Loading...
HomeMy Public PortalAboutBrewer's Ld_919B U.S. DEPARTMENT OF HOMELAND SECUR,TY ELEVATION CERTIFICATE f OMB No. 1660 -000.8 Federal Ernerge;ncy ManagameM Agency ExRires February 28, 20C National Flood insurance Program Important: Read the instructions on pages 1 SECTION A - PROPERTY INFORMATION 1 For Insurance Company Use: Al. But = '+ 4r) p ,m'vL -/ QP64 f ,v r . INC. PoCwyNumber A2. By g Street Acid (including Apt. Unit, Suite andfor Bldg. No.) or P.O. Box No. Company RAC Number 5 C'`"`7 a '6 7 �A - ZIP Coda3i328 A3. Prope Des n t and Block Numbers, Tax Perm! Number, Legal gescripfion, etc.) r 8RE Wn/ 6' 4 A/Q /4J6- A4. Building Use (e.g , Residential. Non- F2etidential, Addition. Accessory, etc.) /i5163 /L ' T / A5. Latitude/Longitude: Let. Long. Horizontal Datum: [❑ NAD 1927 f NAD 1 A5. Attach at least 2 photographs of the building it the Certifseate IS being used to obtain flood insurance. A7. Building Diagram Number '7 A6- For a buiiriing with a crawl space or enclosure(s), provide: p A9. For a building with an attached garage. provide a) Square footage of crawl space or endoeure(s) f a 1 fig ft a) Square footage of attached garage /� wl sq ft b) No. of permanent flood openings to the crawl space or b) No. of permanent flood openings in the attechdg rage enclosure(s) wails within 1.0 foot above adjacent grade walls within 1.0 foot above adjacent grade !Y c) Total net area of flood openings in A8.b _970 sq in c) Total net area of flood openings In A9.b _ L ✓ sq i SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION rBt Comm CmunI & Community Number -- it. Uounty _ 8te E ` / YBt.E" 1: LA / � _ C 4LIIA,w _. i 3. Sta I B4 Map/Panel Number 135. S ftrx j 86. FiRM index 87 FiRM Panel i ba Fiona 99 Base Flood Etevalion(s) [date E . •l - - . Date Zo AO, use base flood depth) 1 /35I6� vo f w _ _ ! 17 -g� - ;:6 ( /- ( /2 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. C] FIS Profile (['FIRM 0 Community Determined ❑ Other (Describe) 911. indicate elevation, datum used for BFE in item B9: Q NGVD 1929 [] NAVD 1988 [❑ Other (Describe) 812. is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes EI Desigrtst,on Date 0 CBRS [] OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on ❑ Construction Drawings" 0 Budding Under Construction' CO Construction 'A new Elevation Certificate wilt be required when construction of the building is complete. C2. Elevations - Zones A1-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, ARJAO. Complete items C2.a-g below according to the Dtdidif• diagram specified in hem A7. Benchmark Utilized ./2 r (Z Vertical Datum A 5 k D ZC' Conversion/Comments Check the measurement used. a) Top of bottom floor (including basement, crawl sparse, or enclosure floor) _ M D meters (Puerto Rico only) b) Top o f the next higher floor if q . 3 LJ feet ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) 444 ❑ feet 0 meters (Puerto Rico only) d) Attached garage (fop of slab) q C Ftfeet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building /0 ._ _ Q'feet [] meters (Puerto Rico onty) (Describe type of equiprent in Comments! f) Lowest adjacent (finished) grade (LAG) _ �Eii - - ❑maters (Puerto Rico only g) Hiphest adjacent (finished) grade (HAG) ' ' :9 r 0 meters (Puerto Rico only) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed end seeded by a lend surveyor, engineer, or architect authorized by few to certify elevation information. 