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Home My Public Portal AboutSecond Av_201FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE important: Read the instructions on pages 1.7. O.M.B. No. 3067 -0077 Expires December 31, 200f. SECTION A - PROPERTY OWNER INFORMATION BU1l,AtNG OWNER'S BUILDING ST Q CITY v\ Q r k vnq V ADDRESS ndud" Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. �=-- L'tL For Insurance Company Use: Policy Number 6a:05. LsICfl PROPEF—C SCR1PTiON (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Company NA1C Number SATE ZIP CODE BUI��n�NG USE ((��.g., R ential, on- residential, Addition, Accessory, etc. Use a Comments area, if necessary.) {a5fC04O ("gift LA TtUDEJLONGITIiDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): ( #€# - ##' - ##.##r or ##.#tom) D NAD 1927 D NAD 1983 D USGS Quad Map D Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NAP COMMUNITY NAME & COMMUNITY /3964 1 bey ( ram � CIlci ∎ 63• STATE CMG . 4014AP AND PANEL L NUMBER 5' cam( 85. tFIX 86. FIRM INDEX DATE G e) T -$C 87. FIRM PANEL EFFECTiVEIREVISED TE 6 -17.-%6 B8. FL Z E(S) . 6 B9. BASE FLOOD ELEVATiON(S) (Zone AO, depth of bonding) i s c 0. IncScate the source d the Ba a Flood Elevation (BFE) data or base flood depth entered in B9. 0 FIS Profile FIRM 0 Corrynunity Determined ❑ Other (Describe): 1. lndgte the elevation datum used for the BFE in B9: NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe 2. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes No Designation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Buiidng elevations are based on: 0 Construction Drawings* ❑ Building Under Canstrudion* [einished Constnic on *A new Elevation Certificate will be required when construction of the building is complete. 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.) Elevations — Zones A1-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, ARiAE, AR/A1-A30, AR/AH, ARiAO 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 lioyG. as appropriate, to document the datum conversion. Datum A)6111 • version/Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? 0 Yes 12'6o 1. a) Top of bottom floor (induding basement or endosure) /3 Zft(m) Ti • h) Top of next higher floor Al A • _fl(m) • c) Bottom of lowest horizontal structural member (V zones only) jMA ft(m) 0 0 • d) Attached garage (top of slab) _A2.ft(m) E , i wm. e) Lowest elevation of machinery and/or equipment �'3 - m +, Al k ft(m) servicing the building (Describe in a Comments area) e f) Lowest adjacent (finished) grade (LAG) J. /ft(m) w so g) Highest adjacent (finished) grade (HAG) /Q. Q ft.(m) 2 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 . Z1' . in. (sq. cm) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION rtification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. fy that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. rrstand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. 'PIERS NAME t(-5‘ed c. 6 Cal c cvu :ss ovaA Z 9 ru& Vir`Ltil 5-7t. LICENSE NUMBER M /tom corfAjrcNemE 11,1 C STATE ZIP CODE /DATE ELEPH E 7 j 1-0 4" Girt —4165 f: to these spaces, copy the corresponding information from Section A. TREET (Indudrmg n Bldg. No.) OR P.O. ROUTE AND BOX N0. For insurance Company Use: Poicy Nunter STATE ZIP SECTION D)S OR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Company NAItNumfier both sides of this Elevation Certificate for (1) community offidal, (2) insurance agent/company, and (3) building owner. AMBITS ❑ Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) mne AO aid Zane A (without BFE), complete Items El through E4. If the Elevation Certificate is intended for use as supporting information fora LOMA or LOMR -F, n C mu s be carpeted. iddlng aagram 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 presents the burg, provide a sketch or photograph.) e top cite boltan icor (indudng basement or enclosure) of the building is _ ft(m) _in.(an) ❑ above or ❑ below (chec( one) the highest adjacent grade. (Use stural grade, if available). mr Bulking Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is _ ft.(m) _in.(an) above the highest adjacent ade. Complete items C3.h and C3.i on front of form. re top of the plater of machinery ardor equipment servicing the building is ft.(m) _in.(cm) ❑ above or ❑ be low (check one) the highest adjacent grade. (Use atural grade, if ava'laoie). K Zone AO only. If ro flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordnance? ] Yes 0 No D Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION property owner or owns authorized representative who completes Sections A, B, C (Items C3.h and Cal only), and E for Zone A (without a FEMA- issued or community- BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are correct io the best of my knowledge. mPERTY OWNERS OR OWNERS AUTHORIZED REPRESENTATIVE'S NAME RESS CITY STATE ZIP CODE ,IATURE DATE TELEPHONE 1MENTS ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) ;al official wiw is aihcrzed by law or ordnance to administer the community's floodplain management ordnance can complete Sections A, B, C (or E), and G of this Elevation ate. Complete the aii able item(s) and sign below. The info rration 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 evation information. (Indicate the source and date of the elevation data in the Comments area below.) A community ofr da mmpleted Section E for a building located in Zone A (without a FEMA-issued or community- issued BFE) or Zone AO. The foliating information (Items G4-G9) is provided for community floodplain management purposes. ERMFT NUNSER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED s permit has been issLed for. ❑ New Construction ❑ Substantial Improvement /aim of as-built laveq floor (induding basement) of the building is: or (n Zone AO) depth of flooring at the bulking site is: — _ft.(m) _ft(m) Datum: Datum: L OFFICIAL'S NAME TITLE AUNITY NAME TELEPHONE JTURE DATE ,1ENTS ❑ Check here if attachments