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Home My Public Portal AboutMILLER AV_3Feb 03 03 11 :13a ,1 wnii.i Ice�nvlum A 1- tutRL tMeKC31=NGY MANAGEMENT AGENCY h' 'ONAL FLOOD INSURANrP PIDnen,Aas ELEVATION important: Read the in SECTION A - PROPERTI UfLDIN�� -/ NAME XOLey BUILDING STREET ADDRESS (Including t., Unit, Suite.,and /or Bldg. No.) CITY PROPERTY BUILDING O.M.B. No. 3067 -0077 Post -it° Fax Note 7671 Date /44 Os 11' To 5,-1 ) /`/ 1� From '41 Co./Dept. 88. FLOOD NE ) t Co, ! Phone # Phone # Fax # Fax # Es IPTIO 4� bers / Tax Parcel Number, Legal Description, etc.) Residential, Ndn -resd entiaal, Araddition, A caAssory, etc. Use a Comments area, if necessary.) N tan Block N s7i LATITUDE/LONGITUDE (OPTIONAL) ( ##° - ## - ##.##" or i!# .t# °) HORIZONTAL DATUM: SOURCE: U GPS (Type): LI NAD 1927 IJ NAD 1983 L_J USGS Quad Map IJ Other. SECTION N B -F FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. F!P COMMXi �oMMUN� %� R + 62. COUNTY NAME /4 83. STATE,-, 64. MAP AND PANEL NUMBER /176 4- / 65. SUFFIX C B6. FICRJMitINDEX D TE 6//7/86 B7. FIRM PANEL EFFECTI R ED DATE 6p7/9& 88. FLOOD NE ) t 89. BASE FLOOD ELEVATION(S) (Zone AO, use depth of flooding) / Zr 610. Indicate the source of the ase Flood Elevation (BFE) data or base flood depth entered in E19. 11 FIS Profile 1.' FIRM J_) Community Dete fined 1_1 Other (Describe): 611. Indicate the elevation datum used for the BFE in B9:1 ergGVD 1929 1 NAVD 1988 I J Other (Describe): 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? I_J Yes I_ No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION {SURVEY REQUIRED) Cl. Building elevations are based on: I_jConstruction Drawings` 1_1Building Under Construction' (_ finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 0 (Select the building diagram most similar to the building for which this certificate is being completed -see pages 6 and 7. lino diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations - Zones Al -A30, RE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1 -A30, AR /AH, AR /AO 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 s ace provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum 461W ZConversion /Comments - Elevation reference mark used Does the elevation reference mark used appear on the FiRM? J�j Yes L___ No ❑ a) Top of bottom floor (including basement or enclosure) 8 . Z. ft.(wij ❑ b) Top of next higher floor 1 . cli, ft. O.) ❑ c) Bottom of lowest horizontal structural member (V zones only) ,1 ft.(m) e o ❑ d) Attached garage (top of slab) 414{ . ft.(m) CI e) Lowest elevation of machinery and/or equipment ul ai iv servicing the building (Describe in a Comments area.) ❑ f) Lowest adjacent (finished) grade (LAG) ft.t,n Z ❑ g) Highest adjacent (finished) grade (HAG) --> it ft.(�y) g �' ❑ h) No. of permanent openings (flood vents) within 1 ft. above ad ace t grade At- 8 ❑ i) Total area of all permanent openings (flood vents) in C3.h 4.1 sq. in. (ss,.efn) / Z - ft. (+ i Ei9 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. f certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. 1 understand that an false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER' LICENSE NUMBER ile TITL ADDRESS COMPAN NAME F1 =M.A r,rm • 1 .1111 LEPHONE 3r CFi= PP \ /KRCF Q1r1F mR rinf\MNII IATi(1N RFPI Ar:FC AI 1 PRF\lInl IA Fi 1ITIf1NIR rrru U VJ 11. 1JG J W I I A. Y L C R C 011 V 11J7 J 1 L L or I v 1 APORTANT: In these spaces, copy the cor onding information from Section A. UILDING STREET 8DDRESS (Inductipg Apt„.. Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number ickia=5 many For Insurance Company Use: rTY STATE ZIP CODE SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) r•L opy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. � COMP 1..1 Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) ,r Zone AO and Zone A (without BFE), complete Items E1. through E4. If the Elevation Certificate is intended for use as supporting ormation for a LOMA or LOMR -F, Section C must be completed. I. 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.) ?. The top of the bottom floor (including basement or enclosure) of the building is 1 -1_1 ft.(m) l_l_Iin -(cm) I_I above or 1J below (check one) the highest adjacent grade. (Use natural grade, if available.) 1. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the budding is IJ-1 ft.(m) I_I_lin.(cm) above the highest adjacent grade. Complete Items C3.h and C3.i on front of form. 1, For Zone AO only: If no flood depth number i5 available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? 1 j Yes I I No 1_1 Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION he property owner or owner's authorized representative who completes Sections A, B, C (Items C3.h and C3.i only), and E for Zone A vithout a FE MA-issued or community - issued BFE) or Zone AO must sign here. The statements in Sections A, 8, C, and E are correct to le best of my knowled e. ROPERTY OWNER'S Cfi R S AUTHORIZED REPRESENTATIVE'S NAME • DDRESS C1 ? STATE ZIP CODE IGNATURE DATE TELEPHORI= OMMEI41' 1J Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) e local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete ctions A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. I The information 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 taw to certify elevation Information. (Indicate the source and date of the elevation data in the Comments area below.) U A community official completed Section E for a building located in Zone A (without a FEMA - issued or community- issued BFE) or Zone AO. 11 The following information (Items G4 -G9) is provided for community floodplain management purposes. 4. PERMIT NUMBER G6. DATE-PERMIT ISSUED G6. DATE CER11FICAIIE OF COMPLIANCE/OCCUPANCY ISSUED This permit has been issued for 1. I New Construction 1J Substantial Improvement Elevation of as -built lowest floor (including basement) of the building is: ft.(m) Datum: BFE or (in Zone AO) depth of flooding at the building site is: ft.(m)Dalum: MCALOFFICIAL'S NAVE OMMUNITY NAME IGNATURE OMMENTS TITLE TELEPHONE DATE I1 Check here if attachments MA Fnrm 1111 nn PPPI AC:FC 41 1 PPF \ /In t iC FrIITI(flI