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Home My Public Portal AboutNaylor Av_6ELEVATION CERTIFICATE Expire. May 31, 1977 Expires May 3 t, J993 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to determine the proper insurance premium rate, andfor to support a request for a Letter of Map Amendment or Revision (LOMA or I.0fAny Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION BUILDING OWNER'S NAME ' ,/C `!'t1 'VIL oU eoz y PiZ_-fF_1_Z_ _5_lf_il:+_16 /441/ L_yv/t1 Lei 6 -,4A) STREET ADDRESS (Including Apt., Unit, Suite and(or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER :0 C_ NA Y'L 0 t2_ A ✓L - ,L1oF_ FOR INSURANCE COMPANY I I .F POLICY NUMBER COMPANY NAIC NUMBER OTHER DESCRIPTION (Lot and Block Numbers, etc.) z �; –l3z tir &L)1LP(,f 62 P0 Iz-7- 6Q'Iq IZ -- CITY STATE ZIP CODE SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM (See Instructions): 1. COMMUNITY NUMBER 2. PANEL NUMBER 3, SUFFIX 4. DATE OF FIRM INDEX 5. FIRM ZONE S. BASE FLOOD ELEVAi ION 4 (In AO Zones, a d�•PU1) I E i7 C9 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): FAq.NGVD'29 ❑Other (describe on brick) 8. For Zones A or V, where no BFE is provided on the FIRM, and the community has-established a BFE for this building site, indical� the community's BFE L_I_J.._J__L_I.I_J feet NGVD (or other FIRM datum –see Section B, Item 7). SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, indica the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level 2(a). FIRM Zones Ai -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation of ❑ —LL_E6. L71 feet NGVD (or other FIRM datum –see Section B, Item 7). (b). FIRM Zones V1 -V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level Iron, the selected diagram, is at an elevation of LL 1 .-1__LI I_ - I feet NGVD (or other FIRM datum –see Section B, Item 7). (c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is L ❑.❑ feet above D or below ❑ (check one) the highest grade adjacent to the building. (d). FIRM Zone AO. The floor used as the reference level from the selected diagram is L.I_I .LI feet above ❑ or below I I (c-lleck one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes 0 No ❑ Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations: K .NGVD '29 ❑ Other (desmil.ln under Comments on Page 2). (NOTE. ff the elevation datum used in measuring the elevations is different than that used on the FIRM (see Section 8, item 77, then convert the elevations to the datum system used on the FIRM and show the conver.,inn equation under Comments on Page 2.) 4. Elevation reference mark used appears on FIRM: ❑ Yes L�I-No (See Instructions on Page 4) 5. The reference level elevation is based on: actual construction ❑ construction drawings (NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in whirl, case this certificate will only be valid for the building during the course of construction. A post- construction Elevation Certificate will be required once construction is complete.) 6. The elevation of the lowest grade immediately adjacent to the building is: ❑_I 1 17111 feet NGVD (or other FIRM datum -see Section B,, Item 7). SECTION D COMMUNITY INFORMATION 1, If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, ileill 1 is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest floor" as defined by the ordinance is: L_❑_L_ ❑.❑ feet NGVD (or other FIRM datum –see Section B, Item 7). 2. Date of the start of construction or substantial improvement FEMA Form 91 -31, MAY 90 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONI Ii IWO 1014 SECTION E CERTIFICATION Is certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation )rmation when the elevation information for Zones Ai —A30, AE, AH, A (with BFE),V1— V30,VE, and V (with BFE) is required. mmunity officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the -tification. In the case of Zones AO and A (without a FEMA or community issued BFE), a building official, a property owner, or an ner's representative may also sign the certification. Terence level diagrams 6, 7 and 8 - Distinguishing Features —If the certifier is unable to certify to breakaway /non- breakaway wall, closure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not .luded in the certification under Comments below. The diagram number, Section C, Item 1, must still be entered. ertify that the information in Sections B and C on this certificate represents my best efforts to interpret the data available. nderstand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. '6 - -- RTIFIER'S NAME LICENSE NUMBER (or Affix Seal) L 5, 0 1112— (2- . 7 " ?` L 1 D 0 d2- t/," Y i 4 6- (,u C_ , 'LE COMPANY NAME 5A t A AjA /4 l-f DRESS j CITY STATE 7.IP 3NATURE DATE PHONE )pies should be made of this Certificate for: 1) community official, 2) insurance agent /company, and 3) building owner. DMMENTS: REFERENCE BASE FLOOD ELEVATION ON WITH SLAB BASEMENT A v tt A ZONES ZONES 1]pT ZONES 1;. ADJACENT a ADJACENT GRADE GRADE BASE FLOOD LEVEL ON PILES, PIERS, OR COLUMNS A v ZONES ZONES The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones. Elevations for all A Zones should be measured at the top of the reference level floor. Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member. Page 2