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Home My WebLink About2-4-037:099t FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 t NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 ELEVATION CERTIFICATE Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: w4WLDlb*OWNER' ME Policy Number "�W Sh/l BUILDING S REET ADDRESS Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number H004- A u L E-A -S7- 1,9,9 6�7s CITY/-///_0 �T IP CODE PROPERTY DESCRIPTION (Loi arid Block Numbers, Tax Parcel Number, Legal Description, etc.) BUILDING SE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.) 7_1A1_ LAT ITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE:Lj GPS (Type} ( ##° - ##'- ##.##" or ##.###W)I-,.J NAD 9927 I9I NAD 1983 W(' USGS Quad Map U Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE 1-1,4v.411 LOy.Ur'y/ /'S3-16 o I 11A/y 14 // 'V'41v.4 / / B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER ❑ c) Bottom of lowest horizontal structural member (V zones only) 0i%9SDATE EFFECTIVE/REVISED DATE ZONE S) (Zone AO, use depth of flooding) 1 S6166 -890 a �� 9- :6 _ �3 A �'5-,9S'0 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. 1_1 FIS Profile 1)4I FIRM 1-1 Community Determined U Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: 1J NGVD 1929 IX NAVD 1988 i—) Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1-1 Yes 1_1 No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) uilding elevations are based on: 1_lConstruction Drawings' J_JBuilding Under Construction' J XFinished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number .S- (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 C3a4 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 SU 13D BH Does the elevation reference mark used appe ❑ a) Top of bottom floor (including basement or enclosure) 96 $ ft.(m) ❑ b) Top of next higher floor /VA — ft.(m) b ❑ c) Bottom of lowest horizontal structural member (V zones only) ft.(m) o 0 ❑ d) Attached garage (top of slab).'S9� Z ft.(m) E ❑ e) Lowest elevation of machinery and/or equipment W' servicing the building Jr 98 S ft.(m) ❑ f) Lowest adjacent grade (LAG) .3'9z O ft.(m) z' O g) Highest adjacent grade (HAG) 3 .0 ft.(m) O h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade J6 • i) Total area of all permanent openings (flood vents) in C3h 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. l certify that the information in Sections A, B, 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. L -`r ✓/L f A/fGk& L r? ADPVSS 10-7109 �i�C � CIiC�C� oST f ii�Ol� STATE SC D la- SIG%TURE ''i,, DATE TELEP NE 12-12-C�'�S IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number CITY STATE ZIP CQ Company NAIC 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 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 El 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 1-1-1 ft.(m) JJJin.(cm) J—J above or 1_J 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? 1_1 Yes' 1-1 No 1_1 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. ;W D REPRESENTATIVE'S NAME ATE ZI 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 item(s) and sign below. G1. ;_I The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, o: 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 AC G3. 1-1 The foll6wing inf.Drmation (Items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBERI G5. DATE PERMIT ISSUED , ISSUEDATE CERTIFICATE OF COMPLIANCE/OCCUPANCY G7. This permit has been issued for: J_J New Construction J—J 'Substantial Improvement G8. Elevation of as -built low flo (incluing bse t f the building is: _ ft.(m) Datum: G9. BFE or (in Zone AO) de of oeo[t°ng amf �he,b�ildih Wg isWorks _ ft.(m) Datum: ►'�! - - LOCAL OFFICIAL'S NAMEthe Elevation Certificate and TITLE COMMUNITY NAME 19 reCOMMends TELEPHONE DA Date k` I k5 X03 Check here if attachments