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Home My Public Portal AboutButler Av_1805 U.S. DEPARTMENT OF HOMELAND SECURITY t LeNATICIN CERTIFICATE OMB No. 1660 -0008 Federal Emergency Management Agency Expires February 28, 2009 'National Flood Insurance Program Important: Read the instructions on pages 1 -8. SECTION A - PROPERTY INFORMATION I For Insurance Company Use: Al. Building Owner's Name / �� _1/ I Policy Number A2. Building Street Address (i_aclud0 Ap ; Suite [Company NAIC Number Bldg. No.) or P.O. Route and Box No. ber 4505 � z , r AUc __ . City ---e � '" State /' . y -� ZIP Code 13 A3. Proper scn ti (Lot a d BN mbers, Tax Parcel Nurp Lega Description, etc.) 5 ef v- Block ue. Pik' j� ° 9 � ` 1 Q - A4. Building Use (e.g., Residential, Non - Residential, Addition, Accessory, etc.)G 4'I A5. Latitude /Longitude: Lat. Long. Horizontal Datum: ❑ NAD 1927 ❑ NAD 198; A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 3 A8. For a building with a crawl space or enclosure(s), provide: A9. For a building with an attached garage, provide: a) Square footage of crawl space or enclosure(s) lD l 3 sq ft a) Square footage of attached garage `=7 sq ft b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attache enclosure(s) walls within 1.0 foot above adjacent grade 4- walls within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b 27 sq in c) Total net area of flood openings in A9.b il,j Z sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP C mmunity Na e & Community Number B2. County B3. State Ah , 1 Name ch - Qt.lQ �. B. gap / Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone ' ✓ �j �( �Z6 Date o Effective/Revised Date Zones) AO, up base flood depth) E10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile I FIRM ❑ Community Determined ❑ Other (Describe) B11. Indicate elevation datum used for BFE in Item B9: [fNGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes [ No Designation Date ❑ CBRS ❑ OPA - SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* ErFFinished Construction `A new Elevation Certificate will 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, ARIA, AR /AE, AR/A1 -A30, ARAN, AR/AO. Complete Items C2.a -g below according to the building di gram specified in Item A7. , )� l �^� ( Benchmark Utilized !v =i Vertical Datum , /L`� 1 O•C� 7 - Conversion /Comme is - /� / 1 6, Coo 046t,-) / Check the measurement used. a) Top of bottom floor (including basement, crawl space o�rr enclosure floor) 8 feet ❑ meters (Puerto Rico only) b) Top of the next higher floor /Cci ' /CL:t' C /9 f 9 . 7 B feet ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural mb pr cy Zones only) Alt feet ❑ meters (Puerto Rico only) d) Attached garage (top of slab) Ib 0+ mA t75 Kt' . 3 ❑a Li meters (Puerto Rico only) e) Lowest elevation of machinery or J'quipment servicing the building `,s._LU let ❑ meters (Puerto Rico only) (Describe type of equipment in Comments) f) Lowest adjacent (finished) grade (LAG) 7 . d [feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade (HAG)' . Z ❑ feet ❑ meters (Puerto Rico only) - SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. / certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Check here if comments are provided on back of form. xa �5+ PROF '` r License Number 1 Y Na, 1.582 G Certifier's Name r f i , a V Title Company Name � T7 / z r ' r 'r , c al . Z.0b 5 1( 0 an erjc i� " l it PE 9 (�,� t ter; r Address QX ZC)%� �t Q. L State /c/a ZIP Code 7 , < Z � , ,� ¢ L3' s Signature .�( �;' / t D e e p VG — 4 i . "At...„,,,,' am . - FEMA Form 81 -31, February 2006 See reverse side for continuation. Replaces all previous editio I For !Mira= Company Use: — IMPORTANT: In these spaces, copy the corresponding Information from Section A. - Building,,St t Addres5 (incdix y Apt., Unit uite, and/or Bldg. No.) or P.O. Route and Box No. [ Policy Number GL/r/C7. City ,—' State a ZIP Code i Company NAIL Number F/3 E SECT ON D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) , --- Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, a4 • *.•ing o -.r. 606-r Commnts 0 e ,(0,0C" ( ./ / fd 6/eL 67 ci, 7 2 p ( la _„/ Ise' 4c-alfC)0 : 64 rt4C-i {), 61 Z '''' 7 iCf` 85, 4 i" Op a .-- 4_1 - . _, r. – , - / 61,19, i . , t'LZ-I i' ' g 1 o n , .4: SignaJre q.-="1'--7— I r.... r cf-- , .. fr-- l'' .- - ■1 I. 4 )-- / i'e- IP here if attachmer e' , SECTION E - E. ILO ' ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT !EWE) .., For Zones AO and A (without BFE), complete Items El-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 measurement used. In Puerto Rico only, enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation Is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawl space, or enclosure) is . 0 feet El meters 0 above or 0 below the HAG. b) Top of bottom floor (including basement, crawl space, or enclosure) is . — 0 feet 1:1 meters EI above or 0 below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in SectiomA Items 8 and/or 9 (see age 8 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is 0 feet L. meters 0 above or u j below the HAG. E3. Attached garage (top of slab) is . 0 feet Ei meters 0 above or 0 below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is . 0 feet 0 meters 0 above or 0 below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain managemen ordinance? 0 Yes 0 No 0 Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or community-issued BFE: or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments , 0 Check here if attachme 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 item(s) and sign below. Check the measurement used in Items G8. and G9. G1 . 0 The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect wh is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. 1:1 A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zone AO. G3, D The following information (Items G4.-G9.) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for 0 New Construction 0 Substantial Improvement GB. Elevation of as-buitt lowest floor (including basement) of the building: . D feet II] meters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site: . 0 feet D meters (PR) Datum Local Official's Name Title Community Name Telephone Signature Date Comments 0 Check here if attachme FEMA Form 81 February 2008 RAnlartps all nal:vim IR orfitir