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Home My Public Portal AboutButler Av_100 r* ELEV.' Tlt]N RTIFICATE F es X re9 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 premiun1 rate, and /or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR). Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION FOR INSURAN` F COMPANY USE BUILDING OWNERS NAME POUCY NUMB — F f2.. A 4 i4 40 ijaU --. STREET ADDRESS (Including Apt . Unit. Suite and/or Bldg. Number) OR PO ROi rTF AND BOX NUMBER I COMPANY NA1C NUMBER i C. ) 0 f%V 371 I- E A V g 11Vl OTHER DESCRIPTION (Lot rind ekock Numbers, etc.) T 5 ` 1 8 L,J t'L p . 1 -- - - CITY ' STATE ZIP CODE TY SE 1 (- A tD , A , ( 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 A. DATE OF FIRM INDEX 5 fiRM ZONE 6. BASE FLOOD ELEVATION J i (. - t L 1 9 - J' tin AO Zones, a depth) 7. indicate the elevation datum systern used on the FIRM for Base Flood / Elevations (RFE). NGVD '29 L Other (describe on back) 8. For Zones A or V, where no BFE is provided on the FIRM, Find' the community has established a fFF for this building site, indicate the community's BFI . i 1 1 LLJ 1 feet NUVU (sir oilier FIRM datum -see Section 8, Item 1) SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level _L_ . 2(a). FIRM Zones Al -A30, AE, AH, and A (with eFE). The top of the reference revel floor from the selected diagram is at an elevation of L 1 1 11 181.1 feet WGVO (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 from the selected diagram, is at an elevation of [ 1 i L_ i J .L 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 1 ,.._1 ..j . J feet above [� or below n (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. Li .11 feet above j 1 or below [J (check 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 fioodpiain management ordinance? {.11 Yes ❑ No [ ] Unknown 3. Indicate the elevation datum system used in determining the above reference levet elevations 2 NGVD '29 [1 Other (describe under Comments on Page 2). (NOTE If the elevation datum used in measuring the elevations is different than that used on the FiRM [see Section 6, Item 7], then convert the elevations to the datum system used an the FiRM and show the conversion equation under Comments on Page 2 ) 4. Elevation reference mark used appears on FIRM: n Yes M No (See Instructions on Page 4) 5, The reference level elevation is based on: actual construction LI construction drawings (NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which 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: L_ L, i t_ ii 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 indlcated in Section C, item 1 is not the "lowest floor" as defined in the community's floodptain management ordinance, the elevation of the building's 'lowest floor" as defined by the ordinance is: L_LLt. 1 1 .j_ _ 1 feet NGVD (or other FiRM datum-see Section B, Item 7). 2. Date of the start of construction or substantial improvertlerd ___ -_ _ . _ __ _. _... _ . . -- FEM foim 81 -31 MAY 90 REPLACES ALL FREVr0US EDITIONS A SEE REVERSE SIDE FOR CONTINUATION SECTION E CERTIFICATION This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation information when the elevation information for Zones A AE, AH, A (with BFE),V1- V30.VE, and V (with BFE) is required. Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the certification In the case of Zones AO and A (without a FEMA or community issued BFE), a building official, a property owner or an , owner's representative may also sign the certification. Reference level diagrams 6, 7 and 8 - Distinguishing Features -lf the certifier is unabte to certify to breakawayinon- breakaway watt, enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not included in the certification under Comments below. The diagram number, Section C, item 1, must still be entered. !certify that the information in Sections Et and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may the punishable by tine or imprisonment tinder 18 1.1 S Code. Section 100 i "S "' 1.-- B . A K f2-,e 1 :) 0 t . , 6 . A . R J .'. ` - - T 1 CERTIFIER'S NAME LICENSE NUMBER for Mix Seat) g— . L L. 5 8 A- o z- - rr - L. A. rr D S u a- J _E Y r l 6 t 1� C -- — TITLE COMPANY NAME _ P • . - o t O s' N ;tip' A l _''� _ . �' ' l 1.---- - - - - -- — ADDRESS CITY STATE ZIP __ rs. _^ f� ;, 4 _,€ -- 4' -, I j ;, ` 1 L '1 1.4- f ` ` j 7 - 4' (, Q SIGNATURE ! DATE PHONE —� Copies should be made of this Certificate for: 1) t ernmunity official 2) lneurance agent/company, and 3) building owner. COMMENTS:. -- ...... -- oN WITH ON PILES, SEAS BASEMENT PIt<R$, OR COLUMNS A V _ A A V ZONES ZONES (4 ZONES YONES ZONES Y' � REiEAEIk E 1 ' " t 9 — � AEFaR ENCE At<FEAE'+Cd B.lSE 4L'Jtt L ---�_ +��+ LEVEL • E 40� —'�Q.' - - f4tVATnJN e t�7 6 BASE ._. T' . : .\, AWAi;E^?Tyl',, r t:f `f%.":..E tE^fAft FLOW GH nOE 1 `� i Ll:v6t £tOli a.EVATION Ft KtSEW ACJAGErlr t t,EVEI LIRADE , ti 1 '1 -j ;!: :M,r:_ rtt ' ? i . : : • ' . 1 6 0 , CfMDa 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 whoutd be measured at the bottom of the lowest horizontal structural member. Page 2