HomeMy WebLinkAbout2-4-050:03302_15)_S 167y: SS N YOSHIVIURA INC 302 P02
ELEVATI(�IV CERT1�l��ATE-GMB xe7.007
EXPIRES: JUNE 30 '99
FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM
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,
Instruction& for completing anis form can be lound un Ina reverse sjag.
UIL INAME
POLICY NUMOI&K
94 1161 Ca A!>O x- !o 2 7
STREET ADDRESS r
Apt.•A/Unci• Yit"Aldp,•e tJ, —ROUT NU 8 R
OTHER DESCRIPTION (Block and lot numbers., oto,)
MY
STATE zip Woe
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
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
owner, or the owner's representative should complete the information in Section t and may also complete the certification. Community officials who are
authorized by local law or ordinance to provlda floodplain management information may also complete this form,
Stt:l WN 1 bu1LuINu tt-MVA 1 WN INPUKMA I IUN
1. Using the Flood Insurance Manual or the NFiP Flood Insurance Application --Part 2 Worksheet, indicate the proper diagram number_
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
elevation of *002'/* feet NGV0. (or other datum -see N5)
3. FIRM Zones Vi430, VE, and V (with 13FE). The bottom of the lowest horizontal structural member of the reference level floor from
the selected diagram is at an elevation of /);/ -"3 feet NGVD (or other datum -see #S).
4. FIRM Zone AQ. The floor used as the reference level from the selected diagram Is 10111feet above highest natural grade next to
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
flood depth number is available, Is the building's lowest floor (or reference level) elevated in accordance with the community's
loodplair. management ordinances? t`L�Yes []No ❑ Unknown ,���� crSGS ��
dicate the elevation datum system used in determining the above reference level elevations:❑VGVD CRtiither (describe on back)
8. Indicate the elevation datum system used on the FIRM for base flood elevations: ❑ NGVO 26
ther (des iI own back)
(A77ENTION: if the elevation datum used in measuringg the elevations is different than that used on the FIRM, then rhe elovation6 providod
must be converted to the datum system used on the FIRM.)
7. Is the reference level based on actual construction? &Yes ❑ No
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-
tion drawings and do not complete question N8. If "No" is chocked, this certification will be valid only for buildings in the course of
construction. After construction of the reference level floor is completed, a post -construction elevation certificate will be required for
continued flood insurance coverage.
8. Provide the following measurements using. the natural grade next to the building (round to the nearest foot).
a. The reference level is: b. The garage floor (it applicable) is:
Ll/lfeet [above ❑ below (check one) the highest grade. I I A feat ,21bove ❑ below (check one) the highest grade.
L� toot above ❑ below (check one) arse lowest grade. L IA feet u above ❑ below (check one) the lowest grade.
SECTION It -FLOOD INSURANCE RATE MAP INFORMATION
Provide the following from the proper FIRM (see instructions on back—Date of FIRM) and accompanying insurance application;
COMMUNITY N. AN L N T I Z N -BA L 1
(In AO Zone, use aepin) ELEVATION ESTABLISHED FOR ZOt•:E A
hi /6G D8 C'/ �j •l� - Sd ^, DR ZONE V. If AVAILA13LE
Elevation reference mark used appears on FIRM ❑ Yes 00 (See reverse side for details)
SECTION 111 CERTIFICATION
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
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
property owner, or the owner's representative can sign ,ne certification, Community officials who are authorized by local law or ordinance to provide
floodplain management information, may also sign the .:eniflcatlon. I certify that the information on this certificate represents my best efforts to intorpret
the data available, I understand that any false statemen! may be punishable by fine or imprisclament under IS U.S. Code, Section 7001.
' • /7 /~ V
1 1 NAME LI EA, UMBER (or AlfixSeal)
4" -e e,— 4e�wl- =. .41
TITLE COMPANY NAME
ADDRESS � � Gt y