HomeMy WebLinkAbout2-4-037:103FEDERAL EMERGENCY MANAGEMENT AGENCY
O.M.B. No. 3067-0077
, NATIONAL FLOOD INSURANCE PROGRAM
Expires July 31, 2002
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1 - 7.
85. SUFFIX
B6. FIRM INDEX
DATEt,t-AA9
SECTION A - PROPERTY OWNER INFORMATION
For Insurance Company Use:
89. BASE FLOOD ELEVATION(S)
(Zone A use deoth of flooding)
,�03, o
ILDI QVVN R , iaO;�5 n ` ^ n�
Policy Number
BUIL DI G ST EET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO,
02 �,gULu�'S � � �P � S'T` w�/�,r/2F�41 A/l sir
Company NAIC Number
.
CITY/ / /+� STATE
!"'� �/w AT
.°le Depart �f7 u tc Wor
n y' =�---h0` review
PROPERTYD SCRIPTION Lt and Block Numbers Tax Parcel Number, Legal Description, etc.)
?3% -2 -. - D37 .• % 4
the Elevation Certificate and
BUILD G SE e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.)
%� /•ta- CI
reeommen s
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: LI GPS (Type]
n 4 ,—q not racnmmend
-
( W. 94.9--' or L) NAD 1927 IN NAD 1983 L_J USGS Quad Map
O
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
y
BI. NFIP COMMUNITY NAME d COMMUNITY NUMBER
WT' /kl( C000+
J B2. COUNTY NAME
B3. STATE
84. MAP AND PANEL
NUMBER
,Ss i G(' - a9U
85. SUFFIX
B6. FIRM INDEX
DATEt,t-AA9
B7. FIRM PANEL
EFFECTIVE/R VISED DATE
1(p 88
88. FLOOD
ZONE(S)
N
89. BASE FLOOD ELEVATION(S)
(Zone A use deoth of flooding)
,�03, o
810. Indicate the source of the Base t -I000 tievauon tort) oata or base 11000 cepth entereo in bV.
j_i FIS Profile )A FIRM 1_1 Community Determined I I Other (Describe):
611. Indicate the elevation datum used for the BFE in 89: IJ NGVD 1929 W NAVD 1988 L_1 Other (Describe):
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? )J Yes Q�j No
Designation Date:
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
wilding elevations are based on: (_iConslruction Drawings' 1JBuilding Under Construction' 1XIFinished Construction
'A new Elevation Certificate will be required when construction of the building Is complete.
C2. Building Diagram Number .5- (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, AR1A1-A30, AR/AH, AR/AO
Complete Items C3a-t below according to the building diagram specified in Item C2. Slate 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 S0130- Q1,( Does the elevation reference mark used appear on the FIRM? (_i Ye No
O a) Top of bottom floor (including basement or enclosure)
O b) Top of next higher floor �✓ — ft. (m) -
O c) Bottom of lowest horizontal structural member (V zones only) A/74ft.
_
O d) Attached garage (top of slab) �J2 . � ft. (m) E g
O e) Lowest elevation of machinery and/or equipment /
servicing the building <O,0'3 9 ft.(m) 7
O f) Lowest adjacent grade (LAG) fI.(m) z N P
O g) Highest adjacent grade (HAG) /02 fl.(m)
O h) No. of permanent openings (flood vents) within 1 ft. above adjacen grade�z—
O i) Total area of all permanent openings (flood vents) in C3h ��L7 sq. in. (sq. cm)
SECTION 0 - 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.
I certify that the information in Sections A, 8, and C on this cerfificale represents my best efforts to interpret the data available.
I erstand�that any false statement may be punishable.by fine orimprisonment under 18 U.S. Code, Section 1001.
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