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U.S. DEPARTMENT GF HOMELAND SECURITY
<br />Federal Emergency. fd;anagement Agency
<br />National Flood Insurance Program
<br />ELEVATION CERTIFICATE
<br />Important: Read the instructions on pages 1-8.
<br />OMB No. 1660-0008
<br />Expires February 28. 2009
<br />t
<br />SECTION A - PROPERTY INFORMATION For Insurance Company Use:
<br />Al. Building Owner's Name '.!-�2cd Policy Number
<br />*-Buiidin Street Address (including Apt., Unit, Suite, and/or Bid . No.) or P.O. Route and Box No. Company NAIC Number
<br />0(5(o
<br />City Nuc E) State u ZIP Code Q G-7 2-f) fl
<br />A3. Property Description(Lol and Block Numbers, Tax Parcel Number, Legal Description, etc.)
<br />fiM(c: { 3 • 2 •� • :073 17'9
<br />A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) r�C,,��llJ�tV tF11..
<br />A5. Latitude/Longitude: Lat. ��?�.S r� h� Long. �. e -J f4 - Horizontal Datum: ❑ NAD 1927 'M NAD 1983
<br />A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
<br />A7. Building Diagram Number
<br />A8. For a building with a crawl space or enclosure(s), provide: A9. For a building with an attached garage, provide:
<br />a) Square footage of crawl space or enclosure(s) sq ft a) Square footage of attached garage NAL sq ft
<br />b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage
<br />enclosure(s) walls within 1.0 foot above adjacent grade walls within 1.0 foot above adjacent grade
<br />c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b tJ& sq in
<br />SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
<br />61. NFP Community Name & Community NumberB2. County ame B3. State
<br />ripiOCO A1'at • CAU l-'tAWA��
<br />B4. Map/Panel Number
<br />B5. Suffoc
<br />B6. FIRM Index
<br />B7. FIRM Panel
<br />B8. Flood
<br />B9. Base Flood Elevation(s) (Zone
<br />meters (Puerto Rico only)
<br />c) Bottom of the lowest horizontal structural member (V Zones only)
<br />Date
<br />Effective/Revised Date
<br />Zone(s)
<br />AO, use base flood depth)
<br />4P& • p 88J5
<br />(f/
<br />�f• o O
<br />Co
<br />�i
<br />2 .4
<br />910. Indicate the source of the Base Flood Elevat on (BFB) data or base flood depth entered in Item B9.
<br />❑ FIS Profile EZFIRM ❑ Community Determined ❑ Other (Describe)
<br />B11. Indicate elevation datum used for BFE in Item 139: gNGVD 1929 ❑ NAVD 1988 ❑ Other (Describe)
<br />B12. Is the building locatedin a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? F1Yes � No
<br />Designation Date W A,- ❑ CBRS ❑ OPA
<br />SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
<br />Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* 19 Finished Construction
<br />*A new Elevation Certificate will be required when construction of the building is complete.
<br />C2. 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. Complete Items C2.a-g
<br />below according to the building diagram specified in Item A7.
<br />Benchmark Utilized 'lG IS -L ) hW 9F-IZ. 1 &JX Vertical Datum \(I� I Ca(O�J l42(D
<br />Conversion/Comments
<br />SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
<br />This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation
<br />information. I certify that the information on this Certificate represents my best efforts to interpret the data available.
<br />I understand that any false statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
<br />Check here if comments are provided on back of form.
<br />Certifler's Name 1> ` ,(b t-5 - Gk�10� , A,A License Number /i „� -7 { , Q
<br />Company Name.
<br />LICENSEDO
<br />ALPROFES$E
<br />:fC8ITECT
<br />Abdress' O• 123 City 5tate ZIP Coder
<br />Signa Date C t Telephone -( �'� ��•
<br />Check the measurement used.
<br />a) Top of bottom floor (including basement, crawl space, or enclosure floor)�R] feet
<br />�.�®
<br />Elmeters (Puerto Rico only)
<br />❑
<br />b) Top of the next higher floor
<br />feet
<br />meters (Puerto Rico only)
<br />c) Bottom of the lowest horizontal structural member (V Zones only)
<br />feet
<br />❑ meters (Puerto Rico only)
<br />d) Attached garage (top of slab)
<br />_❑ feet
<br />❑ meters (Puerto Rico only)
<br />e) Lowest elevation of machinery or equipment servicing the building
<br />!9-1 ._® feet
<br />❑ meters (Puerto Rico only)
<br />(Describe type of equipment in Comments)
<br />f) Lowest adjacent (finished) grade (LAG)
<br />!4 feet
<br />❑ meters (Puerto Rico only)
<br />g) Highest adjacent (finished) grade (HAG)
<br />-2-0 . 15_M feet
<br />❑ meters (Puerto Rico only)
<br />SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
<br />This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation
<br />information. I certify that the information on this Certificate represents my best efforts to interpret the data available.
<br />I understand that any false statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
<br />Check here if comments are provided on back of form.
<br />Certifler's Name 1> ` ,(b t-5 - Gk�10� , A,A License Number /i „� -7 { , Q
<br />Company Name.
<br />LICENSEDO
<br />ALPROFES$E
<br />:fC8ITECT
<br />Abdress' O• 123 City 5tate ZIP Coder
<br />Signa Date C t Telephone -( �'� ��•
<br />
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