HomeMy Public PortalAboutLighthouse Ln_17ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does not provide a waiver of the flood Insurance purchase requirement. This form is used only to
provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to
determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR).
Instructions for completing this form can be found on the following pages.
O.M.B. NO. 3067-0077
Expires May 31, 191P6
SECTION A PROPERTY INFORMATION
FOR INSURANCE COMPANY USE
BO WINO OWNER'S NAME
POLICY NUMBER
STREET ADDRESS (Including Apt., Unit, Sults and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER
/ 7 L1a11T1-ioo$E LA fJ E
COMPANY NAIC NUMBER
OTNEn DESCRIPTION (Lot and Block Numbers, etc.)
(—AD 7— 3 / 7 Ij,4 v/p trl A- S 57 A, Fo
CITY STATE
TY6eE A/ D, C,Eoa --G(A 1l', -&
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
ZIP CODE
Provide the following from the proper FIRM (See Instructions):
I. COMMUNITY NUMBER
13514
2. PANEL NUMBER
Don /
3. SUFFIX
4. DATE OF FIRM INDEX
5. F'RM ZONE
A.f3
6. BASE FLOOD ELEVATION
(In AO Zones, use depth)
fZ
7. Indicate the elevation da urn system used on he FIRM tor Base Flood Elevations (BFE): ® NGVD '29 ❑ Other (describe on back)
8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate
the community's BFE: I 1 1 I 1 1 ❑ feet NGVD (or other FIRM daturn -see Section B, Item 7),
SECTION C BUILDING ELEVATION INFORMATION
Using the Elevation Certificate Instructions, Indicate the diagram number from the diagrams found on Paljes 5 and 6 that best
describes the sub)ect building's reference level 5
2(a). FIRM Zones Al -A30, AE, AN, and A (with BFE). The top of the reference level floor Irom the selected_ diagram is at an elevation
of I I 1 I2I 1 I,L4J feet NGVD (or other FIRM datum -see Section B, Item 7).
(b). FIRM Zones V1-V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level Irom
the selected diagram, Is at an elevation oft I 1 1 1 1.11 feet NGVD,(or other FIRM datum -see Section B, Item 7).
(c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram Is I I I ❑ /eel above ❑ or
below ❑ (check one) the highest grade adjacent to the building.
(d). FIRM Zone AO. The floor used as the reference level from the selected diagram is 1 I I ❑ feet above L] or below ❑ (check
one) the highest grade adjacent to the building. If no flood depth number Is available, is the building's lowest floor (reference
level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown
3. Indicate the elevation datum system used in determining the above reference level elevations: IN, NGVD '29 ❑ Other (describe
under Comments on Page 2). (NOTE: If the elevation datum used In measuring the elevations is different than that used on
the FIRM (see Section 3, Item 7J, then convert the elevations to the datum system used on the FIRM and show the conversion
equation under Continents on Page 2.)
4. Elevation reference mark used appears on FIRM: ❑ Yes iS,No (See Instructions on. Page 4)
5. The reference level elev,atiori is based on: M. actual construction ❑ construction drawings
(NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which
case this certificate will only be valid for the building during the course of construction. A post - construction Elevation Certificate
will be required once construction is complete.)
6. The elevation of the lowest grade immediately adjacent to the building is: I I I 11 PI .feet NGVD (or other FIRM datum -see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
Is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest
floor" as defined by the ordinance is: 1 1 1 LL] LJ feet NGVD (or other FIRM datum -see Section B, item 7).
2. Date of the start of construction or substantial Improvement
FEMA Form 01-31, MAY 93
REPLACES All PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION
SECTION E CERTIFICATION
This certification Is to be signed by a land surveyor, engineer, or architect who Is authorized by state or local law to certify elevation
information when the elevation information for Zones Al —A30, AE, AI-t, A (with BFE),VI— V30,VE, and V (with BFE) Is required.
Community officials who are authorized by local law or ordinance to provide floodplain management Information, may also sign the
certification. In the case of Zones AO and A (without a FEMA or community Issued BFE), a building official, a property owner, or an
owner's representative may also sign the certification.
Reference level diagrams 6, 7 and 8 - Distinguishing Features —It the certifier is unable to certify to breakaway /non- breakaway wall,
enclosure size, location of servicing equipment, area use, wall openings, or Unfinished area Feature(s), then list the Feature(s) not
Included In the certification under Comments below. The diagram number, Section C, Item 1, must still be entered.
1 certify that the information in Sections 8 and C on 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.
B E ,e r $, B A rr
CERTIFIEI'S NAME
12 • L . 5 . '34
52, £a4. :L) Z3�
TITLE
Jam. o. Box ID,c1/
ADODESS
SIGNATIJfE
LICENSE NUMBED for Mlix Seal)
LAND 5.f12VF Yi N.Cc / N C
COMPANY NAME
54" k/ N W 4 14 r'eoQ-6 (A 314 -1'z-
CITY STATE ZIP
%� t 61 S ° 7 (9/2-) 817 -54 (n o
DATE PHONE
Copley should be trade of this Certificate for: 1) community official, 2) Insurance agent /company, and 3) building owner.
COMMENTS:
N GA L D V L L
ON
SLAB
A
ZONES
nErtntucrl
I LEVEL
BASE
FLOOD
ELEVATION
v
ZONES
REFERENCE
LEVEL
ADJACENT
GRADE
WITH
BASEMENT
A
ZONES
ADJACENT
GRADE
BASE
FLOOD
ELEVATION
REFERENCE
LEVEL
ON PILES,
PIERS, 011 COLUMNS
A
ZONES
v
ZONES
BASE
noon
ELEVATION
ADJACENT
• GRADE '.
the diagrams above Must! ate the points at which Ilia elevations should be measured In A Zones and V Zones.
Elevations for all A Zones should be measured at the lop of the reference level floor.
Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member.