6-9-003:006 - Laserfiche WebLink

Home

BUILDING STREET ADDRESS (including Apt, Unit, Su'da, and/or No.) OR P.O. ROUTE AND NO. CITY STATE ZIP CODE [ Company MAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agentfoompany, and (3) building owner. DMMENTS 6/22/02: The completed construction is for 2nd story addition., ❑ Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND20NE A (VATHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1 through E4. ff 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 _ ft.(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is — ft.(m) _in.(cm) above the highest adjacent grade. E4. For Zone AO only: 1f no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ 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, and E for Zone A (without a FEMA4ssued or community -issued BFE) or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE Q 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. G 1. ❑ 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.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or community4ssued BFE) or Zone A0. G3. 0 The following info m -w -ton (Items G4 -G9) is provided for community floodplain management purposes. ISSUED G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8: Elevation of as -built lowest floor (including basement) of the building is: _ft.(m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS 0 ❑ Check here if attachments FEMA Form 81-31, AUG 99 REPLACES ALL PREVIOUS EDITIONS