HomeMy Public PortalAboutCaptains View_53 E VAT R i F 1 C /VI O.M.Q. No 3067-0077
Expires May 31, 1993
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
pr ovide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to
determine the proper insurance premium rate, and /or to support a request for a Letter of Map Amendment csr Revision (LOMA or LOMR).
Instructions for completing this forrn can be found on the fcilowing p,:g.S.
SECTION A PROPERTY INFORMATION I FOR INSURANCE COMPANY USE
BUILDI OWNER'S NAME , POLICY NUMBER
.06/1 1 ,L DEV_FIZ OP/la
STREET / �ADDD ^ AEESS (Inci cling Apt., U it,,Suit a /or,Biddu Number) OR P.9.. 3 UTE AN BOX NUMBER COMPANY NAIC NUMBER
__.. x - C-Ci a; t 9 `� 0, `is 4..: c �
OTHER ESCRIPTION Lot an Block Number , e..)..._ Co
f �. r I -�,�.. 3 �.� �'� s' V ' e v3 #c!
CITY - ( STATE ZIP CODE
3 __ 7 6 : . L 1a I
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions): _
r----- 1. COMMUNITY NUMBE 2. PANEL NUMBER 3. SUFFIX 4. DATE OF IRM INDEX .. Ff9 541 ZONE 6. BASE FLOOD ELEVATION
C 6° h7 ge `! � " ( i n AO Zones, use depth)
7 . Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): 1 1 NGVD '29 Li Other (describe on back)
z3. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate
the community's BFE :1 1 1 1 1 1.1 I feet NGVD (or other FIRM datum -see Section B, Item 7).
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 T .
2(a). FIRM Zones A1-A30, AE, AI-I, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
of I 1 1 Ii 1. ti feet NGVD (or other FIRM datum -see Section B, Item 7).
(b). FIRM Zones V1 -V30, \/ E, 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 I 1 1 1 1 1.1 1 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 1.1 I feet above 1 or
below 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 1 1 1.11 feet above l or below E (check
one) the highest grade adjacent to the building. If no flood depth nurnber is available, is the building's lowest floor (reference
level) elevated in accordance with the community's floodplain management ordinance? LJ Yes I 1 No Li Unknown
3. Indicate the elevation datum system used in determining the above reference level elevations: VNGVD '29 E 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 B, Item 7], then convert the elevations to the datum system used on the FIRM and show the conversion
equation under Comments on Page 2.) ,�-,/'
4. Elevationi reference mark used appears on FIRM: ll� Yes Li No (See Instructions on Page 4)
5. The reference level elevation is based on: L 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 wi.'l 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 le,vest grade immediately adjacent to the building is :1 1 I I I .71 feet NGVD (or other FIRM datum -see
Section h, Item 7).
SECTION D COMMUNITY INFORMATION
1. If tho community official re: ponsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
is not the "lowest floor" as refined in the community's floodplain management ordinance, the elevation of the building's "lowest
floor" as defined by the ordnance is: 1 1 1-1 I J .1 1 feet NGVD (or other FIRM datum -see Section B, Item 7).
2. Date of the start of construction or substantial improvement .
FEMA Form 81 -31 MAY 90 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION
SECTION E CERTIFICATION
This certification is to be signed by a and surveyor, engineer, or architect who is authorized by state or local law to certify elevation
ii iformation when the elevation information for Zones A1—A30, 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
curt Pica :ion. 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 —If the certifier is unable to certify to breakaway /non - breakaway wall,
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 0, Item 1, must still be entered.
I certify that the information in Sections B and C 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.
CERTIF S NAME LICENSE NUMBER (or Affix Seal)
6)6 e r FC. Attliaf:c1
TITLE , y F ,fig Zoo �•_� -. °, COMPANY
��- N�AM,� `j / � � jig'
( ✓'.- {- Zo �� A , aV ,C. J : C 4:f,{, U <F -'. 1.. �"' c m 1 —
' ADDRESS `� CITY I` ' _ STAT ZIP
C_ 6 9 o � ,- ..� , , C c1 P � ��
SIGNATURE k DAT ONE
Copies should be made or this Certificate for: 1) community official, 2) insurance agent /company, and 3) building owner.
COMMENTS: tKyrt 'A�n � L " k *s.1�. 44 '�
; 'au; .X82 \ k .
' ,: . � L c t v r'"t ;
y C, 't-r .t ' '
•
ON WITH ON PILES, -
SLAB BASEMENT PIERS, OR COLUMNS
A _� V A A V
ZONES ZONES ik ZONES ZONES ZONES
REFERENCE ��I/11�
�� LEVEL - REFERENCE
REFERENCE , EASE LEVEL
�EVEL FLOOD 1I'
TH)L ELEVATION
U BASE
FLOOD
L O O ADJACENT REFERENCE ELEVATION
FLOOD LEVEL
ELEVATION REFERENCE ADJACENT GRADE
LEVEL GRADE ^'
�
' : '' :;;: ".:I::.:! '. ADJACENT::
. .. ...: .... .....,._.� GRADE '
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 c it V Zones should be measured at the bottom of the lowest horizontal structural member.
Page 2