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<br /> FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
<br /> NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002
<br /> ELEVATION CERTIFICATE
<br /> Important: Read the instructions on pages 1 -7.
<br /> SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use:
<br /> BUIL ER'S NAME Policy Number
<br /> os N I R.0
<br /> BUILDING SIRE ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIL Number
<br /> _ N OOLAO LE ST W N ( A W6t tS soSTATE ZIP CODE n
<br /> CITY 1 LO V CLO L.0
<br /> PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) 1�
<br /> •1-kAV. --z—4.03-7 .1coG9
<br /> BUILDINGUSE(e. Residential, Non-residential,Addition,Accessory,etc. Use Comments section if necessary.)
<br /> I S I E .JT I-I_ u
<br /> LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: LI GPS(Type) •
<br /> ( ##°-##'-#4.11=r or #4.#####°) LI NAD 1927 (]NAD 1983 Li USGS Quad Map Li Other.
<br /> SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION
<br /> B1. NFIP COMMUNITY NAME 8 COMMUNITY NUMBER 62.COUNTY NAME B3.STATE (�1 1^ j '
<br /> - + JM t 0_GO►�-rk( i -c-1(.06:3 W MAI 1 O
<br /> B4. MAP AND PANEL 65. SUFFIX B6.FIRM INDEX B7. FIRM PANEL B8.FLOOD B9.BASE FLOOD ELEVATION(S)
<br /> NUMBER , DATE, �+ EFFECCTIVE/RIEVISED DATE ZONE(S) (Zone A+,use depthdeof flooding)
<br /> \SS(h(o - 690 - G 6+O.Z `S or base 01 68enteredinB9. 14 `O
<br /> B10. Indicate the source of the Base Flood Elevation(BFE)datadepth
<br /> 1_I FIS Profile IBJ FIRM 1_1Community Determined LI Other(Describe):
<br /> B11. Indicate the elevation datum used for the BFE in B9: I_I NGVD 1929 IBJ NAVD 1988 Li Other(Describe):
<br /> B12. Is the building located in a Coastal Barrier Resources System (CBRS)area or Otherwise Protected Area (OPA)? LI Yes ISI No
<br /> Designation Date:
<br /> SECTION C -BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
<br /> Cl. Building elevations are based on: LIConstruction Drawings' LlBuilding Under Construction' LX Finished Construction
<br /> 'A new Elevation Certificate will be required when construction of the building is complete.
<br /> C2. Building Diagram Number :5-- (Select the building diagram most similar to the building for which this certificate is being completed-see
<br /> pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
<br /> C3. Elevations-Zones Al-A30,AE, AH,A(with BFE),VE,V1-V30,V (with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO
<br /> Complete Items C3a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from
<br /> the datum used for the BFE in Section B,convert the datum to that used for the BFE. Show field measurements and datum conversion
<br /> calculation. Use the space provided or the Comments area of Section D or Section G,as appropriate, to document the datum conversion.
<br /> Datum Conversion/Comments
<br /> Elevation reference mark used SO Bi g Nl Does the elevation reference mark used appear on the FIRM? 1_1Yes IA No
<br /> ❑ a)Top of bottom floor(including basement or enclosure) 61 .; . "2- ft.(m) r
<br /> ❑ b)Top of next higher floor NA .—ft.(m) d ;
<br /> ❑ c) Bottom of lowest horizontal structural member(V zones only) �A .—ft.(m) ooJ
<br /> ❑ d)Attached garage (top of slab) (c,e0C( 0 ft.(m) w` n,,2
<br /> ❑ e) Lowest elevation of machinery and/or equipment ..a (p,(/ ..1
<br /> servicing the building (o 1-6 . 2- ft.(m) ? c�,`b,. ,/:D'..
<br /> ❑ f) Lowest adjacent grade (LAG) (col- . 0 ft.(m) 2.,g,
<br /> o g) Highest adjacent grade (HAG) 4-0(c'S O ft.(m)
<br /> o h) No. of permanent openings(flood vents)within 1 ft. above adjacent grade b
<br /> O i) Total area of all permanent openings (flood vents) in C3h 600 sq. in. (sq. cm)
<br /> SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION
<br /> This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
<br /> I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available.
<br /> iderstand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
<br /> FIER'S NAME LICENSE NUMBER
<br /> AGveo .t/c. E� ayc
<br /> TITL COMPANY NAME �t�:kE L
<br /> jp�/
<br /> C/1//L. 5N�y/•J - i�J2o,o4-e_J
<br /> A
<br /> La -7/09 C x/ei 57_ f iT Y ST E,�7
<br /> SIGN 11RE { 5TE 3 0-- C- P�16% -*9 c 1 1
<br />
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