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Home My WebLink About2-4-037:049FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important: Read the instructions on pages 1 - 7. O.M.B. No. 3067-0077 f Expires July 31, 2002 IN SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER's NAME SOU `S71EA ZACES bEVr:�LC) Pry EO -r mQ(L Policy Number BUILDING irASTR��-RES`�S (In ing, Unit,,,Suite, awn �orBug. No.) OR .0 TE AND BOX NO. Company NA1C Number CITYDE 0 ( L10 STLrZ 91�, 20 PROPERTY D SC IPTION (Lot nd Block Num , Tax Parcel Number, Legal Description, etc.) 21 171 BUILDING USE (e.., Residential, Na -residential, Addition, Accessory, etc. Use Comments section if necessary.) 511� 6- / G LAyT.�ITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: LI GPS (Type) ( 9#0 - ##'- ##.##' or ##.#####°) LJ NAD 1927 LKJ NAD 1983 IN USGS Quad Map U Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION (Zone AO, use depth of flooding) B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER WLE-) J ss((o.6 B2. COUNTY NAME 1 k(-kilki,k(( I B3. STATE ri4wx( B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER e AT EFFECT VE/R SED DATES) 1:5 0 ft.(m) (Zone AO, use depth of flooding) 06940 ft.(m) � 6 5S 16 $S 'ZQN 6,&,o B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. 1_1 FIS Profile 1,,24 FIRM 1_J Community Determined LJ Other (Describe): 1311. Indicate the elevation datum used for the BFE in 139: 1A NGVD 1929 (J NAVD 1988 LJ Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? LJ Yes LJNo Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Building elevations are based on: J_JConstruction Drawings' UBuilding Under Construction' 1XIFinished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number S— (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/Al-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 Q S �3S gh Does the elevation refer n mark used appe ❑ a) Top of bottom floor (including basement or enclosure) l ft.(m) q ❑ b) Top of next higher floor / ft.(m) 10 ❑ c) Bottom of lowest horizontal structural member (V zones only) i mm) o 0 ❑ d) Attached garage (top of slab) _ �o ft.(m) E ❑ e) Lowest elevation of machinery and/or equipment the building 1:5 0 ft.(m) w `° servicing ❑ f) Lowest adjacent grade (LAG) ft.(m) E ca ❑ g) Highest adjacent grade (HAG) /b ft.(m) v ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 8 ❑ i) Total area of all permanent openings (flood vents) in C3h 672 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. t certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. IMPORTANT: In these spaces, copy the corresponding information from Section A. ' For Insurance Company BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX N0. I Policy Number CITY STATE ZIP Cq Company NAIC Number 0 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 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 infomration for a LOMA or LOMB -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 JJJ ft.(m) UJin.(cm) )J above or (J 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 commundy's floodplain management ordinance? iJ Yes' 1_1 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. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME 4WFDRESS CITY STATE ZIP CODE 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. G1. I_I 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.) G2. 1_1 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_1 The following information (Items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been issued for: 1_1 New Construction 1_1 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: _ ft.(m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: _ ft.(m) Datum: LOCAL OFFICIAL'S NAME The Departmen R$ TITLE Engineering Di -i ion hrn, reviewed COMMUNITY NAME the Elevation Certificate anTELEPHONE i( NATURE recommends DATE r v4WMMENTS " L] Check here if attachments P_P:hAA Gnrm R4_11 AI I(_ CIC] Doto • • •-- - -