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• IMPORTANT: In these spaces,copy the corresponding information from Section A. For Insurance Company Use: # Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number City State ZIP Code Company NAIC Number SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) t...opy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner. Comments e� Vv �-Lo GR,¢,v-o• Poo� . i s le ' OM, vi//77R c-A,¢(,/z x is'J o pevYiAe6 s Cz 2•s � 642nd-a S/p,As /94 w o -7Wo //Z SX/O ®Po 4 NGS a AG / (7:07s9 z• rva i) Signature �c Date /Q/7 ❑ Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) Fir Zones AO and A(without BFE),complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, For!teras El-E4. if ��.._�.`•. v..�N..0 �,..c oo...__,G.-, val'iv RIW viny,CIILCI iiieters. _. El....___Provide_elemation_information_forthe.following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the sourest adjacent grade(LAG). a)Top of bottom floor(including basement,crawl space,or enclosure)is ❑feet 0 meters 0 above or 0 below the HAG. b)Top of bottom floor(including basement,crawl space,or enclosure)is . ❑feet 0 meters 0 above or ❑below the LAG. E2. For Building Diagrams 6-8 with permanent flood•openings provided in Sectio0 Items 8 and/or 9(see age 8 of Instructions),the next higher floor (elevation C2.b in the diagrams)of the building Is ._0 feet U meters 0 above or U below the HAG. E3. Attached garage(top of slab)is ❑feet 0 meters ❑above or n below the HAG. E4. •Top of platform of machinery and/or equipment servicing the building is _❑feet ❑meters 0 above or ❑below the HAG. E5. Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? 0 Yes 0 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 FEMA-issued or community-issued BFE) or Zone-AO must sign here. The statements in Sections A,B,and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name 'ss City State ZIP Code Signature Date Telephone Comments • LJ Check here if attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) fhe 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). Ind G of this Elevation Certificate. Complete the applicable item(s)and sign below. Check the measurement used in Items G8.and G9. 31. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) 32. 0 A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. 33. 0 The following information(Items G4.-G9.)is provided for community floodplain management purposes. G4.Permit Number G5. pate Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued 97.This permit has been issued fon 0 New Construction 0 Substantial Improvement i8.Elevation of as-built lowest floor(including basement)of the building: 0 feet 0 meters(PR) Datum ;9.BFE or(in Zone AO)depth of flooding at the building site: 0 feet 0 meters(PR) Datum Local Official's Name Th. Department of Public Wciiko Title Community Name `•'Fltgine/fafg Division MIS r$V1 WsiJ Telephone Signature the vet - Certificate and: fe •mme •S Date comments 0 •.-g not rocaround • = _ ❑Check here if attachrnenti EMA Form 81-31, Febr • Replaces all previc.:_