2-4-037:022 - Laserfiche WebLink

Home

44 ir FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE O.M.B. No. 3067-0077 Expires July 31, 2002 Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BU BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number CITY STATE IP CODE H 1 L.b - - H71: - - - 4-(0 Z ZO PROPERTY DESCRIPTION(l.ot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Addition, AcceSsory,,,.etc. Use Comments section if necessary.),, LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: LJ GPS (Type) ( ##° - ##'- ##.##- or ##.#####°) U NAD 1927 LV NAD 1983 U USGS Quad Map LJ Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER 7. COUNTY NAME83. STATE HMit&tl doUijT l SSl(oto 6-fi>�-a)AfI eCiUfUtd qr B4. MAP AND PANEL 135. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER 1 I DATE EFFECT VE/RE ISED DATE 20 E() � (Zone AO use depth of flooding) j gS Iwo - O8 � C° !o Z 9s' / B10. Indicate the source of the Base Flood E(evation (BFE) data or l5ase Mod depth entered in B9. I_I FIS Profile I,X FIRM IJ Community Determined L_I Other (Describe):, B 11. Indicate the elevation datum used for the BFE in B9: Lig NGVD 1929 L NAVD 1988 " Other (Describe): 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? IJ Yes JZNo Designation Date: Aft SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Building elevations are based on: I_IConstruction Drawings' 1—[Building Under Construction' IkIFinished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number - 4—_ (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, V1430, 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 SUBb gM Does the elevation reference mark used appear on the FIRM? 1_1Yes ILC('No ❑ a) Top of bottom floor (including basement or enclosure) 17Z ft.(m) ❑ b) Top of next higher floor it/ — ft.(m) ❑ c) Bottom of lowest horizontal structural member (V zones only) /V _ ft.(m) 00 ❑ d) Attached garage (top of slab) 46 / ft.(m)°�- E ❑ e) Lowest elevation of machinery and/or equipment servicing the building E� ❑ 0 Lowest adjacent grade (LAG) /c06 3 ft.(m) n.r., ;R O Highest adjacent grade (HAG) /n /D _2 ft.(m) oma` 3 ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent gradei. _ ❑ i) Total area of all permanent openings (flood vents) in C3h 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, understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. FIE,WJ NAME - �� LICEENNSUUMBER TITp��'E%✓/L SNL-�/•t��C2 I�1Jrc/TNAMt K�-�� ADDRESS �S]~ /� � ST PC SIG URE 3 —Z3 ITE TELEPk��NE , Q —G] �-