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Home My WebLink About6-9-005:010 RenovationsEl FEDERAL EMER,GENCTMANAGEMEAGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Imoortant: Read the instructions on oases 7 - 7. r• 1 O.M.B. No, 3067-0077 Expires July 31, 2002 SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME �CJ r�K O ZZ C- Policy Number BUILDING STREET ADDRESS (including Apt., Unit, Suite, andforBidg. No.) OR P.O. ROUTE AND BOX NO. Company MAIC Number CITY uuL& q/ S /vim }•CO 7S .Q � U� f i.' TT / /!� ,¢ ( W - ##-#At-AW or - --------------- (�i'j NAD 1927 LJ NAD 1983 area,9 necessary.) S/nC7 " USGS Quad Map W Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B4. MAP AND PANEL B . SUFFIX 136. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION($j' NUMBER DATE EFFECTNEIREVISED DATE 1 , Z9t3_E(S) (Zone AO, use depth of flooding) 02 77 - 6 -88 Vc B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in 89. (_J FIS Profile IXI FIRM L-1 Community Determined (,J Other (Describe): B11. Indicate the elevation datum used for the BFE in 89: X NGVD 1929 (J NAVD 1988 J_J Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? (J Yes (W No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ((Construction Drawings* JJBuilding Under Construction* ( Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number .5- (Select the building diagram most similar to the building forwhich 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, ARAE, AR/A1-A30, AR/AH, AR/AO Complete Items C3.a-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 1W _SL Conversion/Comments Elevation reference mark used Qv4.lo 11'%51- Does the elevation reference mark used appear on the FIRM? L( Yes (�( No ❑ a) Top of bottom floor (including basement or enclosure) //..ft* m Q b) Top of next higher floor Zep rµ) D • F�-% O c) Bottom of lowest horizontal structural member (V zones only) 5-1 OD ❑ d) Attached garage (top of slab) —ft -(m) w W pp0> (:SSIOt@AL O e) Lowest elevation of machine and/or equipment servicing the building (Describe in a Comments area.) / / .¢7 ft.(m) E m SURVEYOR ❑ f) Lowest adjacent (finished) grade (LAG) J. .7 �(iw) z' f. * NO. 7276 0 g) Highest adjacent (finished) grade (HAG) 6 `LO (sa} g y D h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade yq(�,I,Ii;t X35- 0 oPO i) Total area of all permanent openings (flood vents) in C3.h 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. l certify that the information in Sections R, B, and C on this cert#7cate represents my best efforts to interpret the data a vailable. I understand that any false statement maybe punishable by fire or imprisonment under 18 U.S. Code, Section 1001. CERTIFIEWS NAIUIE <:Q �Cf1i/ - LICENSE NUMBER � s- -TFT-LE, COMPANY NAMElea�E/' �/ • "Ce �G Ti cit PZ S LZ C - ADDRESS �0 z3D X �Ci `t �� Cly Gr�.�/r�OL%:%� STATE u / ZIP CODE 9'1,' 73� EGMA EnrrTi R1_31 n 11 M CFF REVERSE RIr1F Fr1R f`r 1hlTltdl IATInN ic�crnvnc Al I PREVlr)1IR IM1R'ORTANT: In these spaces, co the corresponding informatidn from Section A. For Insurance Cc BUILDING STREET ADDRESS (Including Apt., Unit, Suite, andlor Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number CIfY�U��O �'( j9�!r✓�Gr4 STATE`7,1-3 ZIP CODE Company NAIC t SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenticompany, and (3) building owner. %A %95 d422---7- 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 E4. 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 {JJ ft•(m) JJ.Jim(cm) I _I above or I I below (check one) the highest adjacent grade. (Use natural grade, if available.) E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is JJ J ft -(m) I_,J_Jin.(cm) above the highest adjacent grade. Complete Items C3.h and C33 on front of form. E4. For Zone AO only. If no flood depth number is available, is the,top of the bottom floor elevated in accordance with the community's floodplain management ordinance? (_{ Yes Irl No I_I 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. C (Items C3.h and C3.i only), and E for Zone A (without a FEMA -issued or community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are correct to the best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CWE Slij A URE DATE TELEPHONE COMMENTS IJ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, 8, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. JJ The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (indicate the source and date of the elevation data in the Comments area below.) G2. J_J 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. LJ The following information (Items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been issued for. 1J New Construction J_ j 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 of flooding at the building site is: _ft.(m)Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS Check here if attachments orFKAA Fnrm R1_31 _1111 nn RFPI Ar.FG Al I PRFVlr111R r-F)1Tlr)N.R