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Home My WebLink About6-9-009:003FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE A - PROPERTY OWNER INFORMATION O.M.B. No. 3067-0077 Expires December 31, 2005 For Insurance Company Use: �, nuunraa pncruamg qpt, mt, Suite, and/or Bldg. No.) OR P. ROUTE AND BOX NO. Company NAIC Number _ IVavinA(�Y► MA '7 LA)AMo1gCA- CITY , STATE area, or ##.###Wi IJ NAD 1927 . LI,NAD 1983 SOURCE: - LI GPS (Type): Lj USGS Quad Map IJ geher NUMBERDATE 5166 067 4/02/(1 (tone AO us depth of Hooding) B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. v lr cc7 1-1 FIS Profile I j FIRM I_I Community Determined I_I Other (Describe): B11. Indicate the elevation datum used for the BFE In B9:124j NGVD 1929 NAVD 1988 IJ Other (Describek B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or OtherwiseProtected Area (OPA)? LYes No Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Building elevaticnsrare based on: L_IConstruction Drawings* r 9 "Building Is Under Construction Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. 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 C3.s-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or, the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum Converslon/Comgxents Elevation reference mark use.Does the elevation reference mark used appear on the FIRM? I_I Yes I No ❑ a) Top of bottom floor (Including basement or enclosure) _ ft,( m) ❑ b) Top of next higher floor — N a,P6 G• PITT? fl (m) ❑ c) Bottom of lowest horizontal structural member (V zones only)_� 1 q �0 ❑ d) Attached garage (top of slab) — _ ft (m) .8 ti LICENSED y ❑ e) Lowest elevation of machinery and/or equipment w PriOFESSIONAL m* servicing the building (Describe in a Comments area.) LAND -- ft.(m) a � SLIR1/E`tOR O Q Lowest adjacent (finished) grade (LAG) - ; 53ft.(m) i ❑tjf Na 10743 g) Highest adjacent (finished) grade (HAG) SL ft.(m) ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade - ❑ 1) Total area of all permanent openings (flood vents) in C3.h — sq. in. (sq. cm) wq I U 5 ar ARCHITECT - This certification Is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. l certify that the information in Sections A, B, and C on this Certificate represents my best efforts to interpret the data available. I understand that any false statamant may ha k„ A-- [ .. t (n 0 AA A� V I-'Aif /Su:� LIUbNSE NUMBER i�%O , 1 G 7 4� MKE SS Y/ FEMA Form 81-31, .: DATE TELE HONFi,;>,_-. See reverse side for all IMPORTANT: In these spaces, copy the corresponding information from Section A. ) For Insurance Company Use: i h CITY '0 OR ARCHITECT Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1. through E5. If the Elevation Certificate is Intended for use as supporting Information for a LOMA or LOMR-F, Section C must be completed. E1. Building Diagram Number _ (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2. The top of the bottom floor (including basement or enclosure) of the building is III R. (m) LLI in. (cm) LI above or LI below (check one) the highest adjacent grade. (Use natural grade, if available.) E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is L—IJ ft. (m) 1_I_1in. (cm) above the highest adjacent grade. Complete Items C3.h and C3.1 on front of form. E4. The top of the platform of machinery and/or equipment servicing the building is LLI R• (in) LIJ in. (cm) 1_J above or LI below (check one) the highest adjacent grade. (Use natural grade, if available.) E5. For Zone AO only: If no good depth number is available, is the top of the bottom floor elevated in accordance with the community's property owner or o out a FEMA -issued SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION 'esentative who completes Sections A, B. C (Items C3.h and C3.i only), and E for Zone A BFE) or Zone AO must sign here. The statements In Sections A, B, C, and E are correct to REPRESENTATIVE'S NAME SIGNATURE j // DATE 6, -r( TELEPHONE �i,� � .7C COMMENTS SECTION G - here if The local official who is authorized bylaw or ordinance to administer the community's floodplain management ordinance can complete Sections A, B. C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. IJ The Information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information- (Indicate the source and date of the elevation data inthe,Comments area below.) G2. LI A community official completed Section.E for a building located In Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. G3. 1_I,The following info mtation (Items G4-Gg) is provided for community floodplain management purposes. G4. PERMIT PERMIT G8. Elevation of as -built lowest floor (Including basement) of the building is: G9. BFE or (in Zone AO) depth of flooding at the building site is: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE —ft. (m) Datum: —ft. (m) Datum: L I Check here if attachments FEMA Form 81-31, January 2003 Replaces all previous editions