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Home My Public Portal AboutEighteenth St_6 U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE I OMB No. 1660 -0008 Federal Emergency Management Agency Expires Miarch 31, 2012 National Hood Insurance Program important Read the instructions on pages 1 -9. - SECTION A - PROPERTY INFORMATION p For Insurance_ Company Use: Al . B,�dlng Owner's Name ,... Poky Number IS. 045ett�ta-t 1e.. . � +dV"/C i P�v - .] + - ` C e421V ! V lei A2. Buitdtng Street Address fincludi Apt., Unit, Suite, andiar Bldg. No_) of P_0- Route and Box No •Cor parry NAIC.Number . 1 dllY t N t3 e L.; S L A4Q �_ State e.- e c r A 3 3 2, g A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) le. re,T �s tees tz PI Sur SO) 4 tee 1 e C (3.0Psz L....: L O - W O �. "T" 8 �t3 _ TL I_, 0 M. Building Use (e.g., Residential, Non - Residential, Addttion, Accessory, etc.) (€S t vE* TJ Pt' A5. Latitude/Longitude: Lat. N Ar S" . 3 C4 Long. W et n - 5'0 .9 34. Horizontal Datum: 0 NAD 1927 [ 41AD 1983 AS. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood Insurance_ A7. Building Diagram Number photographs_ ,of For a building with a crawlspace or endosure(s): A9. For a buffing with an attached garage: a) Square footage of crawlspace or endosure(s) R g 9 sq ft a) Square footage of attached garage sq it b) No, of permanent hood openings in the crawtspace or 0 b) No. of permanent flood openings In the attachearage endosure(s) within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade _ c) Total net area of flood openings in A8b �� sq In c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? ❑ Yes l 14° d) Engineered "flood openings? 0 Yes [. i SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFIP Community Name & Community Number B2. County Name B3. State �`i SL.elt ts.a.Q, { 3S' 1 44 I G - t�- a P, Vi 4�� rd I G 16 6 J2 6 t ft 84. Map/Panel Number B5. Suffix B8. FIRM Index 87. FIRM Panel W. Flood r B9. Base Rood Bevation(s) (Zone Pate I F g 2 _ ®�� E vefltevised Date Zone(s) 1 A t dept) 13bS i 4, o 314( • B10. Indicate the source oaf -theme lase Flood Elevation (BFE) data or base flood depth entered in Item B9. 0 RS Profile I,ag r IRM Community Determined ❑ Other (Describe) 811. Indicate elevation datum used for BFE in Item B$: 0 NGVD 1929 1111VD1988 ❑ otiher (Describe) • B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes alo Designation Date ❑ CBRS 0 OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: 0 Construction Drawings' ❑ Building Under Constmctlon ° &Fitinished Construction "A new Elevation Certificate will be required when construction of the budding is complete. C2. Elevations - Zones A1-A30, AE, AH, A (with BFE), VE, V1 V30, V (with BFE), AR, AR/A, ARIAE, AR/A1 -A30, AR/Ati, AR/AO. Complete Items C2.a -11 below according to the building diagram spedfied; In Item AT. Use the same datum as the BFE. Benchmark Utilized m C R 4.. Vertical Datum Ai AV 0 t 9 e Conversion/Comments 1elt" i Pv ' Check the measurement used. a) Top of bottom floor{Induding basement, cra meispace, or enclosure floor) --r k / 0 feet meters (Puerto Rice only) b) Top of the next higher floor 17 "Z Li meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) 1 5 - .. Z L 1 eti'eI ❑ meters (Puerto Rtco only) d) Attached garage (top of stab) ( / n feet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipmentlservidng the building 1('a ....aartaT n meters (Puerto Rico only) (Describe type of equipment and location in Comments) 0 Lowest adjacent (finished) grade next to building (LAG) 1 �--r-u t 0 meters (Puerto Rico only) g) Highest adjacent (finished) grade next to building (HAG) 7 ' ` ,mot ` 0 meters (Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs, including "1" k x' ` 0 meters (Puerto Rico only) structural support 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. k� O / I understand that any false statement may be punishable by fine or imprisonment under 18 U.S Code, Section 1001. r - c h s r s �Chedk here if comments are provided on back of form_ Were latitude and longitude In .