HomeMy WebLinkAbout7-8-012-041FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSLIRANCE PROGRAM
ELEVATION CERTIFICATE
• Important: Read the Instructions on pages 1 - 7. _
SECTION A - PROPERTY OWNER INFORMATION
BUIZeG OWNER'S 4ME
BUILDING STREET ADD/7t/-4
R€SS (Indudi Apt.. Unit. Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
7 B- Ie)9f+ /7t /- c -4
CITY - -. , STATE
—PROPERTY DESCRIPTION (Lot and Bim' um er!,am aQ um �;_�p� etc.)
1,
O.M.B. No. 3067-0077 O
Expires July 31, 2002
For Insurance
LATITUDEILONGITUDE (OPTIONAL) ' �n HORIZONTAL DATUM: : LI (Type):
Rs,W or 0.i 06) Ipl NAD 1927 " NAD 1963 LJ USGS Quad Map I --I 011ier. Co v .v r B M
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered In B9.
Lj FIS Profile * FIRM IJ Community Determined I_j Other (Describe):
811. Indicate the elevation datum used for the BFE in B9: JXJ NGVD 1929 LJ NAVD 1988 U Other (Describer
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPAJ? Lj Yes QSJ No
Designation Date:
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
•
I. Building elevations are based on: I_jConstruction Drawings' - "Building Under Construction* &6Finished 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 At -A30, AE, AH, A (with BFE), VE, V1430, V (with BFE), AR, AR/A, ARAE, AR/A1-A30, AR/AH, ARIAO
Complete Items C3.a-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 _ Conversion/Comment
Elevation reference mark used _e ' 2f s /l Does the elevation reference mark used appear on the FIRM? L_j Yes jX1 No
O a) Top of bottom floor (including basement or enclosure)
B4. MAP P
77
nn sA E
85 1. CDATE
INDEX
87. FIRM PANEL
EFFECTIVFJREVISED DATE
88. FLOOD
ONE(S)
89. BASE FLOOD per of floadirg))
(Zone AO, use doIRM
_ ft.(m) 0 0
O d) Attached garage (top of slab)
2
__rp ❑ e) Lowest elevation of machinery and/or equipment
a e
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered In B9.
Lj FIS Profile * FIRM IJ Community Determined I_j Other (Describe):
811. Indicate the elevation datum used for the BFE in B9: JXJ NGVD 1929 LJ NAVD 1988 U Other (Describer
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPAJ? Lj Yes QSJ No
Designation Date:
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
•
I. Building elevations are based on: I_jConstruction Drawings' - "Building Under Construction* &6Finished 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 At -A30, AE, AH, A (with BFE), VE, V1430, V (with BFE), AR, AR/A, ARAE, AR/A1-A30, AR/AH, ARIAO
Complete Items C3.a-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 _ Conversion/Comment
Elevation reference mark used _e ' 2f s /l Does the elevation reference mark used appear on the FIRM? L_j Yes jX1 No
O a) Top of bottom floor (including basement or enclosure)
Z 4 .2 / ft.(m)
ft.(m) 'g%
U b) Top of next higher floor
_
❑ c) Bottom of lowest horizontal structural member (V zones only)
_ ft.(m) 0 0
O d) Attached garage (top of slab)
2
__rp ❑ e) Lowest elevation of machinery and/or equipment
a e
servicing the building (Describe in a Comments area.)
O f) Lowest adjacent (finished) grade (LAG)
Z 0 .
TTS
L ft.(m) 1
y„ N
O g) Highest adjacent (finished) grade (HAG)
2 y .
�)o ft.(m)
O h) No, of permanent openings (flood vents) within 1 ft. above adjacent
grade
(a i) Total area of all permanent openings (flood vents) in C3.h
sq. in. (sq.
cm)
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation intorieation.
I certify that the inks A, B. and C on this certificate represents my best efforts to interpret the'deta available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.'
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