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U.S.DePARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 %„/
<br /> i-FederalEmergency Management Agency Expires February 28.2009 (v�
<br /> National Flood Insurance Program Important: Read the instructions on pages 1-8.
<br /> . SECTION A-PROPERTY INFORMATION I For Insurance Company Use:
<br /> Al. Building Owner's Name 1 Policy Number 1
<br /> ��'�:�. t.,.....--;:,
<br /> v• dt'''Ty� dmf s���/.��� ���
<br /> A2. Building StreetreAddress(including Apt.,Unit,Suite,and/or Bldg.� No.)or P.O.Route and Box No. I Company NAIC Number
<br /> 67-/�r' 7,4 d- ci.4 l4:a 6 Jr."1-e.✓,#4 ge, L® I
<br /> City , M VOA#9 - `140- `f'!/ State "46.1 ,fll ZIP Code 743
<br /> A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.)
<br /> 7-M9X: ,.3s 4-9'- elt,.. 02 p: #' Fc44ors -. .ii,T 27 G 9A/ E
<br /> A4. Building Use(e.g.,Residential,Non-ResidentialkAddition,Accessory,etc.) ACC 05,,50012/-6/324GE
<br /> A5. Latitude/Longitude:Lat. /r°6-4-8'OZ. reg9 A" Long. 4.4:54,3"/ 06•4-+6 W Horizontal Datum: ❑NAD 1927 XNAD 1983
<br /> A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
<br /> A7. Building Diagram Number
<br /> A3. For a building with a crawl space or encloeure(e):nr^Nide: AZ:. For a oi,iiding wan an attached garage,provide:
<br /> a) Square footage of crawl space or enclosure(s) sq ft a) Square footage of attached garage sq t
<br /> _ Yom)__No._orpetmanentnood openings in the crawi space or o) No.of permanent flood openings In the attached garage
<br /> enciosure(s)-walls-wittsia-1.0-foot-above adjacent grade - walls within 1.0 foot above adjacent grade
<br /> c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in`A9.b sq in
<br /> SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
<br /> B1.NFIP Community Name&Community Number 82.County Name HA_wAyiB3.State
<br /> B4.Map/Panel Number 85.Suffix B6.FIRM Index - 87.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone
<br /> a/ /' Date Effective/Revised Date Zone(s) AO.use base flood depth)
<br /> 1 /fib e27 ' C iC -2.0.� R. 4:=-69.2-off''
<br /> B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
<br /> 0 FIS Profile lo'2 FIRM ❑Community Determined ❑Other(Describe)
<br /> 811. Indicate elevation datum used for BFE in Item B9: f NGVD 1929 ❑NAVD 1988 ❑Other(Describe)
<br /> B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes AiNo
<br /> Designation Date ❑CBRS ❑OPA
<br /> SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
<br /> Cl. Building elevations are based on: 0 Construction Drawings' 0 Building Under Construction' Nr Finished Construction .
<br /> 'A new Elevation Certificate will be required when construction of the building is complete.
<br /> C2. Elevations-Zones A1-A30,AE,All.A(with BFE).VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30.AR/AH.AR/AO. Complete Items C2.a-g
<br /> below according to the building diagram specified in Item AT.
<br /> Benchmark Utilized RAI -3e. Pi/CM "i•19#:*-13711371Vertical Datum /V.G V j7 / ?2q
<br /> Conversion/Comments
<br /> G AitAfae OM s 4 8
<br /> Check the measurement used.
<br /> a) Top of bottom floor(including basement,crawl space,or enclosure floor) 4 4Z E feet ❑meters(Puerto Rico only)
<br /> b) Top of the next higher floor /Y ❑ t 0❑meters(Puerto Rico only)
<br /> c) Bottom of the lowest horizontal structural member(V Zones only) et .��feet meters(Puerto Rico only)
<br /> d) A J garage(top of slab) t' .4-2L_!r t 0 meters(Puerto Rico only)
<br /> e) Lowest elevation of.machinery or equipment servicing the building .9."� ❑meters(Puerto Rico only)
<br /> (Describe type of equipment in Comments)
<br /> f) Lowest adjacent(finished)grade(LAG) 4 .,L feet ❑meters(Puerto Rico only)
<br /> g) Highest adjacent(finished)grade(HAG) b .. ✓ feet ❑meters(Puerto Rico only)
<br /> SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
<br /> This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation
<br /> information. I certify that the information on this Certificate represents my best efforts to interpret the data available
<br /> I unders and that any false statement may be punishable by fine or imprisonment under 18t1.S.`Code:Section 1001 y + • C. ti►e/N
<br /> .P i' ' i TO
<br /> Check here if comments are provided on back of form. l O LICENSED J'
<br /> Certifier's Name 7--� A , ,q A �,Seti License Number A sir• ) PROFES',10 ,�
<br /> Title Company Name i *AS SURVEYOR
<br /> Address �' r g c x City Avhei 4(04/4 State 9 • ZIP Code 7o No. 498 P
<br /> Signatu !rpt -• - Date/� �Q Telephone ?2 g(-ip0 A WA It, ll S
<br /> FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions
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