•. • n A rovkled by a i ■ $ � . 3 d licensed land surveyor? iJ Yes No , C lllffler's Name j License Number 1 8 8 2 �. , -`, , V/ 4 ell i l hN� I C e -1 p ,,. o A. I' om- Company Name -1 4. 6 " f A l A `v . p ► lau de:vN 12owa $ �vr.:vt. 1 " t S Co ZIP Cod e 314OS G'F �'_.. N , b . -. Date Tetep�jone .ate Signature � , r -rx 4' lei 1 �e� Z� ` 3 �Z� . FEMA Form 81 - 31, Mar 09 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A. # For Insurance Company Use: Building Street Addre (mctudin Apt., Unit, Suite, and/ar Bldg. No.) or P.O. Route and Box No. Policy Number 1 1 ATE li2_ City.. 5 ZtP Code Company WPC Number I 1 € .� SL 1 'sr -.4 8 &e0tztco t A. 3 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community officiat. (2) insurance agent/company, and (3) building owner. Comments L. z c.e = dzct � G e r A 1 co 4,, ra l ,. N '-1 i" P L R=a C--ti ft i•\ R '® E GL 0 S v 'fL,� t S P P}t.ii, PA- ev -r`I -n 1r! -[ms's P�g\<. f'r ■T - tivk- P-A._ S ...t Signature k J t. 4N. Date ®-1 p ® LT C heck here if attachments SECTION E - BUILDING ELEVATION INFORMAIj{3P (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete items EI-E5. tf the .Certificate is intended to support a LOMA or LOMR -F request, complete Sections A, B, and C. For Items E1-E4, use natural grade, if available. Check the measurement used, to Puerto Rico only, enter meters. Et Provide elevation information for the hallowing 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, -,...:..,,......,.... en ) t ❑Feet ❑meters ❑above or ❑ bekow the HAG. b) Top of bottom floor (including basement, crawispa en s isli meters E2. For Building Diagrams 6-9 with permanent Hood ❑ ❑above or ❑below the LAG, ro d Sect# items 8 ashdtor 9 (see 8-9 of hrstrucflons), the next higher floor (elevation C2 in the diagrams) of the building is . _ Q feet 1,J meters ❑ above or ffebselow the HAG. E3. Attached garage (top o1 slab) is ❑ feet 0 meters ❑ above or 0 below the HAG. E4. Tap of platform Of machinery and /or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ 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 floodpiatn management ordinance? 0 Yes ❑ No ❑ Unknown. The local official must cerfifytfas lnformaflon 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 (wr'thout a FEMA- issued or community- issued BFE) or Zone AO must sign here. The statements in Sections A, B. and Eare correct to the best ofmy knowledge. Property Owner's or Owner's Authorized F..,,.,...:..: s Name Address State ZIP Code Signature - Date Telephone Comments 0 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 ftem(s) and sign below. Check the measurement used in Items G8 and 09. 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 taw 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 -issues t3FE) or Zone AO. G3. ❑ The following information (Items 04-69) is provided for community floodplain management purposes. G4. Permit Number I G5. Date Permit Issued - I G6. Date Certificate Of Compliance/Occupancy Issued j G7. This permit has been issued for. 0 New Construction ❑ Substantial Improvement JI G8. Elevation of as -bolt lowest floor (including basement) of the building ❑ feet ❑ meters (PR) Datum G9, BFE or (m Zone AO) depth of flooding at the bu8din9 site fk ❑ feet ❑ meters (PR) Datum G10. Community'sedesig hood elevation ❑ feet ❑ meters (PR) Datum , ? 'r ,- ; 1 Local Offici fsName' r 1 Nik y Title Community Name t Telephone Signature Date Corm - penis ❑ Check here if attachments FEMA Form 81-31, Mar 09 Replaces all previous editions