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ELEVATION CERTIFICATE, page 2 IMPORTANT: In these spaces, copy the corresponding information from Section A. Su;ldirijil Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. C'tY 9672-6State ZIP Code FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number. SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) commun ty official, (2) insurance agent/company, and (3) build ng owner. L,ommenrs � S © A"I'l v Signature � � � �ry / Date SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR IONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items EI -E5. If the Certificate is 'ntended to support a LOMA or LOMR-F request, complete Sections A, B,and C. For Items El -E4, use natural grade, if available. Check the measurement used. In Puerto R'co only, enter meters. El. Provide elevation information for the follow.ng and check the appropriate boxes to show whether the elevatio^ 's above or below the h'ghest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawispace, or enclosure) s ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawispace, or enc,osure .s ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided n Section A Items 8 and/or 9 (see pages 8-9 of Instructions), the next h gher floor (elevation C2.b in the d-agrams) of the bu"d ng s ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equ'pment servicing the bu.iding is ❑ 'eet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only: If no flood depth number is ava•lable, s the top of the bottom floor elevated in accordance Wth the commun'ty's foodplain manageme-_ ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify th.s information in Sect'on 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 FEMAgssued or community4ssued BFE) or Zone AO must sign here. The statements in Sections A, 8, and E are correct to the best of my knowledge. Property er or Owner's Authonzp4 R entative's Name Address ❑ Check mere if attachments. SECTION G — COMMUNITY INFORMATION (OPTIONAL) The loca official who is authorized by iaw or ord -ance to administer the community's floodplain - management ordinance can complete Sections A, B, C (or E), and G of th s Elevation Certificate. Complete the appl'cable item(s) and sign below. Check the measurement used in items G8 -G10. in Puerto Rico only. enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyof, engineer, or architect who is authorized by law to cert fy e:evation informat on. (Ind cate the source and date of the elevation data :n the Comments area below.) G2. ❑ A community official completed Sect on E for a build ng located ;n Zone A (without a FEMAissued or commun;ty-iss ed BFE) or Zone A0. G3. ❑ The following information (Items G4 -G10) s provided for community floodp:&n management purposes. G4. Permit Number G5. Date PermA Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. Th's perm t has been issued for: ❑ New Construction ❑ Substantial improvement G8. Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters Datum G9. BFE or (in Zone AO) depth of floov�g, at a building site: ❑feet ❑ meters Datum G10. Community's des;gn flood elevatioli`.'e 6epartment of Publics o ks ❑feet ❑ meters Datum T'r .C• vocal Official's Name Engincegthe Ele•- ,::t;on Certificate and Title Community Name R recomir :ends Telephone Sgnature LI docs not I'600MITIenCil Date Comments H lei! approval MAY 0 7 2014 ❑ Check here if attachments. FEMA Form 086.0-33 (Revised 7/12) Replaces all previous editions.