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Home My Public Portal AboutButler Av_1813NATIONAL FLOOD INSURANCE PROGRAM EVATION CERTIFICAT. v.iw.o. Nu- auvt -UV! Expires July 31, 2002 Important Read the irtsbvctions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION For insurance Company Use. Bldg. No.) OR P.O. ROUTE AND BOX Company or #*. °) L j NAD 1927 U NAD 1983 U USGS Quad Map U Other.. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 10. Indicate the source of th�,8ase Flood Elevation (BFE) data o bas a flood depth en red in t3u. �J FIS Profile FIRM 1_j Community De �eftined U Other (Describe): 11. Indicate the elevation datum used for the BFE in B9: NGVD 1929 L1 NAVD 1988 "Other (Describe): 12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? IJ Yes No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) 1. Building elevations are based on: 1_1Construct1on Drawings* I_lBuilding Under Construction* 1_ inished Construction *A new Elevation Certificate will be required when construction of the building is complete. 2. Building Diagram Number __,e5 (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.) 3. Elevations - Zones Al -A30, AE, AH, A (with BFE), VE, V1 430, V (with BFE), AR, ARIA, AR /AE, AR/Al -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 space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. DatumA[W[0'3 29 conversion/comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? L-J Yes o • a) Top of bottom floor (including basement or enclosure)' _ ft.(m) • b) Top of next higher floor its • T ft (e*} CO • c) Bottom of lowest horizontal structural member (V zones only) ft.(4Vr) $ o �VGISTE • d) Attached garage (top of slab) —ft-(m) E G Q • e) Lowest elevation of machinery and/or equipment u o servicing the building (Describe in a Comments area.) -% It.(tra}- E c ` o. 4 ❑ f) Lowest adjacent (finished) grade (LAG) -7 It.(tW- z • g) Highest adjacent (finished) grade (HAG) v�� O • h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade_ $ s' sUR �y� • I) Total area of all permanent openings (flood vents) in C3.h q1 sq. in. (sq -am) J �nEl SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION J Phis certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by haw to certify ellvation information. certify that the information in Sections A, 8, and C an this certfticate represents my best efforts to interpret the dath avariable. tindandand that anv false statement may be Dunishable by fine or imprisonment under 18 U. S. Code, Section 1001. I Z (Zone AO depth of %Todi�n(g�)� Mi ME 10. Indicate the source of th�,8ase Flood Elevation (BFE) data o bas a flood depth en red in t3u. �J FIS Profile FIRM 1_j Community De �eftined U Other (Describe): 11. Indicate the elevation datum used for the BFE in B9: NGVD 1929 L1 NAVD 1988 "Other (Describe): 12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? IJ Yes No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) 1. Building elevations are based on: 1_1Construct1on Drawings* I_lBuilding Under Construction* 1_ inished Construction *A new Elevation Certificate will be required when construction of the building is complete. 2. Building Diagram Number __,e5 (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.) 3. Elevations - Zones Al -A30, AE, AH, A (with BFE), VE, V1 430, V (with BFE), AR, ARIA, AR /AE, AR/Al -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 space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. DatumA[W[0'3 29 conversion/comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? L-J Yes o • a) Top of bottom floor (including basement or enclosure)' _ ft.(m) • b) Top of next higher floor its • T ft (e*} CO • c) Bottom of lowest horizontal structural member (V zones only) ft.(4Vr) $ o �VGISTE • d) Attached garage (top of slab) —ft-(m) E G Q • e) Lowest elevation of machinery and/or equipment u o servicing the building (Describe in a Comments area.) -% It.(tra}- E c ` o. 4 ❑ f) Lowest adjacent (finished) grade (LAG) -7 It.(tW- z • g) Highest adjacent (finished) grade (HAG) v�� O • h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade_ $ s' sUR �y� • I) Total area of all permanent openings (flood vents) in C3.h q1 sq. in. (sq -am) J �nEl SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION J Phis certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by haw to certify ellvation information. certify that the information in Sections A, 8, and C an this certfticate represents my best efforts to interpret the dath avariable. tindandand that anv false statement may be Dunishable by fine or imprisonment under 18 U. S. Code, Section 1001. SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) 'opy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. C �? �� -� G comp Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) or Zone AO and Zone A (without BFE), complete Items E1. through E4. If the Elevation Certificate is intended for use as supporting formation for a LOMA or LOMR -F, Section C must be completed. 1. 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.) 2. The top of the bottom floor (including basement or enclosure) of the building is 1_1_1 ft.(m) 1_1_Jin.(cm) 1 -1 above or 1_1 below (check one) the highest adjacent grade. (Use natural grade, if available.) :3. For Building Diagrams 6 -8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is 1 -1_I ft•(m) I— I ^lin.(cm) above the highest adjacent grade. Complete Items C3.h and C3.i on front of form. .4. 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? 1_1 Yes 1 No 1_1 Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATPM CERTIFICATION the 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 without a FEMA4ssued or community- issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are correct to he best of a knowled e. kDDRESS CITY STATE ZIP CODE i DATE TELEPHONE L J Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) ie local official who is authorized by law or ordinance to administer the community's floodplain management ordnance can complete actions A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. 1. U 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 law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) 2. 1_J A community official completed Section E for a building located in Zone A (without a FEMA- issued or community - issued BFE) or Zone AO. 3.1 1 The following information (Items G4-G9) is provided for community floodplain management purposes. �. This permit has been issued for: 1 -1 New Construction 1_1 Substantial Improvement 3. Elevation of as -built lowest floor (including basement) of the building is: _ _ft. (m) Datum: 3. BFE or (in Zone AO) depth of flooding at the building site is: +ft.(m)Datum: OCAL OFFICIAUS NAME TITLE CMMUNITY NAME TELEPHONE IGNATURE DATE Check here if attachments 'hAA Fnrm A1_'A1 it it M RFPI Ar.PR At I PRFVIr11 m r-n[TIr1NC