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FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important: Read the instructions on paces 1 - 7. 11 SECTION A - PROPERTY OWNER INFORMATION UILDIN S NAME BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX d57 X6).4 -S-7— j�0,4/,4 k 25,4 Su O.M.B. No. 3067-0077 Expires July 31, 2002 For Insurance Company Use: Policy Number Company NAIC Number CITY /z/%Z.O STATE67 t q -% z Co PROPERTY DESCRIPTION_(Lot ani Block Numbers,Ja-x_Parcel Number, Legal Description, etc.) Accessory, etc. Use Comments section if necessary.) LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: LI GPS (TypeX I� or ## #####°) IJ NAD 1927 'NAD 1983 &USGS Quad Map I—I Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER I B2, COUNTY NAME B3. S�T1ATnE B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER 0 590 I y EFFECRD DATE /w/ ZO E(S) (Zone O, use depth of flooding) &© s D B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. JJ FIS Profile Jyj FIRM JJ Community Determined JJ Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: kJ NGVD 1929 JJ NAVD 1988 JJ Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? JJ Yes JXJ No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Building elevations are based on: J_JConstruction Drawings' JJBuilding Under Construction` XFinished 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, V1 -V30, V (with BFE), AR, ARIA, AR/AE, AR/A1-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 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 0 SCIS I?M Does the elevation reference mark used appe ❑ a) Top of bottom floor (including basement or enclosure) 4i©9 ft. (M) d ❑ b) Top of next higher floor _ �A(m) 9 ❑ c) Bottom of lowest horizontal structural member (V zones only) ft.(m) o 0 ❑ d) Attached garage (top of slab) ft -(m) E ❑ e) Lowest elevation of machinery and/or equipment the building 8ft.(m) W E servicing _��'J ❑ Lowest adjacent grade (LAG)_ 0 44(f) . -4 ft.(m) Z' in ❑ g) Highest adjacent grade (HAG) Ot5�' . Q ft. (m) d ❑ h) No. of permanent openings (flood vents) within 1 ft. above adj��aac//////ent grade k ❑ 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. I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. l understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. dl! ll' SIGNAT n /% G filE/Q/ -?q.