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HomeMy WebLinkAbout2-4-037:098FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 ELEVATION CERTIFICATE 9' Important: Read the instructions on pages 1 -7. SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDJVG OWNE ©i/ Policy Number BUILDING STREET ADD E S (lnctudin Apt., Unit, Suite, and/or Bldg. No_) OR P.O. ROUTE AND BOX NO. Company NAIC Number 4L r4UL /A isA /� 7$ $v&• ctTYMr 9 A CODE PROPERTY PE CRtPTION (ot and tock Nu be s Tax Parcel Number. Legal Description, eta) 6 6UILD1Nq,0Si± (e.g.. Residential. Non-residential, Addition, Accessory, etc. Use Comments section if necessary.) C TUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: LJ GPS (Type) ( W - ##' - ##.##' or # .#####°) L_J NAD 1927 Lg NAD 1983 LJ USGS Quad Map (_J Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME 8 COMMUNITY NUMBER I 82. COUNTY NAMEI B3. STATE yA�v,4!/ /-�5i61, /5'"'4/r dey W -40,6-I / 84. MAP AND PANEL 85. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER C DATE EFFECTIVEIREVISED DATE ZONE(S) (Zone AO, use depth of flooding) lSs�W� - 89.E servicing the building b�m4 -2 - 9s �9 --'�Qg 0 0 Lowest adjacent grade (LAG) fL(m) 810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. j_( FIS Profile 4 FIRM . (_j Community Determined U Other (Describe): B 11. Indicate the elevation datum used for the BFE in B9: 0 NGVD 1929 U NAVD 1988 U Other (Describe): 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? U Yes(ZC) No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: UConstruction Drawings' UBuilding Under Construction' LXIFinished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number - (Select the building diagram most simitarto 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, ARIA, ARAE. AR/Ai-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 8, 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 Ute, S /3,t Does the elevation reference mark used appe O a) Top of bottom floor (including basement or enclosure) 3 i ft.(m) g 0 b) Top of next higher floor D c) Bottom of lowest horizontal structural member (V zones only) IJ4 ft.(m) fL(m) o o 0 0 d) Attached garage (top of slab) _ 39 -7 fL(m) E g 0 e) Lowest elevation of machinery and/or equipment': i servicing the building b�m4 mm) 0 0 Lowest adjacent grade (LAG) fL(m) z 0 g) Highest adjacent grade (HAG) a� �? ft(m) r 0 h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 0 i) Total area of all permanent openings (flood vents) in C3h 54 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 taw 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 maybe punishable byrine orimprisonment under 18 U.S. Code, Section 1001. i t�iL �,�/Cyi.cJ 2 i nry .t%iGkc Z_ UX/0 57- P",04 D/#.TE / '7" IMPORTANT: In these spaces, copy the corresponding information from Section A. I For Insurance Company Use: BUILDING STREET ADDRESS (Including Apt., Unit. Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. I Policy Number —1 CITY STATE ZIP CQ Company NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenticompany, and (3) building owner. COMMENTS J_J 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 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 I" ft.(m) IIlin.(cm) LJ above or LJ below (check one) the highest adjacent grade. E3. For Zone AO only; no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? J_J Yes' J_J No J_J 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 FEMA4ssued or community -issued BFE) or Zone AO must sign here. ROPERTY 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 E), and G of this Elevation Certificate. Complete the applicable items) and sign below. G1. J_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. J_J 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 35. DATE PERMIT ISSUED -G6. CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED G7. This permit has been issued for: J_J New Construction II Substantial Improvement G8. Elevation of as -built Iestfloor (including basemenlg of the building is: _ ft.(m) Datum: G9. BFE or (in Zone AO) ti Rth OT i tth9&1IH� UrsitW9r _ ft.(m) Datum: LOCAL OFFICIAL'S NAM TITLE he Elevation Certificate and OMMUNITY NAME IR recommends TELEPHONE NATURE Lf Goes not recommend DATE fined approval COMMENTS By