HomeMy Public PortalAboutButler Av_606L -5- 8- (
FEuERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1 - 7.
SECTION A - PROPERTY OWNER INFORMATION
O.M.B. No. 3067 -0077
Expires July 31, 2002
For.Insurance Company Use:
BUILDI G OWNER'S ``NAME
OO Q l ���oR, AP,t`A
BUILDING STREET ADDRESS (Including A t., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
(o p (o vi L � e. (�v C- N V E
Policy Number
,Company NAIC Number
CITY STATE
Ti t3Ee Co EOci�
PROP RTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
n C -4 me-- is aESur30lvsst.....) ar 43>: 3s
BUILDII, G USE (e.g., Residential, Non- residential,-Addition;:Accessory, etc. Use Comments section If necessary.)
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: 1 -1 GPS (Type):
( ##° - ##' - ##.##' or ##.##+f# # °) 1_1 NAD 1927 Li NAD 1983
ZIP CODE
313-4 8
wprm-c, -fa
L_I USGS Quad Map Li Other:
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER
T -1 o e-E is L. A N O
B2. COUNTY NAME
C }4- Pfil-11 P41/4".
B3. STATE
"8-69.- a 17R
B4. MAP AND PANEL
NUMBER
B5. SUFFIX
G
86. FIRM INDEX
DATE
6, -f -8C.
B7. FIRM PANEL
EFFECTIVE/REVISED DATE
G- 17 -8C.
B8. FLOOD
ZONE(S)
es S
89. BASE FLOOD ELEVATION(S)
(Zone AO, use depth of flooding)
1. d
810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
I FIS Profile )fFIRM IJ Community Determined 1_,_1 Other (Describe):
B11. Indicate the elevation datum used for the BFE in B9:1 .1-NGVD 1929 11 NAVD 1988 1J Other (Describe):
812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 11 Yes
Designation Date:
Io
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
01. Building elevations are based on: 1JConstruction Drawings* (JBuilding Under Construction* 1 ")Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number 1 (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.)
C3. 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 C3a -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 NV v'a 02,5 2,5 Conversion /Comments hri (3
Elevation reference mark used Does the elevation refer nce mark used appear on the FIRM? 1 -1 Yes
- Zl ft•(ir
ft.(m)
ft.(m)
ft.(m)
❑ a) Top of bottom floor (including basement or enclosure)
O b) Top of next higher floor
O c) Bottom of lowest horizontal structural member (V zones only)
❑ d) Attached garage (top of slab)
❑ e) Lowest elevation of machinery and/or equipment
servicing the building
❑ f) Lowest adjacent grade (LAG)
O g) Highest adjacent grade (HAG)
❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade /V//9
❑ i) Total area of all permanent openings (flood vents) in C3h /■i/fj sq. in. (sq. cm)
8 kit*
r'.
•
u E•`* ;.\
• •
e
t(tk 1;82
4-
e U'Fly
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, 8, and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
LICENSE NUMBER
CERTIFIER'S NAME \ /
Y 1 N. G L P1 T ``-\ t, 1-- t,".1... --1,
TITLE COMPANY NAME
(rots ?r5rL SU(Z1 C=-S1 /rv6 CorKPPCNY, 1 rsC- ,
ADDRESS , �o S CITY STATE ZIP CODE
A 10 Q.vA«o +` f go 10\ ,---1 STATE cR, GA 3132 -Z_
SIGNATURE DATE TELEPHONE
l� 1..."..--44a----4%. -I --141 - C1-1-.. C°5 t z) 14 8 -- 7. t Si-
1 n7_
1-.Pcr-40 Sy2yEYOct
FEMA Form 81 -31, AUG 99 SEE RL RSE SIDE FOR CONTINUATION
REPLACES ALL PREVIOUS EDITIONS