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HomeMy WebLinkAbout2-4-037:059FEDERAL EMERGENCY MANAGEMENT AGENCY O:M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 ELEVATION CERTIFICATE Ask Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number SoU7"Sia :T SLES t7�V ZOt�u t 7T" =rV(Z- BUIL' qING STREET ADDRESS (including Apt., Unit, uile, and/or Bldg. No.) OR P.O. ROUTE D BOX NO. Company NA1C Number rt o©LA4 L� S~; A 1,6,K His su .D CITY SKZIP CODE E q( -I � BUIWING USE(e-g-, Residential. Non-residential. Addition, Accessory, etc. Use Comments section if necessary.) LATITUDE//LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: LI GPS (Type) ( #it' - ##'. #13.##' or ##.#####0) LI NAD 1927 W NAD 1983 LI USGS Quad Map (AI Other. iJ SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFIP COMMUNITY NAME b COMMUNITY NUMBER B2. COUNTY NAME B3. STATE B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER1E EFFEC IVE/REVISED DATE ZONE(S) (Zone A0, use depth of flooding) tSs)�(� a� o C 6 2 Qs' )(01 141 ,0 B10. Indicate the source of the Base Flood Elevation (BFE) data or batse flood depth entered in 89. L.) FIS Profile jy FIRM L) Community Determined LJ Other (Describe): 811. Indicate the elevation datum used for the BFE in B9: [,*-A NGVD 1929 LJ NAVD 1988 "Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? I[ Yes "No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUI C1. Building elevations are based on: Ir{Construction Drawings' LJBuilding Under Construction' L,XIFinished 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 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 US& S R., LA Does the elevation reference mark used appear on the FIRM? I_j Yes [fig No 10 a) Top of bottom floor (including basement or enclosure) ��1� o ft.(m) a O b) Top of next higher floor AJA = fL(m) O c) Bottom of lowest horizontal structural member (V zones only) ft.(m) " O O d) Attached garage (top of stab) -�g ft (m) ' o O e) Lowest elevation of machinery and/or equipment �p , servicing the building % fL(m) O i) Lowest adjacent grade (LAG) , 3 — fL(m) z' iz I-lj- O g) Highest adjacent grade (HAG) -6 —6 `fL(m) O h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade O i) Total area of all permanent openings (flood vents) in C3h 0030 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, 8, 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. ERTIFIER'S NAME , I _ I LlPi M;E,y JMBEJR 0. `r✓ l tJ ) L �N bt l KJ 2_ SA LLS lU M GLFL . P E . A IV' i 0 KA L %U 0 S7- TM Z .CQDE SIGNE .TELEJJ•1ONF, _ IMPORTANT: In these spaces, copy the corresponding Information from Section A. I For Insurance Company Use: BUILDING STREET ADDRESS (including Apt., Unit. Suite, andlor Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy rrumoer CITY STATE ZIP C1 Company NAIC Number 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 attachment: 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. /f 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 1 i t fL(m)1 ( lin.(cm) Lj 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? JJ Yes' JJ No LJ 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 ADDRESS 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 Q. and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. I -J 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. " A community official completed Section E for a building located in Zone A (without a FEMA -issued or community4ssued BFE) or Zone A7. G3. (_---j The-followir;g information (Items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT.ISSUED IG6. ISS DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY G7. This permit has been issued for. L_J New Construction L_ -J Substantial Improvement G8. Elevation of as -built low'�t flo{�r (including base�ynt Qf the building is: ft.(m) Datum: G9. BFE or {n Zone AO) de "iJeo(�1"Vkjp� tiQitldih_ IS iswork5 � ft.(m) Datum: LOCAL OFFICIAL'S NAME the Elevation Certificate and w TITLE - COMMUNITY NAME recommends TELEPHONE SIGNATURE L-1 does not recommend DATE final [si i rClYt7I- COMMENTS sy Date a ( 1 g 1 o"=