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Home My Public Portal AboutChatham Av_1806 FEDERAL EMERGENCY MANAGEMEgT AGENCY 0 M.B. No 3067 -0077 NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 ELEVATION CERTII CITE Important: Read the instructions on pages 1 - 7. _ SECTION A - PROPERTY OWNER INFORMATION I For Insurance Company Use: BUILDING OWNER'S NAME I Policy Number . BUILp ING STREET A RESS (Including Apt., Unil, Suite, and /or Bldg. No.) OR P.O. ROUTE AND BOX NO. I Company NAIC Number CITY . 5/ F PROPERTY D ESCRIPTIQ* (Lo�t and Block Nubers Tax Pa c umber Legal Diption, etc ) LCJ? - 1V . L u m / t ' I .-, . W4120 . BUIL'bIN USE e.g., Residential, Non- residential, AddiVon, Accessory, etc. Use Comments section if necessary.) .7<e LATITUDE /LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: i_I GPS (Type): ( ##° - ##' - ##.14" or ##.####1# ° ) I — I NAD 1927 I I NAD 1983 I j USGS Quad Map I I Other: SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNIT NUMBE 82. COUNTY NAME B3. STATE �!T' - L.10 7 /'4 4— CL /4 Ti.l.tl k,./ 64 B4. MAP AND PANEL B5. SUFFIX 86. FIRM INDEX B7. FIRM PANEL H. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER ATE EFFECTIyEIRE I ED DATE ZO IE(S (Zone AO, use de th of flooding) � t' /4 -- i64 . - o�Z- G 617 �� 6/17 6 ;10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. II FIS Profile I --r5FRM I Community Det jmined II Qther (Describe): 111. Indicate the elevation datum used for the BFE in B9: I --INGVD 1929 I I NAVD 1988 I I Other (Describe): 112. Is the building located in a Coastal_ Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? I I Yes I �o Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) :1. Building elevations are based on: I Drawings* I_IBuilding Under Construction* I /TFinished Construction °A new Elevation Certificate will be required when construction of the building is complete. :2. Building Diagram Number _/ (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagrarn accurately represents the building, provide a sketch or photograph.) :3. 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/A0 Complete Items C3a -i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum /r(^ Y 7 Conversion /Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? I 'Yes I --rNo ❑ a) Top of bottom floor (including basement or enclosure) C?" .2. ft.(m) 5 - ❑ b) Top of next higher floor /4%, - , . _ ft ; . ' ,, Q � il k' . ❑ c) Bottom of lowest horizontal structural member (V zones only) 0, . _ ft.(m) o o � G � S ' Eli, .• '} ❑ d) Attached garage (top of slab) ri • J_ ft-( }- W Q ❑ e) Lowest elevation of machinery and /or equipment - °; ; * N� , 4-49 1r: servicing the building — 7 ctt•(r cr co ❑ f) Lowest adjacent grade (LAG) ' • 4— ft.(a}} z , \'• , ,7 , -k 0 � ❑ g) Highest adjacent grade (HAG) ; 1 ft.(rrt) 2 - . S 0 SUF+ " ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacen grade //1(& _ f v ' i r E' . ❑ i) Total area of all permanent openings (flood vents) in C3h (i1 (D sq. in. (sq. cm) � ` ' , j'' p SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by to certify elevation information. I certify that the information in Sections A, 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. CERTIFIER'S NAM/ / j J, / �, P \/; /DG 4 - LICENSE NUtv1BE 7 4 v / � T 11 r ~ COMPANY NAME ADDRESS, f �l oC1 `�� (( ��s7. .•!1 �� l) `�� (� ��fV• � ZIP CODE J�"T" �. SIGNATURE /1_____/----\---- TE/ / TELEPHONE 3 Z J © 1 :EMA Forrrya(1 34-f{GG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS