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Home My WebLink About2-4-037:02244 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] �- IMPORTANT: In these spaces, copy the corresponding Information from Section A. For Insurance Company Use: BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. I Policy Number CITY STATE Company SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. COMMENTS 1_1 Check here if attachments 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 E3. 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 JJ_I ft.(m) {_,J_Jin.(cm) {_{ above or LJ below . (check one) the highest adjacent grade. E3. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? J_J Yes' J_J No 1-1 Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA -issued or community -issued BFE) or Zone AO must sign here. OWNE SIGNATURE DATE TELEPHONE COMMENTS 1_1 Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) the local official who is authorized by law 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. 31. LJ 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 in the Comments area below.) 32. J_J A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AQ. 33. J_J The following information -(Items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER I G5. DATE PERMIT ISSUED , ATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED 37. This permit has been issued for: J_J New Construction J_) Substantial Improvement 38. Elevation of as -built lowefloo (including basement) of the building is: _ ft.(m) Datum: 39. BFE or (in Zone AO) depthh f ti�iPtAtir6gs Works _ ft.(m) Datum: EnginAAr� in�gDiyision hasreviewedLOCAL OFFICIAL'S NAME the Elevation Certificate TITLE COMMUNITY NAME recommends TELEPHONE am Check here if attachments