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Home My WebLink About1-4-067:0104 FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAMto Expires July 31, 2002 ELEVATION CERTIFICATE : Read the instructions on naaes 1 - 7. SECTION A - PROPERTY OWNER INFORMATIONFor Insurance Company Use: BUJLDIN OWNER'S NAME „- I I Policy Number P.O. ROlJTE AND BOX NO. Company NAIC Number CITY UL f o' — -f -le . S4-1- � G1 PROPERTY DESCRIPTION (Lot and Block Numbers, T x Parcel u ber, Legal Description, etc.) DoT to -7 BUILDING USE (e.g.,Fj�s_id,ntial, o l$idential, Addition, Acces o , etc. Use Comments section if necessary.) - grin LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: LI GPS (Type) ( W -4X- ##.W or ##.#tt###°) IJ NAD 1927 LI NAD 1983 LI USGS Quad Map LI Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION LB1. NFIP C MjVu iTY NAME & COMMUNITY NUMBER B2. COUNTY NAME 4W A tt I � B3. STATEwwkl`` hri1 B4. MAP AN�D// PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUPBER IAAA�®(Gi pA E EFFECTIV /RE ISED DATE Df I/,/RR ZON (S) 1[ (Zone AO use depth of flooding) Lei° B10. Indicate the source of the Base Flood Efev tion (BFE) data or base flood depth entered in B9. 1_1 FIS Profile IJ FIRM /Community Determined L1 Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: LVJ' NGVD 1929 U NAVD 1988 LJ Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? L) Yes 1XI No Designation Date: Allk SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Building elevations are based on: 1_1Construction Drawings' 1_1Building Under Construction' lFinished-Construction 'A new Elevation Certificate ytill be required when construction of the building is complete. C2. Building Diagram Number -!Z (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, AR/A, 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 &L Conversion/Comments V. YOt llc A�B . Lsy -:�-r w - 'Vof &?, . Elevation reference mark used !qaa, – A01, Does the elevation reference mark used appear on the FIRM? 1_1 Yes L&I No ❑ a) Top of bottom floor (including basement or enclosure) mm) .eb) Top of next higher floor_ ft.(m)�%V. TH [Q�� ❑ c) Bottom of lowest horizontal structural member (V zones only) t CJ . 2 ft.(m) N d Attached garage to of slab ft. m .0-0 LICENSED �) 9 9 (top ) — ( ) w cc PROFESSIONAL ❑ e) Lowest elevation of machinery and/or equipment rr servicing the building �7 2 ft.(m) a— * ENGINEER ❑ f) Lowest adjacent grade (LAG) ft. (m)co ❑ g) Highest adjacent grade (HAG) ft.(m) t. Soh) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 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 ' formation. I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data avail ble. i understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ERTIFIER'S NAME K g" �. / LICENSE NUMBER TITLE iN nA tbN taCOMPANY NAME ADDRESS t•La. CITY O� STATE U �I�Y ZIP L;UL (4 U SIGNATURE DATE /Z(/61 TELEPHONE ;6—,v�e Gr=KAA Cnr•rA A1-11 All(', 00 1/ CFr= PP%/PPCF CIr1G Fr1P'r.r1NTIN1 IATInN PPPI Ar PC At I PPF1/Iry n f=nITI0W!Z IMPORTANT: In these spaces, copy the corresponding information from Section A. 1 For Insurance Company Use: BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. I Policy Number j CITY — O tot ; STATE ZIP CQ Company NAIC Number AM SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner:=- ' COMMENTS Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO and ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1 through E3. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMB -F, Section C must be completed. E1. 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.) E2. The top of the bottom floor (including basement or enclosure) of the building is 1_1_I fL(m) JJ_Jin.(cm) 1_1 above or 1_I below (check one) the highest adjacent grade.. E3. For Zone AO only: If no flood depth number is available, is the top of the bottom floorelevated in accordance with the community's floodplain management ordinance? 1-1 Yes' 1_I No 1-1 Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections`A, B, and E for Zone A (without a FEMA -issued or community -issued BFE) or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME Afflk RESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS 1_1 Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance Jo administer the community's -floodplain management ordinance can complete Sections A. B. C (or E), and G of this Elevation Certificate. Complete the applicable it�em(s) and sign belo�v. G1. I-1 The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, en Ineer,;or,&chitect who is authorized by state or.local law to certify elevation information. (Indicate the source and date of the elevation data• a he. Comments area below.) G2. 1_I A community, official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. G3. LI The following information (Items G4-139) i$ provided for community floodplain management purposes. 1 G5. I ISSUED G7. This permit has been -issued for: New Construction 1-1 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: _ ft.(m) Datum: G9. BFE or (in Zone AO) depth gQflooAnq.at the buildinp site, is: - _ ft.(m) Datum: S NAME Er►gineering Division has reviewed TITLE COMMUNITY NAME rr!! Jevation Certificate and TELEPHONE t �"f��Rv�iu� SIGNATURE DATE does not recommend AMENTS 0_Qnaf approval. Check here if attachments F=PKAA Farm R1 .21 AI Ir; CIO