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Home My Public Portal AboutEagles Nest Dr_125NATIONAL FLOOD INSURANCE PROGRAM r L..EVATION CERTIFICATE Important: Read the instructions on pages 1 - 7. O.M.B. No. 3067 -0077 Expires July 31, 2002 BUILDFTG'OWNER'S NAME SECT1ON A - PROPERTY OWNER INFORMATION For Insurance Company Use: Policy Number ::'r DR inep t, U/ ��- '"7 /or dg, 94 RJ$OUTE AND BOX �� `�+�T ��,� �� V g ■.• 4A/v PROPER CRIPT,60N (Lot and B . • Num•- T^ sy ential. Non -re • entia LATITUDE/LONG i E (OPTIONAL) ( ##° - #1* - ##.##" or ##.#011:114r) P STATE 1 r� . I . ,etc dir -•. - se a • mments area, necessary. ton ssory Company NAIC Number ZIPP /28 HORIZONTAL DATUM: SOURCE: LJ GPS (Type): Li NAD 1927 Li NAD 1983 (J USGS Quad Map L_J Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81�.�NFlpP COMMUNITY NAME & COMMUNITY NUMBER 14'5/6+ B2. COUNTY I�AhA�� 4A B3. STATE /'�� [-1 - ��J5 1.-1.-1 1 84. MAP AND PANEL NUMBER /44744- coot. 85. SUFFIX c 86. FIRM INDEX QATE f (l /7 /4G B7. FIRM PANEL EFFECT ' REVI ED DATE 6/(7 i ' B8. FLOOD Z Ec(S T/iJ 89. BASE FLOOD ELEVATION(S) (Zone AO, use depth of flooding) %5 310. indicate the source of the se Flood Elevation (BFE) data or base flood depth entered in B9. I ___( FiS Profile 1 FiRM 1j Community Det p'nined 1_j Other (Describe): 311, Indicate the elevation datum used for the BFE in 89: 1` GVD 1929 (_j NAVD 1988 1_1 Other (Describe): 312. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? (_1 Yes 1 Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) 7,1. Budding elevations are based on: 1_1oonstruction Drawings* i1Building Under Construction' I rnished Construction 'A new Elevation Certificate will equired when construction of the building is complete. •2. Building Diagram Number 7 (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.) ;3. Elevations - Zones A1-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 C3.a -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. ffU�s�e the space provided or the Comments area of Section D or Section G, as appropriate, to documentthe datum conversion. Datum A%iJ(? Z7 Conversion/Comments Elevation reference mark used Does the elevation reference ma k used appear on the FIRM? ❑ a) Top of bottom floor (including basement or enclosure) ja, ❑ b) Top of next higher floor - / ft.(f) ❑ c) Bottom of lowest horizontal structural member (V zones only) .� _ ft.(m) ❑ d) Attached garage (top of slab) . 3 ft•fFTI' ❑ e) Lowest elevation of machinery and /or equipment W servicing the building (Describe in a Comments area.) l7 ..( ❑ f) Lowest adjacent (finished) grade (LAG) ft.((rj 2 g ❑ g) Highest adjacent (finished) grade (HAG) ft.( .- ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade ❑ i) Total area of all permanent openings (flood vents) in C3.h /14 ec sq. in. (sq.-ta1.) 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. f certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. f understand that an false statement ma be •ua ishable b fine or im •risonment under 18 U.S. Code, Section 1001. 3�E 2TIFIER'S E Mi Z LICE SE N MBER 'CV }�1 Yes rlTLE DDD )IGNATL V Pnrm -11 .1111 nn COMPANY NAME AF >= Pr \/ 1 ?e1^ sinF rip PPPl nr1=C Al ! PPPVI I IS Fni -nrwq 1''4 y_ wrri v. rcvu 1 c /ANN/ OVA NU. ropy riurnoer /; )DE r Company NAJC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Ipy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. )MMENTS 1�I Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) Zone AO and Zone A (without BFE), complete Items E1, through E4. If the Elevation Certificate is intended for use as supporting irmation for a LOMA or LOMR -F, Section C must be completed. Building Diagram Number (Select the building diagram most similar to the building forwhich this certificate is being completed – see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) The top of the bottom floor (including basement or enclosure) of the building is 11_I ft.(m) I._-I_jin.(cm) 1 -1 above or 1_I below (check one) the highest adjacent grade, (Use natural grade, if available.) For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is I_I_I R(m) (I_Jin.(crn) above the highest adjacent grade. Complete Items C3,h and C3.i on front of form, 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? I_1 Yes 1I No 1_1 Unknown. The local official must certify this information in Section G. SECTION F-- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION e property owner or owner's authorized representative who completes Sections A, B, C (Items C3.h and C3.i only), and E for Zone A Ithout a FEMA- issued or community - issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are correct to t best of my knowledge. OPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAMT DRESS V/ 1-1 MMENTS CITY STATE ZIP CODE 1 '`•' Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete ions A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. j_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 1 A community official completed Section E for a building located in Zone A (without a FEMA - issued or community- issued BFE) or Zone AO. L. The following information (Items G4-G9) is provided for community floodplain management purposes. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFFCATE OF COMPUANCE/OCCUPJ NCY ISSUED This permit has been issued for 1__1 New Construction j_J Substantial Improvement Elevation of as -built lowest floor (including basement) of the building is: . ft.(m)Datum: 3FE or (in Zone AO) depth offloading at the building site is: ft. (m) Datum: ;Ai. OFFICIAL'S NAME TITLE VIMUNITY NAME TELEPHONE NATURE DATE u1MENTS j_J Check here if attachments A Fr rm R1 -41 _II 11 1111 P PI Ar..PS Al 1 Pt7F \ /IC1I IC PTIMC1RIA