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Home My WebLink About2-4-079:015 . 2003 08:39 8089697842 BRILHANTE HI PAGE 02 • r -2ee3 01 :40 PM PAUL-IH4MURRAY 8089590355 P. 02 J FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM 0.M•B• No, 3067-0077 ELEVATION CERTIFICATE Expires July 31,2002 Im ortant: Read the instructions on a SECTION A•PROPERTY OWNER INFORMATION For Inauranae ber y btAlLAll�I�i o R'S NAME Compsn Use: ----- �. --.-SAM,.. t ti L}`�JAar1Tq» Policy NUm aoLD!NG STREET ADDRESS(including Apt.,Unit,Suite,and/or Bldg•No,)OR P,O.ROUTE AND BOX N0. CITY a 1 .4 A,I C:;), M""LAGt.' nY NAIC Number • Lp STATE ZIP CODE FR07 RTV DESCRIPTION(Lot and Stock Numbers,Tax Parcel Number,Legal Description etc.) A��1 l `_° cS - -1 b si 1 2 ' ' _C-79 015 BUILDING - RA,.Residential, `on-residenbat, •.t on,Accessory,etc. Coffman 3 section it necessary.) zg:- s t Oli 'T-litf._ -- N V4•1_ p ,)E.L.I.-. iATi i UDE/LONG(TUDE 1OP11 NAL) HORIZO AL DATUM: SOURCE: 1 GPS(Type) ( ••efr-NN,w Or 1/6.N altW) U NAD 1927 U HAD 1083 LI USGS Quad Map --1_71----7--- ....,. SECTION Et•FLOOD INSURANCE RATE MAPFIRM INFORMATION , El. COMMUNITY NAME I COMittUNfTY NUMBER 82.COUNTY NAME B3.STATE _ 64:MAP AND PANCL B6, U FIX Be.FIRM INDEX 97,FIRM PANEL ,FLOOD BB, FLOOD AI N(S) ! 6� • TE EFFECTI R.VISED DATE ZONE(S) (Zone AO,use depth of flooding) G 02 9g q ib t8 4. I ", ; .icate the source of they Base Flood Elevation(BFE)data or base flood depth entered 1n H6, L_1 F15 Profile I•'r FIRM 11 Community Dglermined 11 Other(Describe): 811, Indicate the elevation datum used for the BEE In 89:[fNQVD 1929 11 NAVD 1986 II Other(Describe): 2. is the building located In apoestal Barrier Resources System(CBRS)area or Otherwise Protected Ares(OPA)7 1J Yes Lid No Designation Date: kVA SECTION C•BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C'.Building elevations are based on: L--IConatruclion Drawings* LIBulIding Under Conetructian• Finished Construction 'A new Elevation Certificate will be required when construction of the building Is complete, C;2.evllding Diagram Number 5 (Select the building diagram most similar to the building for which this certificate is being completed-see pages S find 7. if no diagram accurately represents the building,provide a sketch or photograph.) • C3.Elevations-Zones Al A30,AE,AH.A(with SFE), VE,V1•V13O, V(with BFE),AR,AR/A,ARAE,ARIAM-A30,AR/AH,AR/AO Co-epiete Items 03e-I below according to the building diagram specified In Item C2.State the datum used,If the datum Is different from ,:-,?..c,-,;1..;,7.-.. used for the BFE in Section 8,convert the Boum to that used for the BFE.Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section 0 or Section 0,as appropriate,to document the datum conversion. Datum___-•___-,- Conversion/Comments Elevation reference mark used 1re'. I. M014 �...._Does the elevation reference mark used appear on the FIRM? LI Yes 1 j No 1? s)Top of bottom floor(Including basement or enclosure) '9•.941 .L.ft(m) 7f Top of next higher floor _._ft(m) h `)� H. A4/./A,R 1?.0743 : 7-; Sot=of lowest horizontal structural member(V zones only) _11(m) 1 qP q At. Attached*age(top of slab) .�-ff'(m') .1LICENSED • PROFESSIONAL � e) Lowest elevation of machinery and/or equipment 8 * LAND SURVEYOR #I servicing the building en(m) f 17.1 `},Lowest adjacent grade(LAG) ' '—� .1......11(m) No.LS-7589 ilii 3, Highest adjacent grade(HAG) 11-.