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Home My Public Portal AboutCaptains View_57 U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION 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 � , A RD 3 �, , ! Policy Number • A2. Buildi treet Ad ess (in uding Apt, pny. Suite, and /or Bldg. No.) or P.O. Route and Box No. I Company NAIC Number City / State ZIP Code A3. Property Descriglolf Lot and BBiock Numbe Tax Parcel Number, Legal Description, ) i q � T�a tf D Q r®' f .vt) zf'9 Q.Q CPp ii/I6 O LV f A4. Building Use (e.g., Residential, Non - Residential, Addition, Accessory, etc.) 7' 1 '7 ) L/C7 / A5. Latitude/Longitude: Lat. Long. Horizontal Datum: U NAD 1927 ❑ NAD 1983 A6. Attach at least 2 photograph of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number A8. For a building with a crawl space or enclosure(s), provide: � 1 A9. For a building with an attached garage, provide A crawl Square footage of cwl space or enclosure(s) / ti/ -4 sq ft a) Square footage of attached garage ` I sq ft b) No. of permanent flood openings in the crawl space or b) b) No. of permanent flood openings in the attached rage enclosures) walls within 1.0 foot above adjacent grade # ii walls within 1.0 foot above adjacent grade l �/ 11 c) Total net area of flood openings in A8,b /1/ sq in c) Total net area of flood openings in A9.b A-- sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1._NEIP Community , me & Community B2. Cou Name I B3 State A 1 03, EE B4. Map/Panel Number 85. Suffix B6. FIRM Index B7. FIRM Panel Btt. Flood B9. Base Flood Elevation(s) (Zone Date Effective/Revised Date Z ne(s) AO, use base flood depth) B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile [FIRM ['Communit De ❑ Other (Describe) [ B11. Indicate elevation datum used for BFE in Item B9: NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes v[1No Designation Date 0 CBRS 0 OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* Finished 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, AR/A, AR/AE, AR/A1 -A30, AR/AH, AR/AO. Complete items C2.a -g below according to the building dia ram specified in Item A7. ,-- ; , r r _ - • Benchmark Utilized /• Vertical Datum ). _ , '' .- 1 ' 9 f Conversion /Comments ff Check the measurement used. a) Top of bottom floor (including basement, crawl space, or enclosure floor) 14' ' E feet ❑ meters (Puerto Rico only) b) Top of the next higher floor ¢ L 'L ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) N A n feet ❑ meters (Puerto Rico only) d) Attached garage (top of slab) OVA n feet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building / �i 19' ❑ meters (Puerto Rico only) (Describe type of equipment in Comments) f) Lowest adjacent (finished) grade (LAG) f ) . j3feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade (HAG) f , afeet 0 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. I certify that the information on this Certificate represents my best efforts to interpret the data available. 14 I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. - u Check here if comments are provided on back of form. 1� R 0i �r� un ° � 15� ` A 4 NO, Certifiers Name >�o I f Al r !r License Number /,,, Z � 1 ` n , ,` 1 ` r OP1 � f' / �rl K 1'1 [ . L 1 , , ,s� } �° Title t 1p `- .. 2-, �3 N1 d! , , c - e rf t? t N$me R0 G Cz / i/y j r c t ,) , 1( ".,,A . * � t Address r_,J p ^ x i -. ) yt {r/ A 41 6 r nrtAt N, Signature �' 6 State " j , ZIP Code y � bQQ p f. ' Te lep f i .. ` , � t FEMA Form 81 -31, February 2006 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A. { For Insurance Company Use: Buildin Str t Address Including,Apt *it, Suite, and /or Bldg. No.) or P.O. Route and Box No. Policy Number `..�n;) T 3: . ; l ; ; -� LA.,/ City - -' J i Stat ,Zlode I Company NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenticompany, and (3) building owner. Comments (+� rf '' :1 I ; - ! 6� i.. t t N . ' r I , t r ' ' t f , t 1' t of r'� ra r # a Signature t I nl 4 Date W C :.�1 � u .. .. L}'1 Check here if attachments SECTION E - BUILDING ELEVATION FORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1 -E5. if the Certificate is intended to support a LOMA or LOMB 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 _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawl space, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6 -8 with permanent flood openings provided in Secti Items 8 an /or 9 (see a 8 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is _ ❑ feet U meters above or U below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or 0 below the HAG. E4. Top of platform of machinery and /or equipment servicing the building is _ Q feet ❑ 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 management ordinance? ❑ Yes ❑ No ❑ 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, 8, 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 ❑ Check here if attachments 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 GB. and G9. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ 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. ❑ The following information (Items G4. -G9.) is provided for community floodplain management purposes. I G4. Permit Number I G5. Date Permit Issued I G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters (PR) Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑ C)ieck here if attachments FEMA Form 81 -31, February 2006 Replaces all previous editions