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ILDING OWNER'S FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE mportant: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION S t�av � [ cp mEkj r z BUILDING STREET ADDRESS (Including Apt., Unit. Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. O.M.B. No. 3067-0077 Expires July 31, 2002 For Insurance Company Use: Policy Number ' Company NAIC Number CITYW' Lo H--1ATE Q ZIP CODE Tax Parcel Number, Legal BUILDING USE (e;g., Residential, Non-residential, Addition, Accessory, etc, Use Comments section if necessary.) Rz-s%%-e- 13 -FIA t. LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL ATOM: SOURCE: (_,_I GPS (TypeX ( ##° - ##' - ##.##" or ##. #°) I I NAD 1927 VNAD 1983 USGS Quad Map (,_,I Other. _ SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP COMMUNITY NAME & COMMUNITY NUMBER 1 82. COUNTY NAME B3. STATE Bd. MAP AND PANEL 1 B5. SUFFIX 1 66. FIRM 1NnFx' B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER pAT�' EFFECTIV /REVISED DATE ZONES) (Zone AO, use depth of flooding) 0890 C ' - 461ZI V/G ,98 141-/ 1 6Cv5- 0 810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. j_) FIS Profile 1X1 FIRM 1_1 Community Determined Lj Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: NGViD 1929 �_� NAVD 1988 (_,1 Other (Describe): 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1_J Yes ( No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Building elevations are based on: 1_1Construction Drawings' 1r1Building Under Construction` lkl'Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number _,,�7 (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, V1 -V30, 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 (1SZ S 19M Does the elevation reference mark used appear on the FIRM? 1_i Yes Dj No O a) Top of bottom floor (including basement or enclosure) O b) Top of next higher floor ' Y 1, _ _ ft.(m) O c) Bottom of lowest horizontal structural member (V zones only) /V ft.(m) o" a O d) Attached garage (top of slab) (e Z> Z ft.(m) E O e) Lowest elevation of machinery and/or equipment // % u, a servicing the building ❑ f) Lowest adjacent grade (LAG) 0/06 ft.(m) . Z�ft.(m) Z'S? O g) Highest adjacent grade (HAG) !�� 4,06: 1 ft.(m) d O h) No. of permanent openings (flood vents) within 1 ft'above adjacent grade 1D O i) Total area of all permanent opening s,(flood'vents) in C3h 3_%'LO 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. l certify that the information in -Sections A, 8, and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ��'S AME r� ./� I NNUtt�BER IT Vill - CNG/%�F/ � CON 'A�NAME GL`> /l/1c 4r�L L A°tlll p,s Box - ArYr��/ ZU 5: - ` �-�-7 / slGy 7UFiE DATE/ TELEPHONE /�/zeli� 8a — 4FI _(?