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FEDERAL EMERGENCY MANAGEMENT AGENCY
<br />O.M.B. No. 3067-0077
<br />, NATIONAL FLOOD INSURANCE PROGRAM
<br />Expires July 31, 2002
<br />ELEVATION CERTIFICATE
<br />Important: Read the instructions on pages 1 - 7.
<br />85. SUFFIX
<br />B6. FIRM INDEX
<br />DATEt,t-AA9
<br />SECTION A - PROPERTY OWNER INFORMATION
<br />For Insurance Company Use:
<br />89. BASE FLOOD ELEVATION(S)
<br />(Zone A use deoth of flooding)
<br />,�03, o
<br />ILDI QVVN R , iaO;�5 n ` ^ n�
<br />Policy Number
<br />BUIL DI G ST EET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO,
<br />02 �,gULu�'S � � �P � S'T` w�/�,r/2F�41 A/l sir
<br />Company NAIC Number
<br />.
<br />CITY/ / /+� STATE
<br />!"'� �/w AT
<br />.°le Depart �f7 u tc Wor
<br />n y' =�---h0` review
<br />PROPERTYD SCRIPTION Lt and Block Numbers Tax Parcel Number, Legal Description, etc.)
<br />?3% -2 -. - D37 .• % 4
<br />the Elevation Certificate and
<br />BUILD G SE e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.)
<br />%� /•ta- CI
<br />reeommen s
<br />LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: LI GPS (Type]
<br />n 4 ,—q not racnmmend
<br />-
<br />( W. 94.9--' or L) NAD 1927 IN NAD 1983 L_J USGS Quad Map
<br />O
<br />SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
<br />y
<br />BI. NFIP COMMUNITY NAME d COMMUNITY NUMBER
<br />WT' /kl( C000+
<br />J B2. COUNTY NAME
<br />B3. STATE
<br />84. MAP AND PANEL
<br />NUMBER
<br />,Ss i G(' - a9U
<br />85. SUFFIX
<br />B6. FIRM INDEX
<br />DATEt,t-AA9
<br />B7. FIRM PANEL
<br />EFFECTIVE/R VISED DATE
<br />1(p 88
<br />88. FLOOD
<br />ZONE(S)
<br />N
<br />89. BASE FLOOD ELEVATION(S)
<br />(Zone A use deoth of flooding)
<br />,�03, o
<br />810. Indicate the source of the Base t -I000 tievauon tort) oata or base 11000 cepth entereo in bV.
<br />j_i FIS Profile )A FIRM 1_1 Community Determined I I Other (Describe):
<br />611. Indicate the elevation datum used for the BFE in 89: IJ NGVD 1929 W NAVD 1988 L_1 Other (Describe):
<br />B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? )J Yes Q�j No
<br />Designation Date:
<br />SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
<br />wilding elevations are based on: (_iConslruction Drawings' 1JBuilding Under Construction' 1XIFinished Construction
<br />'A new Elevation Certificate will be required when construction of the building Is complete.
<br />C2. Building Diagram Number .5- (Select the building diagram most similar to the building for which this certificate is being completed - see
<br />pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
<br />C3. Elevations - Zones Al -A30, AE, AH, A (with BFE), VE, V1430, V (with BFE), AR, AR/A, AR/AE, AR1A1-A30, AR/AH, AR/AO
<br />Complete Items C3a-t below according to the building diagram specified in Item C2. Slate the datum used. If the datum is different from
<br />the datum used for the BFE in Section 8, convert the datum to that used for the BFE. Show field measurements and datum conversion
<br />calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion.
<br />Datum Conversion/Comments
<br />Elevation reference mark used S0130- Q1,( Does the elevation reference mark used appear on the FIRM? (_i Ye No
<br />O a) Top of bottom floor (including basement or enclosure)
<br />O b) Top of next higher floor �✓ — ft. (m) -
<br />O c) Bottom of lowest horizontal structural member (V zones only) A/74ft.
<br />_
<br />O d) Attached garage (top of slab) �J2 . � ft. (m) E g
<br />O e) Lowest elevation of machinery and/or equipment /
<br />servicing the building <O,0'3 9 ft.(m) 7
<br />O f) Lowest adjacent grade (LAG) fI.(m) z N P
<br />O g) Highest adjacent grade (HAG) /02 fl.(m)
<br />O h) No. of permanent openings (flood vents) within 1 ft. above adjacen grade�z—
<br />O i) Total area of all permanent openings (flood vents) in C3h ��L7 sq. in. (sq. cm)
<br />SECTION 0 - 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 information.
<br />I certify that the information in Sections A, 8, and C on this cerfificale represents my best efforts to interpret the data available.
<br />I erstand�that any false statement may be punishable.by fine orimprisonment under 18 U.S. Code, Section 1001.
<br />.(/.E! KCL.E�UMBER
<br />TI LE' UU ANT NAMt
<br />i l�/� CNS /�JE��E' 0- U.4 Gz) �L //C.�
<br />AD ES xw6 S7A� P CODE
<br />SI RE % Xlr"rl `7,EL�EPH�NfE r–� Ie -1 , .
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