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FEDERAL EMERGENCY MANAGEMENT AGENCY O:M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 ELEVATION CERTIFICATE Ask Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number SoU7"Sia :T SLES t7�V ZOt�u t 7T" =rV(Z- BUIL' qING STREET ADDRESS (including Apt., Unit, uile, and/or Bldg. No.) OR P.O. ROUTE D BOX NO. Company NA1C Number rt o©LA4 L� S~; A 1,6,K His su .D CITY SKZIP CODE E q( -I � BUIWING USE(e-g-, Residential. Non-residential. Addition, Accessory, etc. Use Comments section if necessary.) LATITUDE//LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: LI GPS (Type) ( #it' - ##'. #13.##' or ##.#####0) LI NAD 1927 W NAD 1983 LI USGS Quad Map (AI Other. iJ SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFIP COMMUNITY NAME b COMMUNITY NUMBER B2. COUNTY NAME B3. STATE B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER1E EFFEC IVE/REVISED DATE ZONE(S) (Zone A0, use depth of flooding) tSs)�(� a� o C 6 2 Qs' )(01 141 ,0 B10. Indicate the source of the Base Flood Elevation (BFE) data or batse flood depth entered in 89. L.) FIS Profile jy FIRM L) Community Determined LJ Other (Describe): 811. Indicate the elevation datum used for the BFE in B9: [,*-A NGVD 1929 LJ NAVD 1988 "Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? I[ Yes "No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUI C1. Building elevations are based on: Ir{Construction Drawings' LJBuilding Under Construction' L,XIFinished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number �_ (Select the building diagram most similar to the building for which this certificate is being completed -see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations – Zones Al -A30, AE, AH, A (with BFE), VE, V1430, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO Complete Items C3a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B. convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G. as appropriate, to document the datum conversion. Datum Conversion/Comments Elevation reference mark used US& S R., LA Does the elevation reference mark used appear on the FIRM? I_j Yes [fig No 10 a) Top of bottom floor (including basement or enclosure) ��1� o ft.(m) a O b) Top of next higher floor AJA = fL(m) O c) Bottom of lowest horizontal structural member (V zones only) ft.(m) " O O d) Attached garage (top of stab) -�g ft (m) ' o O e) Lowest elevation of machinery and/or equipment �p , servicing the building % fL(m) O i) Lowest adjacent grade (LAG) , 3 — fL(m) z' iz I-lj- O g) Highest adjacent grade (HAG) -6 —6 `fL(m) O h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade O i) Total area of all permanent openings (flood vents) in C3h 0030 sq. in. (sq. cm) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION. . This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information in Sections A, 8, and C on this certificate represents my best efforts to interpret the data available. understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ERTIFIER'S NAME , I _ I LlPi M;E,y JMBEJR 0. `r✓ l tJ ) L �N bt l KJ 2_ SA LLS lU M GLFL . P E . A IV' i 0 KA L %U 0 S7- TM Z .CQDE SIGNE .TELEJJ•1ONF, _