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Home My Public Portal AboutCenter PL_5 ELEVATION CERTIFICATE Fxpire "° n , 7 99 Exptrc 3 6 0 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL 6..0OD INSURANCE PROGRAM ATTENT 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 ftoodptain management ordinances, to determine the proper Insurance premium rate, and /or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMr1). Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION Pon INSUnANCE CoMrANY UM BUILDING OWNER'S NAME r� POLICY NIAIBER T D AJ '7 IZ E p A/ Go ,■J S 1 r " " ,1 c-7' 10 ,J 1173 t STREET ADDRESS (Including Apt., Unit, Suite and/or Mg. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER . C C N"PEW— V` A-C-E, OTHER DESCRIPTION (Lot and Block Numbers, ems) ' K v$ D i v L s i o ri () 1= L-4 T 5 Q1 D ( v($ 1o.,4 0 f - L 3.7 d 5 C, W A-a 'V 7---- CITY y STATE ZIP CODE I PTE I y (--,4 /\1 P, 6 f3 , G t Z d . SECTION 0 FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM (See instructions): , 1. COMMUNITY NUMBER 2. PANEL NUMBER 3. SUFFIX 4. DATE OF FiRM INDEX 5. FIRM ZONE 6. BASE FLOOD ELFV /vtioN (In AO Zones, use depth) r 19 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ei NGVD '29 ❑Other (describe on back) 8. 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: I._Jl_LJ 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 __5 . 2(a). FIRM Zones Al -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation of i I__ _J.__I' 3.1 . LzJ feet 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 from ' the selected diagram, is at an elevation of I_L_I.J_LJ.Li feet NGVD (or other FIRM datum -see Section B, Item 7). (c). FIRM Zone A (without BFE). The floor used as the reference level fr7 h the selected diagram is i i I,LJ feet above i__I or below L I (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 LLJ.LI feet above L 1 or below! 1 (check one) the highest grade adjacent to the building. It no flood depth number is available, Is the building's lowest floor (reference level) elevated in accordance with the community's tioodplain management ordinance? LJ Yes [) No ❑ Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations: ry NGVD '29 ❑ 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 71, then convert the elevations to the datum system used on the FiRM and show the conversion equation under Comments on Page 2.) 4. Elevation reference mark used appears on FIRM: Li Yes 1M No (See Instructions on Page 4) 5. The reference level elevation is based on:' Factual construction LJ construction drawings (NO1 E: Use of construction drawings is only valid it 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. T he elevation ot'the lowest grade immediately adjacent to the building is: I 1 1 1 I ,L 1 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 floodpiain management ordinance, the elevation of the building's "lowest floor" as defined by the ordinance is: I.1J_IJ_I.LJ feet NGVD (or other FIRM datum -see Section 8, 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 CONI It1UATION Cr b 4C3 - 3'Y' 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 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 tllo 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 —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 C, Item 1, must still be entered. 1 certify that the information in Sections B and Con 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. 5E� .5, 5 A-z42.-e rr, Srz—, l Z3 cl CERTIFIERS NAME LICENSE NUMBER (or AMx Seal) TITLE COMPANY NAME P I• E) 0 y. It 0 9 i cra A A/ AI - , psi, - 3 i 1.-L ADDRESS 4/ '' 7 , , • ^ . Y` CITY i 3 / y � - et? ST 7-74-4,-----o ZIP SIGNATURE '•�fiT' [SATE ` ' PHONE - Copies should be made of this Certificate for: 1) community official, 2) insurance agent/company, and 3) building owner. COMMENTS::. -. a r ,'1 u4 a�+..: 4 1t/ A 1.. d, s. oN WITH oN PILES, SLAB BASEMENT ' ' ` " "' " PIERS, OR COLUMNS :, A y A y,, : :• - A V ZONES ZONES i�j• ZONES ZONES ZONES 1�� 1 �� REFERENCE _ REFERENC BASE LEVEL R FN TIE LEVEL I FLOOD i LEVEL r E LEVATION IC _ ;911 jtb14'i "' r s t ''.' RASE : • -: :r BASE TI , ADJACENT , R EFERENCE �r - FLOOD ELEVATION O ADJACENT RADE - .J i LEVEL I , ELEVATION REFERENCE 0.4'..; LEVEL GRADE 11 ` ' I' I• 'r '' ti ! "V c ',,.!, .; ?. ?.v'.,., , ri. ADJACENT . :::'1,'..;;, :':Y: :T::.. .:P: RII:r.. 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 all V Zones should be measured at the bottom of the lowest horizontal structural member. Page 2