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HomeMy WebLinkAbout2-4-016:052U.S. DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY VE-onol Flood Insumme Program Al. Building Owner's Name A2. Building City ELEVATION CERTIFICATE IMPORTANT: Follow the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION or P.O. Route OMB No. 1660.0008 Exp ration Date: July 31, 2015 FOR INSURANCE COMPANY USE Policy Number' Company NAIC Number ZIP Code 96 7� A3. Property Descd tion (Lot and BI ck Numbers, Tax Parcel N tuber, ivegal Description, etc.) t7 A4. Bu.lding Use (e.g., Residential, Non -Res { enpal, Addition, Accessory, etc. A5. Latitude/Longitude: Lat. / % •9r Long. Horizonta Datum: ❑ NAD 1927 KNAD 1983 A6. Attach at least 2 photographs of he building 'f the Certificate s being used to obta'r flood nsurance. A7. Building Diagram Number A8. For a build:ng with a crawispace or enclosure(s): �/1 /1 A9. For a bu d g with an attached garage: , /,� a) Square footage of crawispace or enclosure(s) � 0 sq `t a) Square outage' of attached garage � sq ft b) Number of permanent flood open ngs n the craw'space b) Number of permanent flood open ngs',n the ^ed garage or enclosure(s) with'n 1.0 foot above adjacent grade within 1.0 foot above adjacent grade c) Tota net area of flood open:ngs in A8.b sq 'r c) Tota net area of flood open ngs `n A9.b i� sq :n d) Engineered l'ood openings? 5rYes ❑ No d) Eng'neered flood open ngs? ❑ Yes ,® No SECTION B - FLOOD INSURANCE RATE MAP (Ft 81. NFIP Commun'ty Name & Community Number B2. County N me NAIVA/ 100v SSS /66 pull// INFORMATION (IOU, B4. Map/Pane) Number B5. Sufxx I B6. FIRM Index Date B7. FIRM Panel Effective/ B8. Flood Zon (s t9g, �j{j �� e. ¢�0 2 iRevind to A B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: ❑ FIS Profile ❑ FIRM ❑ Community Determined 50 Other/Source: EA16/A/E&VA0 (7214X0 811.ln&cate elevation datum used for BFE in Item B9: ❑ NGVD 1929 J4 NAVD 1988 ❑ Other/Source: 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA'? Designation Date: / / ❑ CBRS ❑ OPA B3. - i f&W)A B9. Base Flood Elevation(: A0, use base flood de, ❑ Yes ,kNo SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Build ng elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* 1% Fin shed Construction *A new Elevation Certificate will be requ red when construction of the budding is complete. C2. E evations - Zones Ai -A30, AE, AH, A (with BFE), VE, Vi -V30, V (with BFE), AR, AR/A, AR/AE, AR/Al-A30, AR/A , AR/A0. Complete items C2.a-h below according to the building diagram specified in item A7. In Puerto Rico on+y, enter meters. Benchmark Utilized:-C,flAi1I&IM JAJV' "T- Vertical Datum: , Ind cate elevation datum used for the elevations n tems a) through h) below. ❑ NGVO =929 ® NAVD 1988 (3 Other/Source: Datum used for bu ldmg elevations must be the sa a as tha sed for the BFE. Z� Check the measurement used. a) Top of bottom floor (•nclud ng basement, crawispace, or enc osure oor) �_ [fffeet ❑meters b) Top of the next higher floor_ ❑feet ❑meters c) Bottom of the lowest horizontal structura member V Zones on y) I_ ❑ feet ❑ meters d) Attached garage (top of slab) ,1) . 1L E(eet ❑ meters e) Lowest elevation of machinery or equipment servic ng the bu Id g 3 . 9�� Wfeet ❑ meters (Describe type of equipment and :ocat on in Comme is 2�d f) Lowest adjacent (fin',shed) grade next to bu Id'ng LAG) ✓r4 �� [E fee: ❑ meters g) Highest adjacent (finished) grade next to building (HAG)3i S' et ❑ meters h) Lowest adjacent grade at lowest eievation of deck or stairs, inc ud ng . Vf�eet ❑ meters structural support SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION Th s certification .s to be s gned and sealed by a land surveyor. engineer, or architect authorized by law to certify eleva,,on .ormation. I certify ti at a nformat+on on tris Certificate represents my best efforts to Interpret the data ava-lab e understand that any fa se statement may be pun'shable by fine or imprisonment under 18 U.S. Code, Section 1001 A. M,q Check nere i co a is are prov ded o- back of orm. Were latitude and longitude n Sect on A provided by a Qp' sy ❑ Check here if attac ents. licensed land surveyor? ❑ Yes PKNo ro.rise.