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NOU.IP6 ,2002 09:23 FROM:
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<br />` FE AL EMERGENCY MANAGEMENT AGE
<br />ATiONAL FLOOD INSURANCE PRDGRA
<br />MO
<br />ELEVATION CERTIFICATE
<br />Important: Read the instructions on pages 1 - 7.
<br />r. rax eeJ Hyl
<br />O.M.B. No. 3067.0077
<br />Expires July 31, 2002
<br />SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use:
<br />BUi DING OWNER'S NAME�59A� ��� �� �� �or ApliCy Number
<br />BUILDING STREET ADDRESS (Includiqq Apt., Unit. Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO, Company NAIC Number
<br />Y4 0 O L— NU -L_7ES061)
<br />CiTY STATE ZiP CODE
<br />'t4 t LO
<br />PROPERTY OF
<br />SCRiPTION (ot and Black Numbers, Tax Ptimel Number. Logal Description, etc.)
<br />6U—IWING USE (e.g., Residential, Non-residantial, Addition, Accessory, etc. Use Comments section if necessary,)
<br />HORIZONTAL. DATUM, SOURCE: L_J GPS (Type)
<br />(__.I NAL) 1927 ig NAD 1983 LJUSGS Quad Map L Othorr,
<br />SECTION B - FLOOD INSURANCE RATE MAP (FiRM) INFORMATION
<br />81. NAFIP COMMUNITY NAME tI COMMUNITY NUMBER 1 82. tCOUNTY NAME B3. STATE
<br />84, MAP AND PANEL
<br />65. SUFFIX
<br />86: FIRM INDEX
<br />87. FIRM PANEL 88. FLOOD
<br />89. BASE FLOOD ELEVATION(S)
<br />PATE9
<br />EFFECT EIRE ED DATE ZONE }
<br />(Zone A0, use of ,boding)
<br />�C %NUMBER 0(�{.��
<br />/depth
<br />�
<br />810. Indicate the source of the Base Flood Elevation (BFE) data or base flo d depth entered in 89.
<br />Li FIS Profile i� FIRM u Community Determined LJ Other (Desc ibe):
<br />811. Indicate the elevation datum used for the SFE in 139: Lj NCVD 1929 L( NAVD 1988 L) Other (Describe):
<br />1312. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? I.__i Yes (Q No
<br />Designation Data,
<br />SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
<br />01, Building elevations are based on: (_(Construction Drawings' UBuilding Under Construction' i.L(Finished Construction
<br />'A new Elevation Certificate will be required when construction of the building is complete.
<br />C2. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed - see
<br />pages 6 and 7, if no diagram accurately represents the building, provide a sketch or photograph.)
<br />C3. Elevations — Zones Al -A30, AE, AH, A (with BFE), VE, VI -V30, V (with BFE), AR, AR/A. AR/AE, AR/A1-A30, ARIAH, AR/AO
<br />Complete Items C3a-I below according to the building diagram specified in Item C2, State the datum used. If the datum is different from
<br />the datum used for the SFE In Section B. convert the datum to that used for the BFE. Show field measurements and datum conversion
<br />calculation. Use the space provided or the Comments area of Section 0 or Section G, as appropriate, to document the datum conversion.
<br />Datum Conversion/Comments
<br />Elevation reference mark used_U S 8, Does the elevation reference mark used appear on the FIRM? U Yes (Zq No
<br />O a) Top of bottom floor (including basement or enclosure),; 9 ft.(m)
<br />O b) Top of next higher floor N� .. _ fL(m)
<br />0 c) Bottom of lowest horizontal structural member (V zones only)
<br />O d) Attached garage (top of -slab) 7 ft (m)
<br />O e) Lowest elevation of machinery and/or equipment
<br />servicing the building �. . $ ft.(m)
<br />O 1) lowest adjacent grade (LAG) „' ft. (m) z s`r
<br />N ' t �- "•
<br />Q g) Highest adjacent grade (HAG) ,got.(m) �:�r, r �',R �;`
<br />0 h) No, of permanent openings (flood vents) within 1 ft. above adjacent grade � � �p,; �% � � �,.•�'
<br />O i) Total area of ail permanent openings (flood vents) in C3h sq, in, (sq. cm)
<br />SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
<br />This certification is to be Signed and seated by a land surveyor, engineer, or architect authorized by law to certify elevation information.
<br />i certify, that the information in Sections A, 8, and C on this certificate represents my best efforts to interpret the data available.
<br />I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001,
<br />AD
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