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Home My Public Portal AboutEagles Nest Dr_131BUILDING O�vNER'S NAME NATIONAL FLOOD INSURANCE PROGRAM ELI NATION CERTIFICATE Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION V.M.1:1. NO. , Ub /-UU // Expires July 31, 2002 For Insurance Company Use: Policy Number BUILDING STRE DA)RES dinAttApite, agd�{ Idg ) OR P.O. ROUTE AND BOX NO. CITY i' .1-•G 'NJ PROPER,07IPT�ON (Lot an Blodc Nu, Tax Par e/r Legal 6o t.c.) BUILDING U 7 dental, Non-residential, Addition, Accessory,, tc. Use a Comments area, if necessary.) Company NAIC Number LATITUDE/LONGITUDE (OPTIONAL) ( 4#° - ## - 4# *V or 4#.#####°) HORIZONTAL DATUM: 1 NAD 1927 1_ NAD 1983 SOURCE: LJ GPS (Type): LJ USGS Quad Map L_i Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B�FI MU�JY NAME COMMUNITY B R Y/G 62. COUNTY NAME B3. STATE 6.4 B4. MAP AND PANEL NUMBER 000 / 310. Indicate the source of the / JJ64 B5. SUFFIX G 26. FIRM INDEX 6%786 87. FIRM PANEL EFFECTIVE/R.EV1SEIl DATE 17 86 88. FLOOD ZONE(Sl B9. BASE FLOOD ELEVATION(S) (Zone AO) us depth of flooding) e Flood Elevation (BFE) data or base flood depth entered in B9. —1 FIS Profile 1_ FIRM 1_1 Community Determined 1_1 Other (Describe): 311. Indicate the elevation datum used for the BFE in B9: 1 VD 1929 1_1 NAVD 1988 1_1 Other (Describe): 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1 1 Yes 1-1<- to Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) 01. Building elevations are based on: 1_1Construction Drawings* 1'Building Under Construction* IZT<ished Construction *A new Elevation Certificate wil be required when construction of the building is complete. 02. Building 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 building, provide a sketch or photograph.) .33. 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. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum Conversion /Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? 1 1 Yes 1 _•r5o ❑ a) Top of bottom floor (including basement or enclosure) ❑ b) Top of next higher floor l . Z ft.(w)• ❑ c) Bottom of lowest horizontal structural member (V zones only) ft.(m) ❑ d) Attached garage (top of slab) . ft.(m) ❑ e) Lowest elevation of machinery and /or equipment Li, .3 servicing the building (Describe in a Comments area.) 14 . 1 ft.(a}j ❑ f) Lowest adjacent (finished) grade (LAG) ❑ g) Highest adjacent (finished) grade (HAG) • 2 ft.(r 1 7 . 1 ft. ('nr) z ft(Tei--0 ❑ h) No. of permanent openings (flood vents) within 1 ft. above a a ent grade ❑ i) Total area of all permanent openings (flood vents) in C3.h sq. in. (cq. cm)- 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 in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. I understand that an false st• tement ma be • uni hable b fine or im • risonment under 18 U.S. Code, Section 1001. LICENSE NUMBER zz /}/> CERTIFIER'S NAME ,I n t'� .f.3A r /� TITLE COMPANY NAME ADDRESS 'fit/ iie L h6 SIGNATU ,�r C ST ZIP COD T HONE FPMA Pnrm ' 1_R1 .11 II nn SPP RPVFRSP RIflJ PCR r:CNITINII IATICNI RPPI ACPR AI I PRP1 /ICI l$ Pr1ITICNR F.I-L , r `1'JLIUUllly r y , u a lie I A , No.) UK I'.CJ. ROUTE AND BOX NO. Policy Number CITY � STA. /4 3J gZE Company NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. COMMENTS I Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) :or Zone AO and Zone A (without BFE), complete Items El. through E4. If the Elevation Certificate is intended for use as supporting iformation for a LOMA or LOMR -F, Section C must be completed. :1. Building 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 building, provide a sketch or photograph.) E2. The top of the bottom floor (including basement or enclosure) of the building is 111 ft.(m) j_l�lin.(cm) 1_1 above or 1 1 below (check one) the highest adjacent grade. (Use natural grade, if available.) E3. For Building Diagrams 6 -8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is 1 1_J ft.(m) 1_1_lin.(cm) above the highest adjacent grade. Complete Items C3.h and C3.i on front of form. =4. 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? II Yes I I No 1 I Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owners authorized representative who completes Sections A, B, C (Items C3.h and C3.1 only), and E for Zone A (without a FEMA- issued or community- issued BFE) or Zone AO must sign here. The statements in Sections A, 8, C, and E are correct to the best of m knowledge. PROPERTY OWNER'S OR eOWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY SIGNATURE STATE ZIP CODE DATE TELEPHONE COMMENTS 1 I Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) e local official who is authorized by law or ordinance to administer the community's floodpiain management ordinance can complete ections A, 8, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. 1.1 1 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.) 2. 1 -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. .3. 11 The following information (Items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED 7. This permit has been issued for. 1 1 New Construction I1 Substantial Improvement 8. Elevation of as -built lowest floor (including basement) of the building is: 9. BFE or (in Zone AO) depth of flooding at the building site is: . ft.(m)Datum: ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE 'COMMENTS I_I Check here if attachments 7.11/IA Fnrm A1-41 .II II nn RFPI ACES AI 1 PRFVInl iR FfITIr11sIR 1