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02_15)_S 167y: SS N YOSHIVIURA INC 302 P02
<br />ELEVATI(�IV CERT1�l��ATE-GMB xe7.007
<br />EXPIRES: JUNE 30 '99
<br />FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM
<br />This form Is to be used for: 1) Poat-FIRM conateuetion only when the base Il000 Information Is available for the building alta: and 2) Pro -FIRM outldings rs,ad using Post -FIRM riles,
<br />Instruction& for completing anis form can be lound un Ina reverse sjag.
<br />UIL INAME
<br />POLICY NUMOI&K
<br />94 1161 Ca A!>O x- !o 2 7
<br />STREET ADDRESS r
<br />Apt.•A/Unci• Yit"Aldp,•e tJ, —ROUT NU 8 R
<br />OTHER DESCRIPTION (Block and lot numbers., oto,)
<br />MY
<br />STATE zip Woe
<br />This form is to be completed by a land surveyor, engineer, or architect who is authorized by state law to certify elevation information when the elevation
<br />information for zones At -A30, A5, AH, A(with 9175), V1 -V30, VE, and V(with BFI:) is required. in the case of zone AQ, the building official, the property
<br />owner, or the owner's representative should complete the information in Section t and may also complete the certification. Community officials who are
<br />authorized by local law or ordinance to provlda floodplain management information may also complete this form,
<br />Stt:l WN 1 bu1LuINu tt-MVA 1 WN INPUKMA I IUN
<br />1. Using the Flood Insurance Manual or the NFiP Flood Insurance Application --Part 2 Worksheet, indicate the proper diagram number_
<br />2. FIRM Zones Al -A30, AE, AH, and A (with SFE). The top of the reference level floor from the selected diagram is at an
<br />elevation of *002'/* feet NGV0. (or other datum -see N5)
<br />3. FIRM Zones Vi430, VE, and V (with 13FE). The bottom of the lowest horizontal structural member of the reference level floor from
<br />the selected diagram is at an elevation of /);/ -"3 feet NGVD (or other datum -see #S).
<br />4. FIRM Zone AQ. The floor used as the reference level from the selected diagram Is 10111feet above highest natural grade next to
<br />the building (also enter In line 8). This value must be equal to or greater than the AO Zone flood depth number listed below. it no
<br />flood depth number is available, Is the building's lowest floor (or reference level) elevated in accordance with the community's
<br />loodplair. management ordinances? t`L�Yes []No ❑ Unknown ,���� crSGS ��
<br />dicate the elevation datum system used in determining the above reference level elevations:❑VGVD CRtiither (describe on back)
<br />8. Indicate the elevation datum system used on the FIRM for base flood elevations: ❑ NGVO 26
<br />ther (des iI own back)
<br />(A77ENTION: if the elevation datum used in measuringg the elevations is different than that used on the FIRM, then rhe elovation6 providod
<br />must be converted to the datum system used on the FIRM.)
<br />7. Is the reference level based on actual construction? &Yes ❑ No
<br />A "No" answer is only valid if the building does not have the reference level floor in place. Fill in the elevation based on construc-
<br />tion drawings and do not complete question N8. If "No" is chocked, this certification will be valid only for buildings in the course of
<br />construction. After construction of the reference level floor is completed, a post -construction elevation certificate will be required for
<br />continued flood insurance coverage.
<br />8. Provide the following measurements using. the natural grade next to the building (round to the nearest foot).
<br />a. The reference level is: b. The garage floor (it applicable) is:
<br />Ll/lfeet [above ❑ below (check one) the highest grade. I I A feat ,21bove ❑ below (check one) the highest grade.
<br />L� toot above ❑ below (check one) arse lowest grade. L IA feet u above ❑ below (check one) the lowest grade.
<br />SECTION It -FLOOD INSURANCE RATE MAP INFORMATION
<br />Provide the following from the proper FIRM (see instructions on back—Date of FIRM) and accompanying insurance application;
<br />COMMUNITY N. AN L N T I Z N -BA L 1
<br />(In AO Zone, use aepin) ELEVATION ESTABLISHED FOR ZOt•:E A
<br />hi /6G D8 C'/ �j •l� - Sd ^, DR ZONE V. If AVAILA13LE
<br />Elevation reference mark used appears on FIRM ❑ Yes 00 (See reverse side for details)
<br />SECTION 111 CERTIFICATION
<br />This certification is to be signed by a land surveyor, er,;pneer, or architect who is authorized by state law to certify elevation illormanon when the
<br />elevation information for zones AI -A30, AE, AH, A(with OPE). V7 -V30, VE', and Vfwith 8FE) Is •aquirad. In the case of zone AO, the building official, the
<br />property owner, or the owner's representative can sign ,ne certification, Community officials who are authorized by local law or ordinance to provide
<br />floodplain management information, may also sign the .:eniflcatlon. I certify that the information on this certificate represents my best efforts to intorpret
<br />the data available, I understand that any false statemen! may be punishable by fine or imprisclament under IS U.S. Code, Section 7001.
<br />' • /7 /~ V
<br />1 1 NAME LI EA, UMBER (or AlfixSeal)
<br />4" -e e,— 4e�wl- =. .41
<br />TITLE COMPANY NAME
<br />ADDRESS � � Gt y
<br />
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