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Home My Public Portal AboutLewis Av_160U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Read the instructions on pages 1 -9. OMB No. 1660 -0008 Expires March 31, 2012 SECTION Al. Building Owner's Name /147k.4.4..... k.4.4.... 1�r,Jr�►0 A PROPERTY INFORMATION 7 A2. Building Street Address (including Apt., Unit, S ite, and /or Bldg. No.) or P.O. Route and Box No. ' City 772116 �e 7/7-4,1 State A3. Property o Lot and B ock Tax Parcel Number,Lpgalpes ption, etc.) Act Th% , {� (/�t`G� � �% iii 5 00i1 For insurance Company Use: Policy Number Company NAIC Number A4. Building Use (e.g., Residential, Non - Residential, Addition, Accessory, etc.) AQ4/ 7/ - A5. Latitude /Longitude: Lat. Long. A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) b) No. of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b d) Engineered flood openings? ErYes ❑ No 4 d ZZE z sq in sq ft ZIP Code 3/3 45\ OO(60/1-067 Horizontal Datum: NAD 1927 ❑ NAD 1983 A9. For a building with an attached garage: a) Square footage of attached garage b) No. of permanent flood openings in the attached within 1.0 foot above adjacent grade fJ c) Total net area of flood openings in A9.b d) Engineered flood openings? ❑ Yes e-No NA se ft SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFF Comm Verne 8iCommunity Numb toz /3c/6q- B2. CourityNam B3. State �caF B Map /Panel Number 1 k>5 iajzi &c B5. Suffix r B6. FIRM Index ?fierce B7. FIRM Panel Da Cepfb .0.5, B8. Flood 'a t B9. Base Flood Elevation(s) (Zone AO, us ase flood depth) B10. Indicate the source of the Base Flood Elevation (BFE) data or base fldod depth entered in Item B9. ❑ FIS Profile EKRM Community Determined ❑ Other (Describe) B11. Indicate elevation datum used for BFE in Item B9: ENGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes e"No Designation Date ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. 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 C2.a -h below according to the buildiny,diagram specified in Item A7. Use the same datum as the BFE. , / /' / I- / �� Benchmark Utilized 7 -'7 Vertical Datum /(J ((: Conversion /Comments a) b) c) d) e) f) 9) h) Top of bottom floor (including basement, crawlspace, or enclosure floor) Top of the next higher floor Bottom of the lowest horizontal struct al memper (V Zones nly) AtteeFied-garage (top of slab) if✓Ic7e ' rr Slc.t'6 Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) Lowest adjacent (finished) grade next to building (LAG) Highest adjacent (finished) grade next to building (HAG) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support _ Check the measurement used. f .Erfeet /VA ❑ feet /3 .d' [feet ®_feet QC7feet . Q'feet ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a and surveyor, engineer, or architect authorized by law to certify elevation information. 1 certify that the information 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. Chec ere if mm is aarrovi e o of form. Certifier's Rame r %�je �1 �� G-•� �7cVt��'j mdr Title Address Signature Were latitude and longitude in Section A provided by a licensed land surveyor? ❑ Yes ❑ No License Number/67z ' S State ZIP Code ✓ Z/ , Sd Teleph J rz 716 _4_1691.0 FEMA Form 81 -31, Mar 09 \ See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: Buildin7-18Addr s ( includi(g Apt., Unit, nd /or Bldg. No.) or P.O. Route and Box No. 7Z a 4 J SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) City Policy Number State .3 3zs ZIP Code Company NAtC Number Copy both sides of this Elevation Certificate for (1) community fficial, (2) i urance agent/company, and (3) building owne . 6 1-(11 ��,- ?cause 41 CS A C t`fgie /-7601-- 7'- /6.7 ZTv Comments (-f �1 Signature SECTION E - UILDI Date "3 ❑ Check here if attachments LEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1 -E5. If the Certificate is intended to support a LOMA or LOMR -F request, complete Sections A, B, and C. For Items E1 -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑feet ❑meters above or ['below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑feet ❑meters ❑above or ❑below the LAG. E2. For Building Diagrams 6 -9 with permanent flood openings provided in Section A Items 8 and/or 9 (see ages 8 -9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or Li below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and /or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. 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 local 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, 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, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8 and G9. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA- issued or community- issued BFE) or Zone AO. G3. ❑ 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 G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building ❑ feet ❑ meters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site ❑ feet ❑ meters (PR) Datum G10. Community's design flood elevation ❑ feet ❑ meters (PR) Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑ Check here if attachments FEMA Form 81 -31, Mar 09 Replaces all previous editions Building Photographs See Instructions for Item A6. Building Street Address '(induding Apt, U ' , Suite, and/or Bldg. No.) or P.O. Route and Box No. State / y 6e0-. %5 4n 6fg, 31 &Z ZIP Code For Insurance Company Use: Policy Number Company NAIC Number If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to the instructions for Item A6. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." !f submitting more photogre phs than will fit on this page, use the Continuation Page on the reverse. 3111lie. • Ni 1 E -Zeri de Oforfk O'e-41 C(34'17c4 6 -ZS 17 Wei`�. t" ortre-' Building Photographs Continuation Page For Insurance Company Use: Building Street Address (including Apt., Un' Suite, and/or Bldg. No.) or P.O. Route and Box No. (O z: &'`s 'Cie CitY r e I:4 1 Policy Number State /' r3IP Code Company NAIC Number If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: de'.-- "Front View" and "Rear View "; and, if required, "Right Side View" and "Left Side View." • r.11r it gEAg L)IEW