) Is _ _ 11 feet El meters 1:1 above or ❑ below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Sectlg[LA Items 8nd/or 9 (see e 8 of Instructions), the next higher floor pal (elevation C2.b In the diagrams) of the building is . _ ❑ feet U meters above or I�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 _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only: If no flood depth number Is available, Is the lop 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 communly4ssued BFE) or Zone AO must sign here. The statements /n Sections A, B, and E are correct to the best of my knowledge. or Owner's Authorized Signature Stale 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 Ga. and Gg. 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 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 FEMA -Issued or oommuniy4ssued BFE) or Zone AO. G3. ❑ The following Information (items G4. -G9.) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G8. Date Certificate Of Compliance/Occupancy Issued 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