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BUI G STREEf,ADDRESS (Including A� Vrfk S aWBlc g. No.) OR P.O. ROUTE AND BOX NO. _ Po6iyuld CITY STATE ZIP CODE Oom'" *.' ±IAICNti b SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent1company, and (3) building owner. COMMENT fr, I�iN�� (E�i S ilttir� 1 h�i , r)✓ z�, U4 h 011_4 S�✓�� a vt h itc Lr � �l nom, - r ( . �I� ✓ �s d osQ.✓ `w'&_ ieAu )n n*—, ] ❑ Check here If attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete hems El through E4. 9 the Elevation Certificate is intended for use as supporting information fa a LOMA or LOMR-F, Section C must be eatnpleled. E1. Wilding Diagram Number_(Seled the building diagram most sirillar to the building for which this certificate is being completed – see pages 6 and 7. if no diagram accuraldy represents the building, provide a sketch or photograph.) E2. The top of the bottom floor (including basement or enclosure) d the building is _ t(m) _in.(an) ❑ above or ❑ below (check one) ttne highest adaoent grade. (Use natural grade, if available). E3. For Building Diagrams 6.8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is _ fL(m) _in,(cm) above the highest adaoent grade. Complete items C3.h and C31 on iiont of form. E4. For Zone AO only. If no flood depth number is available, is the top d the boflom floor elevated in accordance with the community's floodplain managerrrent ordnance? ❑ Yes ❑ No ❑ Unknown. The local official must ceitfy 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, C (Items C3.h and C3.i only), and E for Zone A (without a FEMA -issued or cor imnity- issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are correct to the best d my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIRCODE 1p 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 d this Elevation Certificate. Compice the applicable item(s) and sign below, G1. ❑ The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date d 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 community4ssued BFE) or Zone A0. G3. The following information (Items G4 -G9) is provided for oommunity, floodplain management purposes. G8. Elevation of as -built lowest floor (inducting basernent) d the building is: _. _fL(m) Datum: G9. BFE or (in Zone AO) depth d flooding at the building site is: — _ f4m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS ❑ Check here if attachments FEMA Form 81-31, JUL 00 REPLACES ALL PREVIOUS EDITIONS