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IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use:' BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number 1156 +4IALOA STRQr.:.T CITY 141Lo +4 gb�2o STATE ZIP CODE Company NAIC Number 1 , SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) py both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. —COMMENTS Li)OG67 Eovipmr.QT darmt"Ilir, Tic: 1k MLt)I#J6 iS TH-Q Oh"Tr.,z It. CAR Mg, 4TvRA-40. tZg0 , 1 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 or enclosure) of the building is 1_1_1 ft. (m)1_1_1 in. (cm) I_I above or 1_1 below (check one) the highest adjacent grade. (Use natural grade, if available.) E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is 1_I_I ft. (m) 1_I_1in. (cm) above the highest adjacent grade. Complete Items C3.h and C3.i on front of form. E4. The top of the platform of machinery and/or equipment servicing the building is 1_1�I ft. (m) IJ_j in. (cm) 1_-j above or 1_1 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 J Yes 1 J No I l 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 only), and E for Zone A (without a FEMA -issued or community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are correct to -the best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE Aft GNATURE 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 A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. I_I The information 16 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.) G2. I_1 A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. G3. 1J The following information (Items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been issued for: 1J New Construction 1_1 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: _ ft. tm) Datum: G9. BFE or (in Zone AO) deD14 g fjQeodina enbui�ldir�u$it�Cs.WOtk3 —ft. (m) Datum: LOCAL OFFICIAL'S NAME sneering ivision hcs reviewed TITLE the ilevation COMMUNITY NAME r" TELEPHONE SIGNATURE M does not recommend DATE COMMENTS final cipprovall FEMA Form 81-31, January OCT 2 D 2005 1 1 Check here if attachments Replaces all previous editions