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Home My WebLink About2-4-037:069 4 , FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 ELEVATION CERTIFICATE Important: Read the instructions on pages 1 -7. SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use: BUIL ER'S NAME Policy Number os N I R.0 BUILDING SIRE ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIL Number _ N OOLAO LE ST W N ( A W6t tS soSTATE ZIP CODE n CITY 1 LO V CLO L.0 PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) 1� •1-kAV. --z—4.03-7 .1coG9 BUILDINGUSE(e. Residential, Non-residential,Addition,Accessory,etc. Use Comments section if necessary.) I S I E .JT I-I_ u LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: LI GPS(Type) • ( ##°-##'-#4.11=r or #4.#####°) LI NAD 1927 (]NAD 1983 Li USGS Quad Map Li Other. SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION B1. NFIP COMMUNITY NAME 8 COMMUNITY NUMBER 62.COUNTY NAME B3.STATE (�1 1^ j ' - + JM t 0_GO►�-rk( i -c-1(.06:3 W MAI 1 O B4. MAP AND PANEL 65. SUFFIX B6.FIRM INDEX B7. FIRM PANEL B8.FLOOD B9.BASE FLOOD ELEVATION(S) NUMBER , DATE, �+ EFFECCTIVE/RIEVISED DATE ZONE(S) (Zone A+,use depthdeof flooding) \SS(h(o - 690 - G 6+O.Z `S or base 01 68enteredinB9. 14 `O B10. Indicate the source of the Base Flood Elevation(BFE)datadepth 1_I FIS Profile IBJ FIRM 1_1Community Determined LI Other(Describe): B11. Indicate the elevation datum used for the BFE in B9: I_I NGVD 1929 IBJ NAVD 1988 Li Other(Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS)area or Otherwise Protected Area (OPA)? LI Yes ISI No Designation Date: SECTION C -BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: LIConstruction Drawings' LlBuilding Under Construction' LX 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 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 Conversion/Comments Elevation reference mark used SO Bi g Nl Does the elevation reference mark used appear on the FIRM? 1_1Yes IA No ❑ a)Top of bottom floor(including basement or enclosure) 61 .; . "2- ft.(m) r ❑ b)Top of next higher floor NA .—ft.(m) d ; ❑ c) Bottom of lowest horizontal structural member(V zones only) �A .—ft.(m) ooJ ❑ d)Attached garage (top of slab) (c,e0C( 0 ft.(m) w` n,,2 ❑ e) Lowest elevation of machinery and/or equipment ..a (p,(/ ..1 servicing the building (o 1-6 . 2- ft.(m) ? c�,`b,. ,/:D'.. ❑ f) Lowest adjacent grade (LAG) (col- . 0 ft.(m) 2.,g, o g) Highest adjacent grade (HAG) 4-0(c'S O ft.(m) o h) No. of permanent openings(flood vents)within 1 ft. above adjacent grade b O i) Total area of all permanent openings (flood vents) in C3h 600 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. I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. iderstand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. FIER'S NAME LICENSE NUMBER AGveo .t/c. E� ayc TITL COMPANY NAME �t�:kE L jp�/ C/1//L. 5N�y/•J - i�J2o,o4-e_J A La -7/09 C x/ei 57_ f iT Y ST E,�7 SIGN 11RE { 5TE 3 0-- C- P�16% -*9 c 1 1 VIPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: UILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Policy Number :ITY STATE ZIP CC Company NAIC Number SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION (CONTINUED) :opy both sides of this Elevation Certificate for(1)community official, (2)insurance agent/company,and (3)building owner. :OMMENTS I Check here if attachments • SECTION E -BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO and ZONE A(WITHOUT BFE) x Zone AO and Zone A (without BFE), complete Items El through E3. if the Elevation Certificate is intended for use as supporting formation for a LOMA or LOMR-F, Section C must be completed. 1. 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.) 2. The top of the bottom floor(including basement or enclosure)of the building is 1-1-1 h•(m)I_I_1in.(cm) I_I above or 1_1 below (check one) the highest adjacent grade. 3. 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?1_1 Yes. 1_1 No II Unknown. The local official must certify this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION he property owner or owner's authorized representative who completes Sections A, B, and E for Zone A(without a FEMA-issued or ommunity-issued BFE) or Zone AO must sign here. Rl°ERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ,D ...cSS CITY STATE ZIP CODE IGNATURE DATE TELEPHONE OMMENTS Check here if attachments SECTION G -COMMUNITY INFORMATION (OPTIONAL) e local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete ctions A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. • I I 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.) 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. I1 The following:information(Items G4-G9) is provided for community floodplain management purposes. 4. PERM:T NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED .This permit has been issued for: 1_I New Construction Li Substantial Improvem t . Elevation of as-built lowg�5t5u(]fil�cl�og J4Awr ?t) of the building is: a Department )� � WorksBFE or (in Zone AO) derp(`tfii�rt t ' e Engineering–6it4sCp� reviewed )CAL OFFICIAL'S NAME �� ORKS the Eie..C1i9n CC kale -and SUBMITTAL RECORD TITLE recommends DMMUNITY NAME ❑ does not recommend 1=1NO Excep ion Taken TELEPHONE c' 'URE El Revise As Noted, DATE finai approval DMMENTS DiStrF'Jute Record Copy ❑ � .�.isP As Note+, %submit --=-1 ❑ r e e 'gid, Resubmit (0,15102 Reviewe-_` . „ Date hments