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Home My Public Portal AboutCaptains View_60FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE BUI Important Read the instructions on pages 1- 7. O.M.B. No. 3067 -0077 Expires December 31, 200f. SECTION A - PROPERTY OWNER INFORMATION �/f &,4/U DbVELLDP44l�Av / BUILDIN�GySTREEI�4DDI t; (Including Apter,t) , anger Bldg. Ndj) 0 L� pU', () I CITY �l ((�v��Ir �/ </L lj.J` 9ATEE �%� PROPERTY DESCRIPTION • and Block bens, Tax P •,r75 /rcK% BUI USE ,(e.g„ . . , Nj n Adytrbon, 2S"iclOo /G/ — �f -fs6( DE/LONGITUDE (OPTIONAL) / HORIZONTAL DATUM: ( ##° -or -tom or ##.# ) ❑ NAD 1927 ❑ NAD 1983 OWNER'S NAME For Insurance Con y Use .. , Policy Number "Company NAIC Number ZIP CODE e 114 i/ l 4-t/ ants area, if necessary.) SOURCE: ❑ GPS (Type): ❑ USGS Quad Map ❑ Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. COMMUNRY 8 COIN thrrY NUMBER /VtE� ,4&L) /354‘4 •4 82000 1/ 7- 4 /+`f B3. STATE B4. MAP AND PANEL 3 r t R 13 E-14 LL CJdr 65^ _ _ l 7 1 y 6Y ''• B7. FIRM PANEL EF�ECl IVEIREVISED DATE r1 .,_ 7 B8. F DD Z(�IE(S) v{ B9. BASE FLOOD ELEVATIONS) (Zane A0, use depth of Aoodrp) / c) FIS Profile tievaoorr (rrrt) data or case Hood depth entered in . B9RM ❑ Community Determined ❑ Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: [ENGVD 1929 ❑ NAVD 1988 ❑ Other B12. Is the buikirg located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes L✓1 No Designation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl . Burling elevations are based on: ❑ Construction Drawings* ❑ Bulking Under Construction* leFinished Construction *A new Elevation Certificett wit be required when construction of the burring is complete. C2. Bunking 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 bulking, 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/A0 Complete Items C3. -a-i below acconing to the building diagram m specified in Item C2. State the datum used. lithe 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 calcination. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum Conversion/Corrrnents Elevation reference mark used /5 5 Does the elevation reference mark used appear on the FIRM? ❑ Yes Ego ► a) Top of bottom floor (inducing basement or endosure) / 5 . B ft(m) O R C ► b) Top of next higher floor ZZ . 8 L(m) ► c) Bottom of lowest horizontal structure member (V zones only) A/, ft,(m) ► c>) Attached garage (tap of slab) /5.3 it.(m) ► e) Lowest elevation of madinery and/or equipment servicing the bulcing (Desaibe in a Comments area) - / t ft(m) ► f) Lamest aciaoent (unshed) grade (LAG) 15.3 ft(m) ► g) Highest adjacent (finished) grade (HAG) !S . 8 ft.(m) ► h) No. of pemiment openings (flood vents) within 1 ft. above a grade AM ► i) Total area of al permanent openings (flood vents) in C3.h 1U •ktsq. in. (sq. cm) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTFICATION 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 Con this certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIF 45 N 82 TITLE ?E s L AAf e-f (JEY0k COMPANY C M;11; v, ADDRESS {?o, /30 ` -� 1 2 2. (� ; =/45 sIGNATURE QATE 7 C)h FEMA Form 81 -31, January 2003 «..1 A See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the cony Nonding information from Section A. BUILDING STREET SS InduFl g Apt, Smpie, a. . B. No.) s.• •.0. R• D NO. �O j ,,X15 ¢� 3 /`0bd CITY / - c� G A /v STATE / / 7 � 6°DE SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) tortiSii 3nce Carmparor Use:. Poicy Number CoMpiany NAIC Wither Copy both sides of this Elevation Certificate for (1) community offidel, (2) insurance agent/oompany, and (3) building owner. COMMENTS ❑ Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items El through E4. If the Elevation Certificate is intended for use as supporting information fora LOMA or LOMR-F, Section C must be completed. El. Buiking 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 aaurately represents the bulking, provide a sketch or photograph.) E2. The top of the bottom floor (inducing basement or endosure) of the building is _ ft.(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if available). E3. For Boiling Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is _ ft.(m) _in.(cm) above the highest adjacent grade. Complete items C3.h and C3.i on front of form. E4. The top of the platform of machinery and/or equipment servicing the bulking is ft.(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if avalable). E5. 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? ❑ Yes ❑ No ❑ Unknown. The kcal official must certify this information in Section G. SECTION F • PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's 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, B, C, and E are correct to the best of my lknowledge. PROPERTY OWNERS OR OWNER'S AUTHORIZED REPRESENTATIVES NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The bcal official who is authorized by law or ordnance to administer the conmunitys floodplain management ordnance can complete Sections A, B, C (or E), and G of jhis Elevation Cer ific ate. Cgmple a the applicable item(s) and sign below. G1. ❑ The information in Section G was taken from other documentation that has been signed and embossed by a ioensed surveyor, encjneer, 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 aea below.) G2. ❑ A camiurrty official completed Section E for a building located in Zone A (without a FEMA-issued or community- issued BFE) or Zone AO. G3. ❑ The fobwing information (Items G4-G9) is provided for comrnuntty floodplain management purposes. G4. PERIATICM3ER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPIJANCFJOCCUPANCY ISSUED G7. This permit has been issued for ❑ New Construction ❑ Substantial Improvement G8. Elevation of ass -buiht lowest icor (inducing basement) of the bullring is: it(m) Datum: G9. BFE or (in Zone AO) depth of flooding at the bulling site is: _. _ ft(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS ❑ Check here if attachments FEMA Form 81 -31, January 2003 Replaces all previous editions