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HomeMy WebLinkAbout2-4-037:068O.M.B. NO. 3067-0077 ELEVATION CERTIFICATE ExpiresMc73t,t996..•,.. FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM a ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form Is used only to4o,•'r' ide elevation information necessary to ensure compliance with applicable community floodplain management ordinerices, tq 1i imine the proper Insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMRIP Instructions for completing this form can be. found on the following pages. 't- SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE BUILDING OWNER'S NAME POLICY NUMBER SutJS-Co�� LTy P�r�tt� R,S L-c_C- STREET ADDRESS (Including Apt., Unit, Suite and/or BldN umber) OR P.O. ROUTE AND BOX NUMBER COMPANY NAIL NUMBER (r•Eo t� l_ -Pr U LSA S -T �2t-Z�'T . .. . _ OTHER DESCRIPTION (Lot and Block Numbyyrs, etc.) CITY ��STATE' ZiP CODE SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM (See Instructions); - i. COMMUNITY NUMBER 2. PANEL NUMBER 3. SUFFIX ., 4. DATE,QF FIRM INDEX "!l 5. FIRM ZONE 6. BASE FLOOD ELEVATION lin AO Zones, use depth) © 990 �f)C � t�,l�� .4� 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): XNGVD'29 ❑Other (describe on back)' S. For Zones A or V, where no SFE is provided on the FIRM, and the community has established a BFE for this building site, indicate the community's BFE: 1 Li j.0 feet NGVD (or other FIRM datum—see Section B, Item 7), SECTION -C, BuiLDING ELEVATION. INFORMATION 1. Using the Elevation Certificate Instructions, indicate.the diagram num4ef ft•om the`diagrams found on Pages 5 and 6 that best cribes the subject building's reference level �. . FIRM Zones Al -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation. of L1�1.1S feet NGVD (or other FIRM datum—see Section B, -Item 7), (b). FIRM Zones V1430, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from the selected diagram, is at an elevation of t i i l I.0 feet NGVD (or other,FIRM,datum—see Section B, Item 7): (c). FiRM Zone A (without BFE). The floor used as the reference level from the selected diagram is I I LH feet above ❑ or below ❑ (check one) the highest grade adjacent to the building, (d). FiRM Zone AO. The floor used as the reference level from the selected diagram is L1J.0 feet above ❑ or below ❑ (check one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown, 3. Indicate the elevation datum system used in determining the above reference level elevations: ❑ NGVD'29 ❑ Other (describe.,.. under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than that used on the FIRM [see Section B, Item 7], then convert the elevalions to the datum system used on the FIRM and show the conversion t equation under Comments on Page 2.)I 1. Elevation reference mark used appears on FIRM: ElYes Uf No (See Instructions on Page 4) ' The reference level elevation is'based on: V actual construction ❑ construction drawings (NOTE: Use of construction drawings is only valid it the building does not yet have the reference level floor in place, In which case this certificate will only be valid for the building during the course of construction. A post -construction Elevation Certificate i will be required once construction is complete,) ����,,,,��rr The elevation of the lowest grade immediately adjacent to the building is: U).0 feet NGVD (or other FIRM datum -see Section B, item 7). SECTION D COMMUNITY. INFORMATION `i community official responsible for verifying building elevations specifies that the reference level indicated in Section C, item 1 t..' t the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest floor" as defined by the ordinance is: 1111 l l IJ feet NGVD (or other FiRM datum -see Section B, Item 7). :)ate of the start of construction or substantial improvement EMA Form 81 .31, MAY 93 REPLACES AU. PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUAMON SECTION E CERTIFICATION This certification is to be signed by a land surveyor, engineer, or architect who is authorized by st4te or local law to certify1blevation. Information when the elevation information for Zones Al—A30, AE, AH, A (with BFE),V1—V30,VE; and V (with BFE) is required. Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the' certification, in the case of Zones AO and A (without a FEMA or community issued BFE), a building official, a property owner, or an owner's representative may also sign the certification. Reference level diagrams 6, 7 and 8 - Distinguishing Features—II the certifier is unable to certify to breakaway/non-breakaway wafl,i: =: . enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not:; Included in the certification under Comments below. The diagram number, Section C, Item 1, must still be entered. • ;i: iil I certify that the information in Sections B and C on this certificate represents my best efforts to interpret the data available. _ 1 understand that any false statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001.�z �c� f Cpl Q. CERTIFIER'S NAME Q ttGt .N I (or Affix Sul) z!v!L PROFESSIONAL TITLE C NY NAME ��• V9 1//4P� )`Z) ADORES !I �% /f / cf No- 8e46 — - — STATE ZIP.,., SIGNA URE PHONE Copies should be made of this Certificate for: 1) community. official, 2)'Insurance agent/company, and 3) building owner.,,,,:,..,," COMMENTS: The, Deparinjen! of c ors Engineering Division has reviewed the Elevation - Certificate and ON SLAB A V ZONES ZONES FLOOD ELEVATION ADJACENT GPAOE ❑ does not recommend final approval By, 3`l(dk 00 WITH BASEMENT A ON PILES, PIERS, OR COLUMNS A v The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones. Elevations for all A Zones should be measured at the top of the reference level floor, Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member. Pag© 2