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• <br /> IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: <br /> 'BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Policy Number <br /> CITY STATE ZIP CC' Company NAIC Number <br /> e Department of Public Works <br /> I ggineering LvisiEdPON OVJ akiEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) <br /> te <br /> C 1,4 rpc <br /> •= •th sides o i it Et� ��i irate for(1)community official,(2)insurance agent/company,and(3)building owner. <br /> C"• EN <br /> I cioSes not recommend <br /> final approval <br /> • <br /> sy <br /> Date 47 00 <br /> I I Check here if attachments <br /> SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO and ZONE A(WITHOUT BFE) <br /> 'or 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 l ft(m)l ) lin.(cm) LJ above or L 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?i_1 Yes' 1_.f No 11 Unknown. The local official must certify this information in Section G. <br /> SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION <br /> rhe 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 /> 'P" 'ERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME <br /> ‘DLrtESS CITY STATE ZIP CODE <br /> ;IGNATURE • DATE TELEPHONE <br /> :OMMENTS <br /> I_1 Check here if attachments <br /> SECTION G-COMMUNITY INFORMATION(OPTIONAL) <br /> e local official who ti'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 /> . 1_1 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 /> L1 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 /> .I I The following information(Items G4-G9)is provided for community floodplain management purposes. <br /> 4.PERMIT NUMBER , G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEJOCCUPANCY <br /> ISSUED <br /> .This permit has been issued for: l I New Construction Li Substantial Improvement <br /> . Elevation of as-built lowest floor(including basement)of the building is: _ft.(m)Datum: <br /> . BFE or(in Zone AO)depth of flooding at the building site is: ft.(m)Datum: <br /> )CAL OFFICIAL'S NAME TITLE <br /> IMMUNITY NAME TELEPHONE <br /> 3r'•TURF DATE <br /> • <br /> )rw...cNTS <br /> .1 J Check here if attachments <br />