HomeMy WebLinkAbout6-9-005:002 Garage U.S.DePARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 %„/
i-FederalEmergency Management Agency Expires February 28.2009 (v�
National Flood Insurance Program Important: Read the instructions on pages 1-8.
. SECTION A-PROPERTY INFORMATION I For Insurance Company Use:
Al. Building Owner's Name 1 Policy Number 1
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A2. Building StreetreAddress(including Apt.,Unit,Suite,and/or Bldg.� No.)or P.O.Route and Box No. I Company NAIC Number
67-/�r' 7,4 d- ci.4 l4:a 6 Jr."1-e.✓,#4 ge, L® I
City , M VOA#9 - `140- `f'!/ State "46.1 ,fll ZIP Code 743
A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.)
7-M9X: ,.3s 4-9'- elt,.. 02 p: #' Fc44ors -. .ii,T 27 G 9A/ E
A4. Building Use(e.g.,Residential,Non-ResidentialkAddition,Accessory,etc.) ACC 05,,50012/-6/324GE
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
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number
A3. For a building with a crawl space or encloeure(e):nr^Nide: AZ:. For a oi,iiding wan an attached garage,provide:
a) Square footage of crawl space or enclosure(s) sq ft a) Square footage of attached garage sq t
_ Yom)__No._orpetmanentnood openings in the crawi space or o) No.of permanent flood openings In the attached garage
enciosure(s)-walls-wittsia-1.0-foot-above adjacent grade - walls within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in`A9.b sq in
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP Community Name&Community Number 82.County Name HA_wAyiB3.State
B4.Map/Panel Number 85.Suffix B6.FIRM Index - 87.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone
a/ /' Date Effective/Revised Date Zone(s) AO.use base flood depth)
1 /fib e27 ' C iC -2.0.� R. 4:=-69.2-off''
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
0 FIS Profile lo'2 FIRM ❑Community Determined ❑Other(Describe)
811. Indicate elevation datum used for BFE in Item B9: f NGVD 1929 ❑NAVD 1988 ❑Other(Describe)
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes AiNo
Designation Date ❑CBRS ❑OPA
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
Cl. Building elevations are based on: 0 Construction Drawings' 0 Building Under Construction' Nr Finished Construction .
'A new Elevation Certificate will be required when construction of the building is complete.
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
below according to the building diagram specified in Item AT.
Benchmark Utilized RAI -3e. Pi/CM "i•19#:*-13711371Vertical Datum /V.G V j7 / ?2q
Conversion/Comments
G AitAfae OM s 4 8
Check the measurement used.
a) Top of bottom floor(including basement,crawl space,or enclosure floor) 4 4Z E feet ❑meters(Puerto Rico only)
b) Top of the next higher floor /Y ❑ t 0❑meters(Puerto Rico only)
c) Bottom of the lowest horizontal structural member(V Zones only) et .��feet meters(Puerto Rico only)
d) A J garage(top of slab) t' .4-2L_!r t 0 meters(Puerto Rico only)
e) Lowest elevation of.machinery or equipment servicing the building .9."� ❑meters(Puerto Rico only)
(Describe type of equipment in Comments)
f) Lowest adjacent(finished)grade(LAG) 4 .,L feet ❑meters(Puerto Rico only)
g) Highest adjacent(finished)grade(HAG) b .. ✓ feet ❑meters(Puerto Rico only)
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 on this Certificate represents my best efforts to interpret the data available
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
.P i' ' i TO
Check here if comments are provided on back of form. l O LICENSED J'
Certifier's Name 7--� A , ,q A �,Seti License Number A sir• ) PROFES',10 ,�
Title Company Name i *AS SURVEYOR
Address �' r g c x City Avhei 4(04/4 State 9 • ZIP Code 7o No. 498 P
Signatu !rpt -• - Date/� �Q Telephone ?2 g(-ip0 A WA It, ll S
FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions
•
IMPORTANT: In these spaces,copy the corresponding information from Section A. For Insurance Company Use: #
Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number
City State ZIP Code Company NAIC Number
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
t...opy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner.
Comments e�
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GR,¢,v-o• Poo� . i s le ' OM, vi//77R c-A,¢(,/z x is'J o pevYiAe6 s Cz 2•s �
642nd-a S/p,As /94 w o -7Wo //Z SX/O ®Po 4 NGS a AG / (7:07s9 z• rva i)
Signature �c Date /Q/7
❑ Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
Fir Zones AO and A(without BFE),complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B,
For!teras El-E4. if ��.._�.`•. v..�N..0 �,..c oo...__,G.-, val'iv RIW viny,CIILCI iiieters.
_. El....___Provide_elemation_information_forthe.following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade(HAG)and the sourest adjacent grade(LAG).
a)Top of bottom floor(including basement,crawl space,or enclosure)is ❑feet 0 meters 0 above or 0 below the HAG.
b)Top of bottom floor(including basement,crawl space,or enclosure)is . ❑feet 0 meters 0 above or ❑below the LAG.
E2. For Building Diagrams 6-8 with permanent flood•openings provided in Sectio0 Items 8 and/or 9(see age 8 of Instructions),the next higher floor
(elevation C2.b in the diagrams)of the building Is ._0 feet U meters 0 above or U below the HAG.
E3. Attached garage(top of slab)is ❑feet 0 meters ❑above or n below the HAG.
E4. •Top of platform of machinery and/or equipment servicing the building is _❑feet ❑meters 0 above or ❑below the HAG.
E5. 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? 0 Yes 0 No ❑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,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,and E are correct to the best of my knowledge.
Property Owner's or Owner's Authorized Representative's Name
'ss City State ZIP Code
Signature Date Telephone
Comments
• LJ Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
fhe local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E).
Ind G of this Elevation Certificate. Complete the applicable item(s)and sign below. Check the measurement used in Items G8.and G9.
31. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who
is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
32. 0 A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO.
33. 0 The following information(Items G4.-G9.)is provided for community floodplain management purposes.
G4.Permit Number G5. pate Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued
97.This permit has been issued fon 0 New Construction 0 Substantial Improvement
i8.Elevation of as-built lowest floor(including basement)of the building: 0 feet 0 meters(PR) Datum
;9.BFE or(in Zone AO)depth of flooding at the building site: 0 feet 0 meters(PR) Datum
Local Official's Name Th. Department of Public Wciiko Title
Community Name `•'Fltgine/fafg Division MIS r$V1 WsiJ
Telephone
Signature the vet - Certificate and:
fe •mme •S Date
comments 0 •.-g not rocaround
• = _
❑Check here if attachrnenti
EMA Form 81-31, Febr • Replaces all previc.:_