HomeMy WebLinkAbout2-4-037:060NOU.IP6 ,2002 09:23 FROM:
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` FE AL EMERGENCY MANAGEMENT AGE
ATiONAL FLOOD INSURANCE PRDGRA
MO
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1 - 7.
r. rax eeJ Hyl
O.M.B. No. 3067.0077
Expires July 31, 2002
SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use:
BUi DING OWNER'S NAME�59A� ��� �� �� �or ApliCy Number
BUILDING STREET ADDRESS (Includiqq Apt., Unit. Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO, Company NAIC Number
Y4 0 O L— NU -L_7ES061)
CiTY STATE ZiP CODE
't4 t LO
PROPERTY OF
SCRiPTION (ot and Black Numbers, Tax Ptimel Number. Logal Description, etc.)
6U—IWING USE (e.g., Residential, Non-residantial, Addition, Accessory, etc. Use Comments section if necessary,)
HORIZONTAL. DATUM, SOURCE: L_J GPS (Type)
(__.I NAL) 1927 ig NAD 1983 LJUSGS Quad Map L Othorr,
SECTION B - FLOOD INSURANCE RATE MAP (FiRM) INFORMATION
81. NAFIP COMMUNITY NAME tI COMMUNITY NUMBER 1 82. tCOUNTY NAME B3. STATE
84, MAP AND PANEL
65. SUFFIX
86: FIRM INDEX
87. FIRM PANEL 88. FLOOD
89. BASE FLOOD ELEVATION(S)
PATE9
EFFECT EIRE ED DATE ZONE }
(Zone A0, use of ,boding)
�C %NUMBER 0(�{.��
/depth
�
810. Indicate the source of the Base Flood Elevation (BFE) data or base flo d depth entered in 89.
Li FIS Profile i� FIRM u Community Determined LJ Other (Desc ibe):
811. Indicate the elevation datum used for the SFE in 139: Lj NCVD 1929 L( NAVD 1988 L) Other (Describe):
1312. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? I.__i Yes (Q No
Designation Data,
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
01, Building elevations are based on: (_(Construction Drawings' UBuilding Under Construction' i.L(Finished 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, VI -V30, V (with BFE), AR, AR/A. AR/AE, AR/A1-A30, ARIAH, 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 SFE 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 0 or Section G, as appropriate, to document the datum conversion.
Datum Conversion/Comments
Elevation reference mark used_U S 8, Does the elevation reference mark used appear on the FIRM? U Yes (Zq No
O a) Top of bottom floor (including basement or enclosure),; 9 ft.(m)
O b) Top of next higher floor N� .. _ fL(m)
0 c) Bottom of lowest horizontal structural member (V zones only)
O d) Attached garage (top of -slab) 7 ft (m)
O e) Lowest elevation of machinery and/or equipment
servicing the building �. . $ ft.(m)
O 1) lowest adjacent grade (LAG) „' ft. (m) z s`r
N ' t �- "•
Q g) Highest adjacent grade (HAG) ,got.(m) �:�r, r �',R �;`
0 h) No, of permanent openings (flood vents) within 1 ft. above adjacent grade � � �p,; �% � � �,.•�'
O i) Total area of ail permanent openings (flood vents) in C3h sq, in, (sq. cm)
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be Signed and seated 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.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001,
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