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FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE rtant: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATlof3he O.M.B. No. 3067-0077 Expires July 31, 2002 BUILDIN OWNER'S NAME trigineering Rdlrit+j51 MbRus reviewea W 1111414 BUILDING/ STREET DDRS (including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND B 0• recom �Wffny NAIC Number CITY STATE 60 101 1 CODE f�/GG jV2 967'20 final approval BU LATITUDE/LONGITUDEy./({OyPyT.y.IµO�/N umber. Legal Description, etc.) Addition, Accessory, etc. Use Comments section if HORIZONTAL DATUM: SOURCE: La LJ NAD 1927 L�g NAD 1983 1 SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Bt. NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2. COUNTY NAME B3. STATE I B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER tis iroi -fro I DATE024 0=1 EFFE TIVE/ VISED DATE 4� I ZONE(S) (Zone AO, use depth of flooding) B10. Indicate the source of the Base Flood Eldvation (BFE) data or base flood depth entered in B9. 1_1 FIS Profile Jyj FIRM 1-1 Community Determined L_) Other (Describe): B 11. Indicate the elevation datum used for the BFE in B9: 1J NGVD 1929 JX I NAVD 1988 U Other (Describe): 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? I_I Yes (KI No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: (_1Construction Drawings' 1_1Building Under Construction' IXFinished Construction 'A new Elevation Certificate ill 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, AR/AE, AR/A1-A30, AR/AH, AR/AO Complete Items C3a-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/Comments Elevation reference mark used S"oR. Bw( Does the elevation reference m rk used appear on the FIRM? 1_1 Yes I No ❑ a) Top of bottom floor (including basement or enclosure) Cl ft.(m) ❑ b) Top of next higher floor A — ft.(m) ❑ c) Bottom of lowest horizontal structural member (V zones only) W A _ ft.(m) N 6 ❑ d) Attached garage (top of slab) A _ ft.(m) E ❑ e) Lowest elevation of machinery and/or equipment m servicing the building ft.(m) a= �- E 10 (��' �%� ❑ f) Lowest adjacent grade (LAG) �� /% ft.(m) z � V �` �/ ❑ g) Highest adjacent grade (HAG) ft.(m) F' ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade ❑ i) Total area of all permanent openings (flood vents) in C3h (JA 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 information. i 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 statement may be punishable by fine orimprisonment under 18 U.S. Code, Section 1001. CEF TjFIER'S NAME ► LIGE NU1vIB�R _ ... `e i V ! (_ E tj w w eel2 v RZtJWt,0 0 1 CALL "PE ADD SS STATE IP C DE �' --�I KAL-4 u Q0 s -r ��oro Hr 1to1W3 SIG URE on—, I � _ KTI F �, TF�LnEPen r-. !� C, r