•� �;�.,,e _REGIST� Fn •4. Title n/L//L Add,ess P ^ Sigrat,ae FEMA Form 086-0.33 (Revised 7/12) `Va^`eG//uGG L-0. '^ State 4, Z9p,�gd� /� TIF o e 965 7 � See reverse side for continuation. ENGIN ME HERE No. 7469-C / Replaces all previous editions. ELEVATION CERTIFICATE, page 2 IMPORTANT: In these spaces, copy the corresponding information from Section A. Su;ldirijil Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. C'tY 9672-6State ZIP Code FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number. SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) commun ty official, (2) insurance agent/company, and (3) build ng owner. L,ommenrs � S © A"I'l v Signature � � � �ry / Date SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR IONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items EI -E5. If the Certificate is 'ntended to support a LOMA or LOMR-F request, complete Sections A, B,and C. For Items El -E4, use natural grade, if available. Check the measurement used. In Puerto R'co only, enter meters. El. Provide elevation information for the follow.ng and check the appropriate boxes to show whether the elevatio^ 's above or below the h'ghest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawispace, or enclosure) s ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawispace, or enc,osure .s ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided n Section A Items 8 and/or 9 (see pages 8-9 of Instructions), the next h gher floor (elevation C2.b in the d-agrams) of the bu"d ng s ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equ'pment servicing the bu.iding is ❑ 'eet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only: If no flood depth number is ava•lable, s the top of the bottom floor elevated in accordance Wth the commun'ty's foodplain manageme-_ ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify th.s information in Sect'on 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 FEMAgssued or community4ssued BFE) or Zone AO must sign here. The statements in Sections A, 8, and E are correct to the best of my knowledge. Property er or Owner's Authonzp4 R entative's Name Address ❑ Check mere if attachments. SECTION G — COMMUNITY INFORMATION (OPTIONAL) The loca official who is authorized by iaw or ord -ance to administer the community's floodplain - management ordinance can complete Sections A, B, C (or E), and G of th s Elevation Certificate. Complete the appl'cable item(s) and sign below. Check the measurement used in items G8 -G10. in Puerto Rico only. enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyof, engineer, or architect who is authorized by law to cert fy e:evation informat on. (Ind cate the source and date of the elevation data :n the Comments area below.) G2. ❑ A community official completed Sect on E for a build ng located ;n Zone A (without a FEMAissued or commun;ty-iss ed BFE) or Zone A0. G3. ❑ The following information (Items G4 -G10) s provided for community floodp:&n management purposes. G4. Permit Number G5. Date PermA Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. Th's perm t has been issued for: ❑ New Construction ❑ Substantial improvement G8. Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters Datum G9. BFE or (in Zone AO) depth of floov�g, at a building site: ❑feet ❑ meters Datum G10. Community's des;gn flood elevatioli`.'e 6epartment of Publics o ks ❑feet ❑ meters Datum T'r .C• vocal Official's Name Engincegthe Ele•- ,::t;on Certificate and Title Community Name R recomir :ends Telephone Sgnature LI docs not I'600MITIenCil Date Comments H lei! approval MAY 0 7 2014 ❑ Check here if attachments. FEMA Form 086.0-33 (Revised 7/12) Replaces all previous editions.