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VIPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: <br /> UILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Policy Number <br /> :ITY STATE ZIP CC Company NAIC Number <br /> SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION (CONTINUED) <br /> :opy both sides of this Elevation Certificate for(1)community official, (2)insurance agent/company,and (3)building owner. <br /> :OMMENTS <br /> I Check here if attachments • <br /> SECTION E -BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO and ZONE A(WITHOUT BFE) <br /> x Zone AO and Zone A (without BFE), complete Items El through E3. if the Elevation Certificate is intended for use as supporting <br /> formation for a LOMA or LOMR-F, Section C must be completed. <br /> 1. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed– <br /> see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) <br /> 2. The top of the bottom floor(including basement or enclosure)of the building is 1-1-1 h•(m)I_I_1in.(cm) I_I above or 1_1 below <br /> (check one) the highest adjacent grade. <br /> 3. 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 <br /> floodplain management ordinance?1_1 Yes. 1_1 No II Unknown. The local official must certify this information in Section G. <br /> SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION <br /> he property owner or owner's authorized representative who completes Sections A, B, and E for Zone A(without a FEMA-issued or <br /> ommunity-issued BFE) or Zone AO must sign here. <br /> Rl°ERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME <br /> ,D ...cSS CITY STATE ZIP CODE <br /> IGNATURE DATE TELEPHONE <br /> OMMENTS <br /> Check here if attachments <br /> SECTION G -COMMUNITY INFORMATION (OPTIONAL) <br /> e local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete <br /> ctions A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. <br /> • I I The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, <br /> engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the <br /> elevation data in the Comments area below.) <br /> I )A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE)or <br /> Zone AO. <br /> I1 The following:information(Items G4-G9) is provided for community floodplain management purposes. <br /> 4. PERM:T NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY <br /> ISSUED <br /> .This permit has been issued for: 1_I New Construction Li Substantial Improvem t <br /> . Elevation of as-built lowg�5t5u(]fil�cl�og J4Awr ?t) of the building is: a Department )� � WorksBFE or (in Zone AO) derp(`tfii�rt t ' <br /> e Engineering–6it4sCp� reviewed <br /> )CAL OFFICIAL'S NAME �� ORKS the Eie..C1i9n CC kale -and <br /> SUBMITTAL RECORD TITLE recommends <br /> DMMUNITY NAME ❑ does not recommend <br /> 1=1NO Excep ion Taken TELEPHONE <br /> c' 'URE El Revise As Noted, DATE finai approval <br /> DMMENTS DiStrF'Jute Record Copy <br /> ❑ � .�.isP As Note+, %submit --=-1 <br /> ❑ r e e 'gid, Resubmit (0,15102 <br /> Reviewe-_` . „ Date <br /> hments <br />