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HomeMy Public PortalAboutChatham Av_1806.pdfFEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 FLEE"4ATION CERTIFICATE Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION ( For Insurance Company Use: BUILDING OWNER'S NAME u� Policy Number BUILPING STREET A RESS (Including Apt., Unik Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. I Company MAIC Number CITY PROPE TY DESCRIPTI (Lot and Block Numbers Tax Pac I uniber, Legal D�iption, etc ) BUIL'IJINQ USS' e.g., Residential, Non-residential, AddMon, Accessory, etc. Use Comments section if necessary.) LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: �_� GPS (Type): ( ##° - ##'- ##.##" or ##.#tt###°) �_� NAD 1927 1-1 NAD 1983 1—J USGS Quad Map 1_1 Other: SECTION B - FLOOD I14SURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUN/ ITY NUMBElR' 82. COUNTY NAME B3. STATE B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBERAl E EFFECTE/RE I ED DATE ZO IE(S (Zone AO, use depth of flooding) 14164- o� G 6117 /96 �l�� 6 X10. Indicate Ithe source of the Ba Flood Elevation (BFE) data or base flood depth entered in B9. FIS Profile I_ IRM �_I Community Detelmined �_� Other (Describe): 111. Indicate the elevation datum used for the BFE in B9: 1�rNGVID 1929 1_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_1 Yes --Mo Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) 1. Building elevations are based on: �_lConstruction Drawings` �_lBuilding Under Construction' /fFinished Construction "A new Elevation Certificate will 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. L Datum h r;rtX 7-6� Conversion/Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? 1,_1 Yes 1 --j'No ❑ a) Top of bottom floor (including basement or enclosure) ft. (n* O ❑ b) Top of next higher floor 14b,�. _ ft.(m) O� ❑ c) Bottom of lowest horizontal structural member (V zones only) a1/4 -j' _ ft.(m) 00 ❑ d) Attached garage (top of slab) r ft. (r4:4- w �r ❑ e) Lowest elevation of machinery and/or equipment ° Nk 1g servicing the building % tt.(n �E / O q L] f) Lowest adjacent grade (LAG) '�7 • 4, ft. (w+ 2 L[O v �O Elg) Highest adjacent grade (HAG) ; - ft.(" ,p SUF+J Jam' ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacen grade X68. fy�f�T F-1 ❑ i) Total area of all permanent openings (flood vents) in C3h 1A D,,-- sq. in. (sq. cm) 1, r o SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by 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 orimpnsonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME / j J , / LICENSE NUMBEfj,,,7A 9 TITLE `�/ c� r Y COMPANY NAME ADDfj)=S�� �� °l� �� �J(�71/' ZIP CODE SIGN /` T" �...r ((ATURE ` �T / TELEPHONEJ©�(� =EMA Four 16-3 -AfJG 99 SEE REVERSE SIDE F6R CONTINUATION REPLACES ALL PREVIOUS EDITIONS