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<br /> U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
<br /> Federal Emergency Management Agency Expires February 28.2009
<br /> National Flood Insurance Program Important: Read the instructions on pages 1-8.
<br /> SECTION A-PROPERTY INFORMATION For Insurance Company Use:
<br /> Al. Bilin Owner's Name Policy Number
<br /> .it/ANAwkt 1t,L 5Togs . LI.G
<br /> A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O Route and Box No. Company NAIC Number
<br /> 72 i00 AS cl VRAMi_.su rre s rev. 1llq�
<br /> KLA►ulA- 1<4t`1A fix WAtt 41 4z,
<br /> A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
<br /> "1.1A1;, `l-Z- tr1_0 ; vim'
<br /> A4. Building Use(e.g.,Residential, on-Resi tial, ition,g44Accessory,etc.)
<br /> A5. Latitude/Longitude:Lat. N I9.P27q' Long.W i55.99 f3• Horizontal Datum: p NAD 1927 p NAD 1983
<br /> A6. Attach at least 2 photographs of the building if the rtificate is being used to obtain flood insurance.
<br /> A7. Building Diagram (
<br /> Numberj__j<)CM66•jl � DIl•1tWCp/t
<br /> A8. For a building with a crawl space or endosure(s33, r provide: A . For a building with an attached garage,provide:
<br /> a) Square footage of crawl space or enclosure(s) sq ft a) Square footage of attached garage sq ft
<br /> b) No.of permanent flood openings in the crawl space or b) No.of permanent flood openings in the attached garage
<br /> enclosure(s)walls within 1.0 foot above adjacent grade walls within 1.0 foot above adjacent grade
<br /> c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in
<br /> SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
<br /> B1.NFIP Community Name 8 Community Number B2.County Name B3.State
<br /> 141404.11 -DUNK IS91414, 4464.4.Ati G NTti' 1401444 tt
<br /> B4.Map/Panel Number B5.Suffix 66.FIRM Index B7.FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone
<br /> Date Effective/Revised Date Zone(s) AO,use base flood depth)
<br /> t55166 434-0 G 4ja2/04 AtevId,r ,litAjt5t3 A-E `Lc?'
<br /> B10_ Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
<br /> ❑FIS Profile INFIRM 0 Community Determined ❑Other(Describe)
<br /> B11. Indicate elevation datum used for BFE in Item 89: f4 NGVD 1929 ❑NAVD 1988 ❑Other(Describe)
<br /> B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes ® No
<br /> Designation Date ❑CBRS ❑OPA
<br /> SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
<br /> Cl. Building elevations are based on: ,Construction Drawings' ❑ Building Under Construction* EiaFinished Construction
<br /> 'A new Elevation Certificate will be required when construction of the building is complete.
<br /> C2. Elevations-Zones Al-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,ARAE,AR/A1-A30,AR/AH,AR/AO. Complete Items C2.a-g
<br /> below according to the building diagram specified in Item A7.
<br /> Benchmark Utilized VAN t0 ra1 Vertical Datum N G\'9 1'12.1
<br /> Conversion/Comments t
<br /> Check the measurement used.
<br /> a) Top of bottom floor(including basement,crawl space,or enclosure floor) 9 .Z.' feet 0 meters(Puerto Rico only)
<br /> b) Top of the next higher floor Q .27 feet ❑meters(Puerto Rico only)
<br /> c) Bottom of the lowest horizontal structural member(V Zones only) tit,A. . feet ❑meters(Puerto Rico only)
<br /> d) Attached garage(top of slab) N.A_ ._❑feet ❑meters(Puerto Rico only)
<br /> e) Lowest elevation of machinery or equipment servicing the building +440 feet ❑meters(Puerto Rico only)
<br /> (Describe type of equipment in Comments)
<br /> f) Lowest adjacent(finished)grade(LAG) 1-Q12.®feet ❑meters(Puerto Rico only)
<br /> g) Highest adjacent(finished)grade(HAG) Q.17 IN feet El meters(Puerto Rico only)
<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
<br /> information. /certify that the information on this Certificate represents my best efforts to interpret the data available.
<br /> I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. `nOl'
<br /> tt. (A
<br /> ®Check here if comments are provided on back of form. •Ce er's Name License Number //*
<br /> Te IY`�"'� meltrt�A. S = 3e st.v� Siri�•A.N'�tt Z -Ci3f, k, �.
<br /> Signature � (i J3I/Qa Telephone too. i .go2o All, 1�
<br /> �_ See side for continuation. Replaces allprevious editions
<br /> FEMA Fo 81 31, February 2006 reverse u p
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