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U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
<br /> ' Federal Emergency Management Agency Expires February 28.2009
<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 p, ,,..- I Policy Number
<br /> 42. Building Street Address(including Apt, Unit,Suite,and or Bldg. No.)or P.O.Route and Box No. li Company MAIC Number
<br /> 6-/ 74 iv=' ,- iZe
<br /> City -SAM VOA A) - go -; i?'// State 1/1,4
<br /> i 14,,,e9// ZIP Code
<br /> A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) l
<br /> '-.1,k a) .-9.- s-. Q2. Pr>. 94, . 0° . - 7 27 (Q/.1ANA)
<br /> A4. Building Use(e.g.,Residential Non-Residential,Addition,Accessory,etc.) i /APP./F. S/ P one/ 7741..
<br /> A5. Latitude/Longitude:Lat 1?b.58'D - •-/n jV Long. /..5,76-'°el 00.PO•N/ Horizontal Datum:- ]NAD 1927 ei NAD 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 .5-
<br /> :
<br /> °A8. For a building with a crawl space or enclosure(s),provide: A . i=o;a building with an attached garage,provide:
<br /> a) Square footage of crawl space or enclosure(s) _ _ sq ft . a) Square footage of attached oaraoe Sc
<br /> _ __tel__nta oi_permanent.flood openings in the crawl space or b) No.of permanent flood openings in the attached garage
<br /> ---_enciosure(s)-walls-within-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 /> 131.NFIP Community Name&Community Number' B2.County NameB3.State
<br /> /,4-415V4 i . . D2 7th G 009:W i/ /�w/g'1/ --
<br /> 34.Map/Panel Number B5.Suffix B6.FIRM Index 87.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone
<br /> 40744. 4,2,er. a'(... #' Date Effective/Revised Date Zone(s) AO,use base flood depth)
<br /> B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
<br /> ❑FIS Profile ►k FIRM ❑Community Determined ❑Other(Describe)
<br /> B11. Indicate elevation datum used for BFE in Item B9: NGVD 1929 0 NAVD 1988 0 Other(Describe)
<br /> 812. Is the building located In a Coastal Barrier Resources System(CBRS)area or erwise Protected Area(OPA)? 0 Yes igiNo
<br /> ❑
<br /> Designation Date CBRS 0 OPA
<br /> SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
<br /> Cl. Building elevations are based on: ❑Construction Drawings' ❑ Building Under Construction' C1 Finished Construction
<br /> 'A new Elevation Certificate will be required when construction of the building is complete.
<br /> C2. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,ARIA.ARAE,AR/A1-A30,AR/AH,AR/AO. Complete Items C2.a-g
<br /> below according to the building diagram specified in Item Al. 0�1
<br /> Benchmark Utilized RA/'-Ja F/RM '2i9P,FAY Vertical Datum /VG V P / 927
<br /> Conversion/Comments
<br /> Check the measurement used.
<br /> 7.66fa) Top of bottom floor(including basement,crawl space,or enclosure floor) . feet 0 meters(Puerto Rico only)
<br /> b) Top of the next higher floor ON,'Lir $?'4a y 01-•Per• _❑f t 0 meters(Puerto Rico only)
<br /> c) Bottom of the lowest horizontal structural member(V Zones only) � 19 feet 0 meters(Puerto Rico only)
<br /> d) Attached garage(top of slab) ^/i A/ , g . ❑f ❑meters(Puerto Rico only)
<br /> e) Lowest elevation of machinery or equipment servicing the building feet 0 meters(Puerto Rico only)
<br /> (Describe type of equipment in Comments)
<br /> Lowest adjacent(fnished) de(LAG)__. 7. f
<br /> �ga0 meters(Puerto Rico only)
<br /> g) Highest adjacent(finished)grade(HAG) 7. -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. /certify that the information on this Certificate represents my best efforts to interpret the data available.
<br /> I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section.1001. , - O C• M Citi
<br /> .i .. 1' "i0% TO
<br /> eJ Check here if comments are provided on back of form. I ©�
<br /> 1C•N.SEDtill.
<br /> Certifier's Name , O •PROFE ,i•,0•.,
<br /> .
<br /> �� .Re��� ®" .4/1 c `rte License Number ..4 B e- +1 I /
<br /> Title z. • �/ �u A/s v ori► .� �ar�0 0-/ • tit
<br /> / ��� Company Name 1 * S .R EYO- '�
<br /> 'A/� ,s��l 1/��®�� �� • No. 4968
<br /> +tidies r Ota City�./ State ZIP Code 9•67i5.---
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<br /> Signatur' / �` .' �t�� ••� i �� / /Y SQ,•
<br /> / i� / �� Date/Q Telephone WA)(. U
<br /> FEMA Form 81-31, February 2006 See reverse side for continua on. - Replaces all previous editions
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