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,NOV-.06-2002 09:23 FROM: lU:y61tfy5S FQ RAL EMERGENCY MANAGEMENT AG NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important: Read the instructions on pages 7 - 7. H. OUJ/003 O.M.B. No. 3067-0077 Expires July 31, 2002 SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDINUOVM ER•S NAME L� Policy Number aA �✓ i. w:l 11 i t�% BUl QING STREET ADDRESS (Including Apt., Unit, Suite, andlor Bldg, No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number Q o L- ku �LE A FK- A u T- SL P, CITY STATE ZIP CODE ( W - ff -#a.=" or ,etc. Use HORIZONTAL DATUM SOURCE: LJ GPS (Type) _ LJ NAD 1927 to NAD 1983 )„J USGS Qued Map U Other SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFIP COMMUNITY NAME 8 COMMUNITY NUMBERBZ. COUNTY NAME 83. STATE t"41�w0'Ct1 i 5' {'�h (l) t l r of-t'T Hj- -t.134► ( I 84, MAP AND PANEL B5. $UFFI 86. FIRM INDEX 07. FIRM -PANEL B8, FLOOD 89. BASE FLOOD ELEVATION($) NUMBER 1 LjA� EFFECT E1R[ ED DATE i .� ZONE ) i (Zone A0, use depth of hooding) 47•D 810. Indicate the source of the Base Flood Elevation (8FE) data or base ilo d depth entered in 89. LJ FIS Profile i/ FIRM "Community Determined L. --I Other (Describe): 811, Indicate the elevation datum used for the BFI" in B9; I.A NGVD '1929 LJ NAVO 1988 U Other (Describe): 617. Is the building located in a Coastal Barrier Resources System (CBRS) area or 0(herwise Protected Area (OPA)7 LJ Yes 041 No Designation Dale: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: L_JConstruction Drawings' I_jBuilding Under Construction' IXFtnished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number ,5' (Select the building diagram most similar to the building for which this certificate is being completod - 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 BFI:), VE, V1 -V30, V (with BFI:), AR, ARIA, AR1AE, Aft/A1-A30, AR/AH, AR/AO Complete items C3a-1 below according to the building diagram specified in Item C2. Stale the datum used. If the datum is different from the datum used for the 8FE in Section 8, convert the datum to that used for the SFE. Show Geld measurements and datum conversion calculation. Use the space provided or the Comments area of Section Q or Section G, as appropriate, to document the datum convorsion. Datum Conversion/Comments Elevation reference mark vsedQS4S 8,6 Does the elevation reference mark used appear on the FIRM? J,,,J Yes LN No 0 a) Top of bottom floor (including basement or enclosure) <J 1 ft,(m) w 0 b) Top of next higher floor A44, ft.(m) & _ O C) Bottom of lowest horizontal structural member (V zones only) 32Nl4 ft.(m) „o +� ��• Y - '�•-. 0 d) Attached garage (top of stab) 0 e) Lowest elevation of machinery and/or equipment servicing the building �/ Z ft.(m) 2 0 0 lowest adjacent grade (LAG) � � • _ fQm) Q g) Highest adjacent grade (HAG) fL(m) _ b H + rS`1, s� O h) No, of permanent openings (flood vents) within 1 ft. above adjacent grade 6. C1 i) Total area of all permanent.openings.(fiood vents) in C3h tS%s sq, in. (sq. cm) SECTION 0 - 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 certi0calo represents my best efforts to interpret the data available. 1 understand that any false statement may beunishable by fine or im risonmonl under 18 U.S. Code, Section 1001. CE"FIER'S NAME LICENSE UMBER !►!iL �c/friy � i�n.v�r .!� .t&-4- Apj� SS / U�CI� r A/Mv STA 2;R DATE TELEPHONE f CCUA C-,-. 0CA4 AI Ifl-- W .__ CCC OCUCOCC CHIC CAA I A1L1TFAu IAT1A1.1 nrnl A^e- •I I nne-%11^1let Lv-