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HomeMy Public PortalAboutChatham Av_1716U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660 -0008 Federal Emergency Management Agency I Exoires February 28, 2009 National Flood Insurance Program Important: head the instructions on pages 1 -8. SECTION A - PROPERTY INFORMATION For Insurance Company Use: Al. Building Owner's Name Policy Number To Li Ay c.. %Ad Y L-t-Y 1 CT A2. Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. Company NAIC Number 1 -11 (a G t-f &- u.a. A .,v E r-+ � I I IE L Cit State ZIP Code - rVtsae 16 e.bti.rr::� .3! 3Z8 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) 4x:C T' ZC7 -/�. 01= .r• LG i ZOfi w,o.r2f� 1' 10. 5 i i i3Ec?. A4. Building Use (e.g., Residential, Non - Residential, Addition, Accessory, etc.) /'2i:' A5. Latitude /Longitude: Lat. ^l 31 ° S9" Z.'4. L " Long. W $O ° S I ' O&A. 4 ' Horizontal Datum: ❑ NAD 1927 [� NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 8 A8. For a building with a crawl space or enclosure(s), provide: A9. For a building with an attached garage, provide: a) Square footage of crawl space or enclosure(s) rJ B $ sq ft a) Square footage of attached garage U sq ft b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage enclosure(s) walls within 1.0 foot above adjacent grade y walls within 1.0 foot above adjacent grade c) Total net area of flood openings In A8.b -7 Z, y Q sq In c) Total net area of flood openings In A9.b �� sq In SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name CITY o�TY3E� �SLOnrQ (3�(�� CE1dt -Lt4M B3. State �Eo2cj,, B4. Map /Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone _[I feet Date Effective /Revised Date I Zone(s) A0, use base flood depth) 135142'-! 0002. C OS o ca - 111 - aG A$ 14 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. FIS Profile ® FIRM [] Community Determined ❑ Other (Describe) 611. Indicate elevation datum used for BFE in Item B9: [ NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? C] Yes [g No Designation Date R CBRS [] OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) 01. 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 Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, ARIA, ARIAE, ARIA1 -A30, ARIAH, ARIAO. Complete Items C2.a -g below according to the building diagram specified in Item AT Benchmark Utilized USCG- Axt.Ocu UA4&-^ J-T Vertical Datum U12."! Conversion /Comments f�ibN 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 on this Certificate represents my best efforts to interpret the data available. 1 understand that any false statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ® Check here if comments are provided on back of form. Z. .MC- c. /A. _KE.A-rC2,..1' BLS C9E02�yIa 2743 Le.titQ 5�2�lEYa t2 C t- k& -rA.A - u Ry<=- Yiwtca E,Z 7#e_ IF x4c- . Title Company Name P.O. r3o)c to 14o�t�i �+,.�re..r.v.ar -a �ECV m. 31'V Z 0 Address City St to ZIP Code t,.. AW_X ; -'c.s E�3, Z2, Zoo? QIZ-303 -0302 FEMA Form 81 -31, February 2006 Telephone See reverse side for`continuation. \STEq, Q 0 No, 2743 S IFS nn KEP� Replaces all previous editions -07 Check the measurement used. a) Top of bottom floor (including basement, crawl space, or enclosure floor) b) Top the higher floor 7 l V . Z El feet (;R feet ❑ meters (Puerto Rico only) ❑ meters Rico only) of next c) Bottom of the lowest horizontal structural member (V Zones only) _[I feet (Puerto 0 meters (Puerto Rico only) d) Attached garage (top of slab) .^Q feet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 1 �'f v Q feet EJ meters (Puerto Rico only) (Describe type of equipment in Comments) 0 Lowest adjacent (finished) grade (I-AG) Z O ® feet E] meters (Puerto Rico only) g) Highest adjacent (finished) grade (HAG) 5 E feet Q meters (Puerto Rico only) 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 on this Certificate represents my best efforts to interpret the data available. 