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mum FEVERAL EMERGENCY MANAGEMENT AGENCY
8"" NATIONAL rLOOD INSUPANCE PROGRAM
Is ELEVATION CERTIFICATE
IM iorliank: Read the Instructions on p*JL"-- I T.
arcTlou A . PROPERTY OWNER INFORMATION
Orchiding API.. Urk-11- Suite, A"'Or 91*9, NO*) OR P-0 ROUM ANO %OX NO.
;'tc. —1010 coni—mlirkli, airalon W necessary.)
O.M,B. No. 3067 -CIO"
Expires July 31. 2002
F6i, Insurance
Compairry
H. - ZOuRGE, L
AQ—- UKL—OMIAL DATUK J OP3 (Type)�
LA'TsTuDE&0NGlTVVt {(?4'710 AL) ( No I ais, . OW P9, 0 W psow
4 O ') L_J HAD 1027 1_1 NAG 1063 LJ USGV Quad Map L—I C"hof,
$ECylo" 13 FLOO iNSURANCE RATE MAP (FIRM) INFORMATION
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NO PANEI- - a. FIA;_I�- �X
A ��07. FIRM PAN6% B& FLOOD 119 a~- r-L%mou rLxv#%1#WM0
i� " ��p Sti�t fFF 0 DATE ('Zama AO,
HUMBER I — A , I CT'1V9RI!"yx I- I z9NEI& I
810, Indicate the source of the 9
'&ae Flood Elevation (OFE) data or base rood depth eAt4lifed in SO.
FIS Profile 1--TT-IRM 1_1 Community Determined 1-1 Other (Ortactibe);
611, indicate the efev;tsen datum used for tht OFE in 89* 1_.,I'NGVD 1929 1_1NAVD188e 1_1Other (Describo):
Bl2 Is the but)d*N 10=16-d in 0 C09r.101 811irtiorRerources System tCORS) area of Otherwise Protected Area (OPA)? Lam,,,.( YesL!1'00
Dartion2-lion
SECTION C - ISUiLOING ELEVAkT)ON 114FORMATION (SURVEY REQUIRED)
I
Suilding elevations art- based on, J_nonsoruction Drawings- L_180d" Under onstFumlo". toned C4mothliclion
-A now Ele-4011 COmft-Ate Wit be required wham construction of the building Is conVIete.
C2. Eluilding Diagram Number U! (Select the bVIVIng 61#4%ram moll himilst 10 the building for vitlich this certificate is Doing Completed - see
pages a and 7. it 00 cilalgirarn jecuralsly mpies6nit the building, provide asketert or photograph.)
C3. Elevaliori3 - Zones AI -A30. AE. AH. A (With OFE). VE, VI -V30, V (with FIFE), AR, ARIA, AFVAE. AR/Al-A30, APJAH. AFtIAO
Complete Items Gia -i below according to the bvitding diagram speellied In llern C2. State the datum used. It lhe datum it different from
the datum used for the OFE Irl Section S. convert the datum (o that used for the SFE. Show field measurements and datum conversion
cstculation. Vac the spece provided or the C*ft1rnenI& area of Section 0 or Section G. as appgopriale, to document the Gets^ C4*PV4f%lO1n.
Daturn convorsion1commenla
r-levailort reference rnafx used Does the elevation fefertnce mark used appear" an the FIR 2
0 A) Too of bottom floor (Including basement of enclosure) Ica
0 b) Top of mexi higher floorlks- fit (r.4- iq
0 c) Bottom of lowestborizonl6i structural membtf (V tones Only) EN
-
0 d) Attached garage (lop of slab)
0 a) Lowest elevation or machinery andfor oquAprneal
Servicing the building 0
0 9 Lowest adjacent (itatoo (LAG) vifSu
0 g) Highest adjacent gra o (HAG) T L El
0 h) No. of permanent openings (flood wants) within I fl above adjacent grade
0 i) Total area of all permanent openings, (Hood wants) in C3h s in. (sq. cm) L
SECTION 0 - SURVEYOR, ENCINEKA. OR ARCHITECT CERTIFICATION
This coNficz0on is to be 4;qnetl and tested by a land surveyor, engineer.Of isfChllaCt SUIhOtilted by low to canity, e)evbt;*A 1111MMAIlOn.
I certify rho/ (its informariorr in Sections A. 9, and C On (ft;3 carliftele reprozonts my best of brfs to Inlesirintf the data available.
I Undorsfilind Thal any false stalomeni may be punishable by fine or imprisonment under 18 V.S, Code, Section 1001.
0
FEMA Forr;_1.41-31, AUG 99 SEE REVERSE SIDE FOR CONTINUA110N REPLACES ALL PREVIOUS EDITIONS