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IMPORTANT: In these spaces, copy the corresponding information from Section A. I. For insurance Company Use: Apt., Unit, Suite, and/or Bldg. No.) OR P.O. RO STATE ZIP CODE SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) y both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. MMENTS I _I 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 Items E1. through E5. If the Elevation Certificate is intended -for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. 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.) E2. The top of the bottom floor (including basement.orenclosure) of the building is I I 1 -ft. (m) I I . I in. {cm) L- above or LI below (check one) the highest -adjacent -grade. (Use -natural grade, If available.) E3. For Building Diagrams 6-8 with openings (see page T), the next higher floor or -elevated floor (elevation°.b) of the building is I I 11. (m)_I I lin. (cm) above :the highest.adjacent.grade. Complete items C3.h.and C3.i-oni ont of -form. E4. The top of the. platform of machinery and/or equipment servicing the building is I I I ft. (m) l I I in. (cm)" above or LJ below (check one) the highest adjacent:grade. (Use natural grade, if -available.) E5. For Zone AO only. If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's _ floodplain management ordinance? I I Yes I I .No .I I Unknown. The local official must certify 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.oniy), and -E for Zone A (without a FEMA -issued or community -issued BFE) or Zone AO must sign here. The statements in Sections A, A C, and E are comact-to the best of my knoMedg�_ PROPERTY OWNER'S.OR OWNER'S AUTHORIZED REPRESENTATIVES NAME ,ADDRESS CITY - STATE ZJP CODE. ATURE DATE TELEPHONE COMMENTS I—I 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., B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. 31. Ll 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 of the elevation data in the Comments area below.)_ 32. LI A community official con. pleted'Section E for a building located in Zone A (without a -FEMA -issued orcommunity-issued'BFE) or Zone AU. 33. L_1 The following information (Items G4 -G9) is provided,for community floodplain management purposes. G4. PERMIT NUMf3F R• G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED ;7. This permit has been issued for: �_I New Construction I_I Substantial Improvement �8. Elevation of as -built lowest floor (including basement) of the building is: —ft. (m) Datum: ;9: BFE or (in Zone AO) depth of flooding at the building site is: _ ft. (m) Datum: The Departmenf of Ptrhlir Wake LOCAL OFFICIAL'S NAME Engineering Division has reviewed TITLE COMMUNITY NAME f e Elevation Certificate cnd TELEPHONE SIGNATURE recorrirnes,dz DATE floes not re,corr mencl COMMENTS final approval Q.. C1 (244 04 1 1 Check here if =MA Form 81-31, January 2tSt5Ve ``' Replaces all previous editions