1 certify that the ink motion on this Cep represents my best erode to inliorpret the data available. I understand that any fafse statement may be punishable by lire or lrrpriaorenent weer 18 U.S_ Code, Section 1001 ----- ��tt Q to f L1 Check here if comments are provided on back of form. . ` OP o P R o - "¢ Gangs Nana C 8 Rr C . .7 /L.1.. (k1 N "' ' /66Z L * r ' .; No. 1582 T / RED ✓� ` 1-�� /�i w Address 13,,Q X Ze 9 CkY r ) /8e , stab � ZIP Code d !3 2 � \ , 'z ,. ' 4 � X / (? ©SI Ry '1\.s.Cz._\1\1\ \ i_ r. Dane Z - - U� QIZ - 7 fJ - 4vD '`a -- .1 ` v . L FEMA Form 81 -31, February 2006 ' See reverse side for continuation. Replaces all precious edit IMPORTANT: in these spaces, copy the corresponding Inform U on h+on'+ A c (Far theatres Cpm anY 1 : Building � , � ' .. `.: ( kr8 ��N�garrA C.-f,/o. U te+ e Sk:t) Policy i�lurnbe� C4 rY 8 EC J' stye 6,4 - _ j 1 MAIL Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both aides of this Elevation Certificate for (1) cnmrnunily official, (2) Insurance agent/company, and (3) building owner. Comments f\ f■ Q �y .i l l Si �� < \ V�-1\ J( " _ Z � CJ Check her attachments Ei SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without SFE), complete Items E1 -E5. if the Certificate is intended to support a LOMA or LOMR -F request, complete Sections A, B, and C. For Items E1 -E4, use natural grade. If available. Check the massui merit used. in Puerto Rico only, enter meters. El Provide elevation information for the following and cherdc the appropriate boxes to show whether the elevation is above or below the highest a cijacent grade (HAG) and the lowest adjacent grade ((AG). a) Top of bottom floor (including basement, crawl space, or enclosure) is D feet 0 meters 0 above or L] below the HAG. b) Top of bottom floor (including basement, crawl space, or endosure) is — D feet [3 meters Q above or ❑ below the LAG. E2 For Budding Diagrams 6-8 with permanent flood openings provided In Sacliget,A Items 8 a •for 9 (see egg. 8 of inrNudlons), the next higher floor (elevation C2.b in the diagrams) of the building is _ 0 feed Li meters above or U below the HAG. - E3. Attached garage (top of fiat) is _- 0 feet 0 testate ❑ above or 0 below the HAG. E4 Tap of platform or machinery and/or equipment servicirb3 the bullring a 0 feet 0 meters [] above or [ below Iles HAG. E5. Zone AO only if no flood depth number is available, is the top of the bottom floor elevated in extedarice with the community's tloodplain management ordinance? 0 Yes ❑ No ❑ Unknown. Tee lobe) of iciel 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. 8, and Elect Zone A twdhout a FEMA - Issue or community:sseed BFE) or Zone AO must sign here. The statements in Sections A, 8, and E are correct to the best of my . J , + :. Property Owners or Owner's Authorized Representative`s Name Address City State ZIP Coda Signature Data Telephone Comments _._.. -- _ _ E Check here if attachmen 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 iterm(s) and sign below. Check the measurement used in items G8 and G9. Cl. [] The information in Section C vats taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to coney elevation information (frailest* the source and date of the elevation data in the Comments area below.) G2 0 A community official completed Section E for a beading loaded in Zone A (without a FEMA- issued or community-lezued BFE) or Zone AO. G;s 0 The following information (Items 04. -09.) is provided for community ffoodpiain management purposes. I G4. Permit Number I G5. Date Permit issued 1 06. Date Certificate Of Compfianoergccupency Issued G7. This permit has been issued tor. C New Construction ❑ Substantial improvement 08. Elevation of as-buis lowest floor (including basement) of the building: [] feet Thrusters (PR) Datum GB. BFE or (in Zone AO) depth of flooding at the building site. ❑ feet ❑ meters (PR) Datum Local Olectars Name Tie Community Name Telephone Signature DES Comments ❑ Check here if attacdtnter FEN% Form 81 -31, February 2906 Replaces all previe editio