$q 4.ff,(m) r ^_ '-," Rb.of permanent openings (flood vents)within 1 n,above adj amt grade,1,j'l.A, 441144 N tJ 5' p O �)Total area of all permanent openings(flood vents)in C3h I4sq.In,(sq.cm) G ,c-----.6 SECTION 0•SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a lend surveyor,engineer, or architect authorized by law to certify elevation information. I cnrllfy that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the date available. jrce .'and that an false statement me be •unl hable b fine orirn•risonmenf under 18 U.S.Code Section 1001, `° !BR'S NAME .r- ' ' ANY NAMF L-LC.1, pjt rIZS3tok1�L, L-41D dUrtVrsyoK, , -avL 6 . iIrzpAlf' IP. Assala-its , LL...C,,, AMR-SS 1%e ibezncCITY ILO) tl STATE .� ) 31P COPE Cl�^f 1,118.1 '� �� r �"�r-«--^ - ., DATE -o,7 142176 YELEPHO - act 959•g.99 5 .. :. -1= A!Ir.PO -CFF RF'lfF cF Rir1F Fr1f7 r:r1NTINi IATIr1N PDI AC. AI I PP Vlrll Is Rr1ITIr1NF '/3P/2003 08:39 8089697842 BRILHANTE HI PAGE 03 ?%-2903 01040 PM PAUL9HyMURRAY 8089590355 P. 03 In these spaces,co...the corresponding Intonation from Section A. For Insurance Company Ute: �1 E `NG - R EETADDRESS.E (Including Suite,and/or Bldg,No.) •R P.O.ROU AND BOX NO, Policy Number P CITY i STATE , , ZIP CC 4..7 Z rtpany MAIC Number SECTION P.SURVEYOR,BNOINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate(or(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 8FE) f=ar Zone AO.and Zone A(without SFE),complete Nems E1 through E3. if the,Elevation Certificate is intended for use as supporlfnp inter;; tion fora LOMA or LOMR-F,Section C must be completed. siding 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 budding,provide a sketch or photograph.) E2,The top of the bottom floor(including basement or enclosure)of the building is ) I I fL(m)f I Iln,(cm) ( I above or G_-,)below (check one)the highest adjacent grade. 5.3. 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 `!�=drteln management ordinan ?Li Yes' No 1 Unknown. The'001 official must Cecil this information in Section Q, �� ia_I rte•ce SECTION F-PROPERTY OWNER(QR 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 SFE)or Zone AO must sign here. t PROPERTY OWNER'S OR Ovi R'S AU T�HQRIZS• PRESENTATIVE'S NAME ACORE-SS CITY STATE Za3 CODE Steri •711RE • TE T LEPNON COMNtl:N7S — .. .—.» • Check here If attachments SECTION G•COMMUNITY INFORMATION(OPTIONAL) Tilt loc.; official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete •c ?^ri A,8,C(or E),end G of this Elevation Certificate. Complete the applicable Item(s)Arid Sign bsidw. 01.LI The lnformetIon In Sedion C was taken from other document.Uon that has been signed and embossed by a licensee surveyor, engineer,or architect who is authorized by state or local law to certify elevation information. (Indicate the source end date of the elevation dale In the Comments area below.) L, A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-Issued BFE)or Zone A0. G3.1...j The following information(Items G4-G9)is provided for community floodplain management purposes. G4.PE MIT NUMBER G5. DATE PERMIT issuEP OS. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED f37,This permil has been issued for: Li New Construction Li Substantial Improvement of as-buil)lowest floor rnciuol (' np basement)of the building is; _ _N.(m)Datum: E'F (ir!Zone AO)depth of flooding at the building elle is: V.'.CA'.OFFICIAL'S NAME TITLE • MUNITY NAME - - • •. r11- • 0 .1.)• re "or s TELEPH• E '• • DATE fg recommends [) does not recommend fmai approval J ) Check here If attachments • . a< �, ni ir.nn By T. • >7r-ni Ar`FQ All n19r_ti/ins!C rnrnnatc Date `e-1$1k03