|
ELEVATION CERTIFICATE
<br />FEDERAL EMERGENCY MANAGEMENT AGENCY
<br />NATIONAL FLOOD INSURANCE PROGRAM
<br />ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to
<br />provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to
<br />determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or
<br />Instructions for completing this form can be found on the following pages.
<br />SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE
<br />BUILDING OWNER'S NAME POLICY NUMBER
<br />W►LL�A'M A.. Cs�sHA�ol� G. ���
<br />STREET ADDRESS (Including Apt., Unit. Suite andlor Bldg. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY MAIC NUMBER
<br />AL -APA l VolOT ROAD
<br />OTHER DESCRIPTION (Lot and Block Numbers, etc.)
<br />L0T 1 11 KA?bHC7 1)tNC," L0TS rALAFAI ?OWT) Tru_ Z
<br />CITY STATE ZIP CODE
<br />TAt-}oIA%
<br />SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
<br />Provide the following from the proper FiRM (See Instructions):
<br />7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): [?INGVO '29 ❑ Other (describe on back)`
<br />8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate
<br />the community's BFE: ! i ! ! ! !.0 feet NGVD (or other FIRM datum -see Section B, Item 7).
<br />SECTION C BUILDING ELEVATION INFORMATION
<br />1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
<br />describes the subject building's reference level --S
<br />a). FIRM Zones Al -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
<br />of ! I I i I I IJ feet NGVD (or other FIRM datum -see Section B, Item 7).
<br />(b). FIRM Zones V1430, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from
<br />the selected diagram, is at an elevation of ! ! I It IgI.LoI feet NGVD (or other FIRM datum -see Section B, item 7).
<br />(c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is I_ I ).0 feet above ❑ or
<br />below ❑ (check one) the highest grade adjacent to the building.
<br />(d). FIRM Zone AO. The floor used as the reference level from the selected diagram is t I LLJ feet above ❑ or below ❑ (check
<br />one) the highest grade adjacent to the building. if no flood depth number is available, is the building's lowest floor (reference
<br />level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown
<br />3. Indicate the elevation datum system used in determining the above reference level elevations: 9 NGVD '29 ❑ Other (describe
<br />under Comments on Page 2). (NOTE: if the elevation datum used in measuring the elevations is different than that used on
<br />the FIRM (see Section B, Item 7], then convert the elevations to the datum system used on the FiRM and show the conversion
<br />equation under Comments on Page 2.)
<br />4. Elevation reference mark used appears on FIRM: ❑ Yes 9 N (See Instructions on Page 4)
<br />5. The reference level elevation is based on: Rf actual construction ❑ construction drawings
<br />(NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which
<br />case this certificate will only be valid for the building during the course of construction. A post -construction Elevation Certificate
<br />will be required once construction is complete.)
<br />6. The elevation of the lowest grade immediately adjacent to the building is: I ! !�!.0 feet NGVD (or other FIRM datum -see
<br />Section E, Item 7).
<br />SECTION D COMMUNITY INFORMATION
<br />1. if the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
<br />Onot the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest
<br />cr' as defined by the ordinance is: 1 1 i ! ! I.LJ feet NGVD (or other FIRM datum -see Section B, Item 7).
<br />2. Date of the start of construction or substantial improvement
<br />FEMA Form fit -31, MAY 90 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATiON
<br />t. COMMUNITY NUMBER
<br />2. PANEL NUMBER.
<br />3. SUFFIX
<br />4. DATE OF FIRM INDEX
<br />5. FIRM ZONE
<br />6. BASE FLOOD ELEVATION
<br />Y�
<br />tin AO zones, use depth)
<br />)G
<br />7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): [?INGVO '29 ❑ Other (describe on back)`
<br />8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate
<br />the community's BFE: ! i ! ! ! !.0 feet NGVD (or other FIRM datum -see Section B, Item 7).
<br />SECTION C BUILDING ELEVATION INFORMATION
<br />1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
<br />describes the subject building's reference level --S
<br />a). FIRM Zones Al -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
<br />of ! I I i I I IJ feet NGVD (or other FIRM datum -see Section B, Item 7).
<br />(b). FIRM Zones V1430, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from
<br />the selected diagram, is at an elevation of ! ! I It IgI.LoI feet NGVD (or other FIRM datum -see Section B, item 7).
<br />(c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is I_ I ).0 feet above ❑ or
<br />below ❑ (check one) the highest grade adjacent to the building.
<br />(d). FIRM Zone AO. The floor used as the reference level from the selected diagram is t I LLJ feet above ❑ or below ❑ (check
<br />one) the highest grade adjacent to the building. if no flood depth number is available, is the building's lowest floor (reference
<br />level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown
<br />3. Indicate the elevation datum system used in determining the above reference level elevations: 9 NGVD '29 ❑ Other (describe
<br />under Comments on Page 2). (NOTE: if the elevation datum used in measuring the elevations is different than that used on
<br />the FIRM (see Section B, Item 7], then convert the elevations to the datum system used on the FiRM and show the conversion
<br />equation under Comments on Page 2.)
<br />4. Elevation reference mark used appears on FIRM: ❑ Yes 9 N (See Instructions on Page 4)
<br />5. The reference level elevation is based on: Rf actual construction ❑ construction drawings
<br />(NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which
<br />case this certificate will only be valid for the building during the course of construction. A post -construction Elevation Certificate
<br />will be required once construction is complete.)
<br />6. The elevation of the lowest grade immediately adjacent to the building is: I ! !�!.0 feet NGVD (or other FIRM datum -see
<br />Section E, Item 7).
<br />SECTION D COMMUNITY INFORMATION
<br />1. if the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
<br />Onot the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest
<br />cr' as defined by the ordinance is: 1 1 i ! ! I.LJ feet NGVD (or other FIRM datum -see Section B, Item 7).
<br />2. Date of the start of construction or substantial improvement
<br />FEMA Form fit -31, MAY 90 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATiON
<br />
|