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IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: Building Street Address (inciyding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number ,-i e..P ' _ V.& ► & l N I A L 1 A ^1 r-' c -r- --t rti V _ 9 - I i, -TA CityR I �� State k Awi q ZIP Code Company NAIC Number l SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. • .r C SECTION E -BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRE15) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), 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). 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 _ ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9 (seepage 8 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is _ [:]feet [:]meters [:]above or Lbelow 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 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 correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name .ss City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) rhe 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), rnd G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8. and G9. 31. ❑ 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.) 32. ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. 33. ❑ The following information (Items G4. -G9.) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued 37. This permit has been issued for: ❑ New Construction ❑Substantial Improvement 38. Elevation of as -built lowest floor (including basement) of the building: ❑feet ED meters (PR) Datum 39. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters (PR) Datum Local Official's Name Wie Depultillunt Of Publk ftridTitle Fn-lneering Myicion has reviewed Community Name the Elevation Certificate and Telephone Signature Date final a "7 ❑ Check here if attachments Date MAR 13 20(1