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Home My Public Portal AboutCampbell Av_194 ELEVATION CERTIFICATE Q M IV No 3067-007? Expires Addy 31, 1903 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM TTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to 'ovide elevation information necessary to ensure compliance with applicable community floodp(ain management ord+'nanr_.es. to stermine the proper insurance premium rate, and /or to support a request fora Letter of Map Amendment or Revision (LOMA or LOMA). Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION FOR INSIJ'rtANCE COMPANY usr BUI NG OWNER'S NAME POLICY NUMBER IA W .. „ AS A 0 .O I J tt U oV ELL __ . _ __._ 5T DDRESS Ir ludind Apt,, unit. S and/or Bldg. Number) OR P.O ROUT Nt) BOX NUMBER COMPANY NAIC NUMBER 0TH R 0 CRIPTl o ON (Lot o And Block u b9re, etc.) + STATE i co SECTION 8 FLOOD INSURANCE RATE MAP (FIRM) INFORMATION provide the following from the proper FIRM (See Instructions): 1. COMMUNItY NUMBER 2 NUMBER 3, SUf'P'IX 9 PATE OF FIRM INDEX 5. FIRM ZONE A. BASE FLO0O ELEVATION 1 SS 1 4,4 .0i /6 ` r t J ,r 1 M `- M 4 ( In A Z o �b s e LE dowhy . Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): t_TNGVD '29 C_) Other (describe on back) 3. For Zones A or V, where no BFE is provided on the FIRM, and the community has estabilshed a BFE for this building site, indicate the community's BFE: L_.l__ .1._.. i .0 feet NGVD (or other FIRM datum -see Section B, Item 7)_ SECTION C BUILDING ELEVATION INFORMATION I. Using the Elevation Certificate Instructions, indica the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level .„ , . 2(a). FIRM Zon 1 -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation Vii.. Of f rl lifeet NGVD (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 front the selected diagram, is at an elevation of 1 ( I 1 ,L,L feet NGVD (or other FiRM datum -see Section 8, Item 7). _ (c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is 1.1 J feet above 1 _i or below i....1 (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 I I I .L.1 feet above ❑ or below L (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 floodpiain management ordinance? ❑ Yes No 1- Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations: NGVD '29 E) Other (describe under Comments on Page 2). (NOTE: U 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 Ft : ❑ Yes VIVO (See Instructions on Page 4) 5. The reference level elevation is based an l� actual construction CI construction drawings (NOTE: Use at construction drawings Is only valid if the building does not yet have the reference level floor m place, In which case this certificate will only be valid for the building during the course of construction. A pat•construction Elevation Certificate will be required once construction is complete.) //� 6. The elevation of the lowest grade immediately adjacent to the building is:rl1 A .l'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 Indicated in Section C, item 1 is not the "lowest floor” as defined in the community's fioodpiein management ordinance, the elevation of the builcing's "lowest floor" as defined by the ordinance is: 1 1 1 I _ .1 1.L feet NGVD (or other Fif1M datum -see Section B. Item 7), 2. Date of the start of construction or substantial improvement . .__ . _____r. _ • FEMA form et -31 MAY 90 REPLACES ALL PREviOuS EDITIONS SEE REVERSE sips FOR CONTINUATION SECTiON E CERTIFICATION This coniticatlon is to be signed by a land surveyor, engineer, of architect who is authorized by state or local law to certify elev,e ion information when the elevation information for Zones A1--A30, AE, AN, A (with RFE),V1 -V30,VE, and V (with BFE) is required, Community officials who ere authorized by local law or ordinance to provide floodptain management information, may also in the cenificatlon. In the case of Zones AO and A (without a FEMA or community issued FIFE), a building off asi, a property owner. or an owner's representative may aiso sign the certification. Reference level diagrams &, 7 and 8.Oitgnguishing Features -4f the certifier is unable to certify to breakaway /non- breakaway wall, enclosure size, location of servicing equipment, eree us;r, welt openings, or unfinished eras Feature(s), than list the Features) not included in the certification under Comments below. The diagram number, Section C, Item 1, must still be entered, I certify that the information in Sections 8 sand C this cerlifioate rvpresortls my beet effon t to interpret the data available. i understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Cods, Section 1001. tti I * alp 111, ll&Me " 414. ' �. Lis , . 40 4 7-% . 7 !MEN* NAME LICENSE HuraBan is Mix s,►.l, TITLE NAME _Alosafromosar Itel.________6 _<=tempiAL3Wie A ` - CRY STATE zn i 1 . � _ . 0 1/1445_ _. 1°'.�". 81 � t r PHONE Copies elktuIti be made at this Certifies)* for: 1) community official, 2) Insurance spent/c mpeny, end 3) building owner, COMMENTS: WITH oN4•11.se, A V A A v ZONES ZONa6 ( ZONES ZONES ZONES rr vAT ru� t� . r � N�a►�ad►n ccrv .02 Mar {IFS awl • � \i .1,: r.i ?i.t . �•'-r to '�,�'•, MIKZMf The dlagrems 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 01 me referents ►•ver floor, ElevalIone for all V Zones should be measured at the bottom of the lowest horizontal structural member Page 2