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Home My Public Portal AboutEstill Av_1429FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067 -0077 NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 ELEVATION CERTIFICATE Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME E Policy Number BUILDINGSTREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR . . ROUTE AND BOX NO. Company NAIC Number S- CITY l STATE ZIP CODE ---) PROPERTY-DESCRIPTION (Lot and Block Numbers, Tax Par Nu er, Legal Description, etc. ,. BUILDING USE (.g., Residential, Non - residential, Addition, Acce sory c. Use Comments section if necessary.) LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: 1_1 GPS (Type): ( ##° - ##'- ##.##" or ##.##if# #°) I_l NAD 1927 1_1 NAD 1983 Ll USGS Quad Map 1 -1 Other: SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME f� B3. STATE B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FL ELEVATIONS) NUMB C DATE EFFECTIVE/REVISED DATE ZONES) (Zone AO, use depth of flooding) -1;6 '!�' -/ 7''* 01 V - `-7- / S', c_�) B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. 1 -1 FIS Profile L+l:r'I'RM I -1 Community Dete ined 1 -1 Other (Describe): 611. Indicate the elevation datum used for the BFE in B9: I _ NGVD 1929 1_1 NAVD 1988 1_1 Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? IJ Yes I 0 Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: 1_1Construction Drawings` 1_1Building Under Construction" I Llfinished Construction "A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number to (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.) C3. Elevations —Zones Al -A30, AE, AH, A (with BFE), VE, V1430, V (with BFE), AR, AR/A, AR/AE, AR/A1 -A30, AR/AH, AR/AO Complete Items C3a -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. Datum Conversion /Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? 1 -1 Yes I_ o ❑ a) Top of bottom floor (including basement or enclosure) 1,14, .?(m) ❑ b) Top of next higher floor ❑ c) Bottom of lowest horizontal structural member (V zones only) ..m) w �`` " "'!Q wo ❑ d) Attached garage (top of slab) t�nJJe a ..�tii� /�- m) 0 r�Cy�ST L) e) Lowest elevation of machinery and /or equipment w servicing the building m) E ❑ f) Lowest adjacent grade (LAG) z' 0 g) Highest adjacent grade (HAG) ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjace grade ❑ i) Total area of all permanent openings (flood vents) in C3h sq. in. (sq. cm) nnnn 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. l certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. l understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. CERTIFIER'S NAME LICENSE NUMBER TITLE / � n C� CO nM� P Af NAME . c /L J� �rC � ADDRESS P ZICO 2 O v STATE , v , l r C N SIGNATURE V DATE l� U TELEPH NE r b CD FEMA Form 81 -31, AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In there spaces, copy the corresponding information from Section A. For Insurance Company Use: BUILDING STREET AD DR SS (Including Apt., Unit, Suit ,and /or Bldg. N ) OR P.O. ROUTE AND X NO. Policy Number CITY STAT ZIP CODE Company NAIC Number 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 1 -1 Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO and ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1 through E3. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR -F, Section C must be completed. E1. 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.) E2. The top of the bottom floor (including basement or enclosure) of the building is L-1 -1 ft.(m) 1- 1- 1in.(cm) 1_1 above or 1 -1 below (check one) the highest adjacent grade. E3. 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_1 No 1_1 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. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS I 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. G1. 1 -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 law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. 1_1 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. 1_1 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 is: _ ft.(m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: _ ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE Check here if attachments FEMA Form 81 -31, AUG 99 REPLACES ALL PREVIOUS EDITIONS FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE O.M.B. No. 3067 -0077 Expires July 31, 2002 Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME / Policy Number BUILDING STREET ADDRESS Including Apt., Unit, Suite, and/or Bldg. No.) O P . ROUTE AND BOX NO. Company NAIC Number 14 C CITY / STATE ZIP CODE Gt r1 G( ,U �% PROPERTY DES RIPTION (Lot and Block Numbers, Tax Par, u cer, Legal Description, etc.) l� � "2 Ni BUILDING USE (e.g., Resid ntial, Non -re idential, Addition, Accesso c. Use Comments section if necessary.) LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: I_� GPS (Type): ( ##° - ##' - ##.##" or ##.##### °) � L I NAD 1927 l NAD 1983 I —I USGS Quad Map I —� Other: SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIIP COMMUNITY NAME 8 CO MUNITYY N,%BER B2. COUNTY NAME B3. STATE 'B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FL ELEVATI0N(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding) 000 / C -/ 7 2� -d 6 V-1 S. o 110. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. 1_1 FIS Profile FIRM I_� Community rNGVD rmined �_I Other (Describe): 111. Indicate the elevation datum used for the BFE in B9: I 1929 �_1 NAVD 1988 1_1 Other (Describe): 112. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1_l Yes 1_ No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) ;1. Building elevations are based on: 1_lConstruction Drawings' I_lBuilding Under Construction* J_IFinished Construction *A new Elevation Certificate wii I be required when construction of the building is complete. ;2. 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.) ;3. Elevations — Zones Al -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 C3a -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. Datum Conversion /Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? 1_1 Yes ❑ a) Top of bottom floor (including basement or enclosure) A ❑ b) Top of next higher floor ❑ c) Bottom of lowest horizontal structural member (V zones only) /., (m) 00 ❑ d) Attached garage (top of slab) I .sk -4 7 / ft.(m) w ❑ e) Lowest elevation of machinery and /or equipment g servicing the building /(� _ m) 2 0. 2 8 �= ❑ f) Lowest adjacent grade (LAG) m) z' ' ❑ g) Highest adjacent grade (HAG) ❑ h No. of permanent openings flood vents within 1 ft. above adjacent grade ,A, r Ut. ❑ i) Total area of all permanent openings (flood vents) in C3h _ V sq. in. (sq. cm) 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. 1 certify that the information in Sections A, B, and C 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, CERTIFIER'S NAME/v , _ , LICENSE NUMBER TITLE / COMPANY NAME ADDRESS - CITY STATE ZIP CODE -7 %� L1 I� �` , �. li7 i� �A SIGNATURE T DATE TELEPHONE =EMA Form 81 -31, AUG 99 (/ SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EC AS IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: BUILDING STREET ADDRESS (Including t., Unit, Suite, and /or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number 2 J . CITY STAT/ ' ZIP CODE Company NAIC Number / 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 -I Check here if attachment: SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO and ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1 through E3. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR -F, Sebtion C must be completed. E1. 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.) E2. The top of the bottom floor (including basement or enclosure) of the building is 1-1 -1 ft.(m) 1- 1- 1in.(cm) 1_1 above or L_I below (check one) the highest adjacent grade. E3. 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_1 No 1_1 Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owners 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. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS 1 -1 Check here if attachment: 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. G1. 1 -1 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.) G2. L1 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. L1 The following information (Items G4 -G9) is provided for community floodplain management purposes. G6. DATE CE 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 is: _ ft.(m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: _ ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS Check here if attachment FEMA Form 81 -31, AUG 99 REPLACES ALL PREVIOUS EDITION