1 understand that any false statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ® Check here if comments are provided on back of form. Z. .MC- c. /A. _KE.A-rC2,..1' BLS C9E02�yIa 2743 Le.titQ 5�2�lEYa t2 C t- k& -rA.A - u Ry<=- Yiwtca E,Z 7#e_ IF x4c- . Title Company Name P.O. r3o)c to 14o�t�i �+,.�re..r.v.ar -a �ECV m. 31'V Z 0 Address City St to ZIP Code t,.. AW_X ; -'c.s E�3, Z2, Zoo? QIZ-303 -0302 FEMA Form 81 -31, February 2006 Telephone See reverse side for`continuation. \STEq, Q 0 No, 2743 S IFS nn KEP� Replaces all previous editions -07 IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number t -7 1 (o C R A -T-1 -A nn A,- F. J v CS State ZIP Code Company NAIC Number /YB��? T3c.ati►� re- Cp1,a. -313 Z8 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments TF_M GZ0. ISAV 151-4 1_= s7 G1- 4-ALJ r�d.G.t= A4 CZ�� tSTi+; rrrZS'r' ICLOd�. /Ft ✓a' ,s is 5`�e�r *a bi v.zt� i"c. ©orz ,a„r f3vt��r t (935 e.ns,� t S �f2r= r= fz.�. 1 =,•� G2 e tS ,a.�.. .o.i2 Gc.�.�.�. r�a�s� 0'-J A -t.aS 0 O 0 P i-.&-r f--0.1Z AA AJ K U Z - Z Z - Zo O '% Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and A (without BFE), complete Items E1 -E5. If the Certificate is intended to support a LOMA or LOMR -R request, complete Sections A, B, and C. For Items E1 -E4, use natural grade, if available. Check the measurement used. E1. 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, crawl space, or enclosure) is _ T I_I feet I_I meters I I above or I I below the HAG. b) Top of bottom floor (including basement, crawl space, or enclosure) is _ I_I feet I_I meters I I above or I I below the LAG, E2. For Building Diagrams 6 -8 with permanent flood openings provided in Section A Items 8 and/or 9 (see page 8 of Instr ons), the t higher floor (elevation b in the diagrams) of the building is . _ I I feet I_I meters I I above or 11 bel the HAG. E3. Attached garage (top of slab) is _ I_I feet 1_1 meters 1_I above or 11 below the HAG. /t l /�- E4. Top of platform of machinery and/or equipment servicing the building is _ I_I feet 11 meters I I above or _ AG. 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 fioodplain management ordinance? I I Yes I I No I I 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 I -1 Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's fioodplain 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: 1_1 New Construction 1 -1 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: — 1_I feet I_I meters Datum G9. BFE or (in Zone AO) depth of flooding at the building site: — 1_I feet 1_I meters Datum Local Official's Name Title Community Name Telephone Signature Date /1J Comments 1_1 Check here if attachments FEMA Form 81 -31, XXXXX Replaces all previous editions Building Photographs See Instructions for Item A6. For Insurance Company Use: Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number I Z 140 (f-" a't-s� A ^-t A,1 s..t o e City, State ZIP Code Company NAIL Number AiG i S �.0 �� GEC/ZCa rd. —31 32-S 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." If submitting more photographs than will fit on this page, use the Continuation Page, following. -- -1" -t , r. P%L -Jlr Y /G&--) OP 140uSj 4.,Cc: I; T S I r--, e "i/ t= W o (= (moo u s E w% -vt-& Ao.I,z G4>0,j 01-rto- .trL 25' Building Photographs Continuation Page For Insurance Company Use: Building Street Address (including Apt., Unit, Suite, and/or Bldg. No_) or P.O. Route and Box No. Policy Number 1 -7 r to Cites_ State ZIP Code Company NAIC Number /`)'B rr_ L G% 1 3 Z9, If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, 'Right Side View" and "Left Side View." A. M_ v/ rr,J oC� 140UsE (2ic�t�r StnF �(� rw OF 14OUe2E