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YJ
<br />O.M.B. No
<br />3067-
<br />ELEVATION CERTIFICATE Expires May 31
<br />FEDERAL EMERGENCY -MANAGEMENT AGENCY
<br />NATIONAL FLOOD INSURANCE PROGRAM
<br />ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to
<br />provide elevation'Information necessary to ensure compliance with applicable community floodplain management ordinances, to
<br />determine the proper insurance premium rate, and/or to support a•request for a Letter of Map Amendment or Revision (LOMA or LOMB
<br />Instructions for completing this form can -be found on the following pages.
<br />SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE
<br />BUILDING OWNER'S NAME POLICY NUMBER
<br />STREET ADDRESS (Including Apt., Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY MAIC NUMBER
<br />7"K: ? .215 : �3 Z La7' /Q-7
<br />OTHER DESCRIPTION (Lot and Block Numbers, etc.) - -- -
<br />,4ina�o rGr•r�cG Su6diy:S�on
<br />CITY STATE ZIP CODE
<br />SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
<br />Provide the following from the proper FIRM (See Instructions):
<br />7. Indicate the elevation datum system used on the FIRM for Base Flood -Elevations (BFE): ❑ NGVD '29 ❑ Other (describe on back)
<br />8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate
<br />the community's BFE: l I 1 I I I.0 feet NGVD (or other FIRM datum -see Sectidn @, Item 7)•
<br />i SECTION C BUILDING ELEVATION INFORMATION
<br />1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
<br />describes the subject building's reference level / .
<br />2(a). FIRM Zones Al -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
<br />of! i 17017 .1,9 feet NGVD (or other FIRM datum -see Section B, Item 7).
<br />(b). FIRM Zones V1430, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from
<br />the selected diagram, is at an elevation of I I I I I i .H feet NGVD (or other FIRM datum -see Section B, Item 7).
<br />I (c). FIRM Zone A (without BFE). The floor used as the reference level from•the-selected diagram is 1011 j A!°] feet above 2ror
<br />below ❑ (check one) the highest grade adjacent to the building.
<br />(d). FIRM Zone AO. The floor used as the reference level from the selected diagram is I I LH feet above ❑ or below ❑ (check
<br />one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference
<br />level) elevated in accordance"ith the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown
<br />3. Indicate the elevation datum system used in determining the above reference level elevations: 10NGVD '29 ❑ Other (describe
<br />under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than that used on
<br />the FIRM (see Section B, Item 7j, then convert the elevations to the datum system used on the FIRM and show the conversion
<br />equation under Comments on Page 2.)
<br />4. Elevation reference mark used appears on FIRM: ❑ Yes ❑ No (See Instructions on Page 4)
<br />5. The reference level elevation is based on: Eiractual construction .❑ construction drawings
<br />(NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which
<br />case this certificate will only'be valid for the building during the course of construction. A post -construction Elevation Certificate
<br />will be required once construction is complete.)
<br />6. The elevation of the lowest grade immediately adjacent to the building. is: L 1 17I/ 11 .L3..I feet NGVD (or other FIRM datum -see
<br />Section B, Item 7).
<br />SECTION D COMMUNITY INFORMATION
<br />1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
<br />is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest
<br />floor" as defined by the ordinance is: I I I I I I.0 feet NGVD (or other FIRM datum -see Section B, Item 7).
<br />2. Date of the start of construction or substantial improvement
<br />---• - -. ���..,.n..c cnirinn�c SEE REVERSE SIDE FOR CONTINUA'
<br />I
<br />1. COMMUNITY NUMBER
<br />2. PANEL NUMBER
<br />3. SUFFIX
<br />4. DATE OF FIRM INDEX
<br />5. FIRM ZONE
<br />6. BASE FLOOD ELEVATION
<br />G
<br />Cin AO Zones, use depth)
<br />7,3 54. o
<br />7. Indicate the elevation datum system used on the FIRM for Base Flood -Elevations (BFE): ❑ NGVD '29 ❑ Other (describe on back)
<br />8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate
<br />the community's BFE: l I 1 I I I.0 feet NGVD (or other FIRM datum -see Sectidn @, Item 7)•
<br />i SECTION C BUILDING ELEVATION INFORMATION
<br />1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
<br />describes the subject building's reference level / .
<br />2(a). FIRM Zones Al -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
<br />of! i 17017 .1,9 feet NGVD (or other FIRM datum -see Section B, Item 7).
<br />(b). FIRM Zones V1430, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from
<br />the selected diagram, is at an elevation of I I I I I i .H feet NGVD (or other FIRM datum -see Section B, Item 7).
<br />I (c). FIRM Zone A (without BFE). The floor used as the reference level from•the-selected diagram is 1011 j A!°] feet above 2ror
<br />below ❑ (check one) the highest grade adjacent to the building.
<br />(d). FIRM Zone AO. The floor used as the reference level from the selected diagram is I I LH feet above ❑ or below ❑ (check
<br />one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference
<br />level) elevated in accordance"ith the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown
<br />3. Indicate the elevation datum system used in determining the above reference level elevations: 10NGVD '29 ❑ Other (describe
<br />under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than that used on
<br />the FIRM (see Section B, Item 7j, then convert the elevations to the datum system used on the FIRM and show the conversion
<br />equation under Comments on Page 2.)
<br />4. Elevation reference mark used appears on FIRM: ❑ Yes ❑ No (See Instructions on Page 4)
<br />5. The reference level elevation is based on: Eiractual construction .❑ construction drawings
<br />(NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which
<br />case this certificate will only'be valid for the building during the course of construction. A post -construction Elevation Certificate
<br />will be required once construction is complete.)
<br />6. The elevation of the lowest grade immediately adjacent to the building. is: L 1 17I/ 11 .L3..I feet NGVD (or other FIRM datum -see
<br />Section B, Item 7).
<br />SECTION D COMMUNITY INFORMATION
<br />1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
<br />is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest
<br />floor" as defined by the ordinance is: I I I I I I.0 feet NGVD (or other FIRM datum -see Section B, Item 7).
<br />2. Date of the start of construction or substantial improvement
<br />---• - -. ���..,.n..c cnirinn�c SEE REVERSE SIDE FOR CONTINUA'
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