HomeMy Public PortalAboutFifteenth St_204 FEDERAL ElifiERGENCY MANAGEMENT AGENCY O.M.B. No. 3067 -0077
NATIONAL FLOOD INSIMNCE PROGRAM Expires December 31, 200f
ELEVATION CERTIFICATE
if TWA* Radd the Instruedons en - 1.7.
SECTION A. PROPER* OWNER INFORMATION
BUI14,0G owNejs I Il***
1-I Ail., . 1, .
BUU.CIN A SS Unit, Suits, an ice Bldg. No.) OR PO. ROUTE AND BOX NO.
C9T"e' STATE ZIP ODC)E
( 4 lanG.+ H am „ awe '�+'.y'`! I@oI'.�T _.
BUILDI SE (e g��rR askivtial, N9n4esidenital, & on, , etc. Use a Comments area, If nary.)
dt. r ditie.in 'Y' ! CI
LATITU ONGTUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: p GPS (Type):
( A° - NV -SW.Tfr or htr#. 0 h{AIO 1927 0 NAD 11193 0 USGS Quad Map 0 Other: .
SEC ION E - FLOOD INSURANCE RATE MAP MISS) INFORMATION —
• to E . p• Alp _. t �UPIiY r t f' A 133. $T IE y
1 B4, MAP AND PAWL ci I - -W. FPM PPM L 1 09. BASE FLOOD ELEVATIOP )
85. S1 FIX I . FRfv ' r 3r • O E IT'F' DATE r ONS(S) (Zone Ac deaf) discoing)
B10, incicatete scums cite = _.:,, .• ► Siewgon (BFE) Gala or tome d depth erased in :4 .
0 FIS Fhr e ft RM 0 C rrerunily Ddernirect 0 Other ( ),
B1 1. indicate the elevation 0 NAVD 1 0 Other(D ribhe : _
n Area 'A)? ❑ Yes [,. ¢ n ion De
812. is the r Coastal Banter Cl3i�) arm or . ..
ATION )
Cl. Building elevations ere bad on: 0 Construction Dr Mr 0 Bullring Under Construction* 1 Ainc ed Cowtruction
"A new Bevalion Certilloatewf be rewired when COnStUdOn (0116
C2. Building Diagram Numbe< ( Se act the building diagraii n st wrier to the bolting for whit file Certitate : IS being conflated - see pages 8 and ;T. ff no da ys n
=rat* nvesents the ng, provide a ....... •)
C3. Elevations - Zones Al -A30, AE, AN, A (With BFE), vE, vi-va9, V (with BFE), AR, AREA, ARIAE,'AR/A1 A.30, AR/A1-1, AFtiAC)
C o m p l e t e Items Ca-a.) t h e w awning t o the b u i l d i n g (Javan specified In item C2. fAete the datum used If the datum is efferent from the datum used for the BFE in
Sec ioh B, convert the datum to that used fcu the SFE . Show feld measurements ark datum conversion (.1ctialion. Use the spew pD 4de i or i . , ..FF . :, ii. area of
Section Do . r . . , as applopride, todo lm 1 the do cob: , O RC
DaumAl(1) '. r 4:r . ' '
Etev icn reference mark used Doan tare ration i ce mark used to FIRM 0 Yes r n UP
� , ""
� a) Tod of bottom moor C� o enclosure) f � . d tt(rn)
NO 1582
ti) Tap of nad higher lox t�(m) �"
1- c) Bottom of low( troriaonrl structural member (V only) ....t „h.(rn) 1 1 4
d) Atti (top cf stab) . _(m) st't
N e) t est ct anckoreq w ea r - "c �'
ng (Descite in a )
/ It(m) s �
I. f) (finisher (LAG) - ,..43.0 ft(nh) � S I� ��
g) (trh t) t (HAG) _ ....5 t %
i$- h) No, of permanent enings (foci rte) v rin 1 h, t gr �p P f E t - % 0
bi- i) Taal arm of all permanent owing& (flood vents) in C3.h MAN, tn. (eq. car=) 0 A/
SECTION 0 • . . ' ARCHITECT CERTIFICATION Wreas
slatitSY This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
I certify the the information in Sections A, B. and C on this certi Irate represents my Dart marts to interpret the date available.
I understand that any false statement may be punishable by fine or imatisonment under 18 U.S. Code, Section 1001.
CERTIFIERS NAM i 41 w p jt[fr I� CE ` j ``'E NUMBER .
, - �rf
TITLE , f ig , .. � a M 1 7 _`"' " 6 /14 --- 11 k
ADDS W 9 _ _779.6 ' CITY STATE p CODE
SIGNATURE ; � ' ._ -0 T 1( let
o
FEMMMA Form 81 -31, January 2003 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these species, copy the corresponding I n farm Section A
•
BULDW r6RE DREESS (I • .,• 9 n Or Mtg. No.) OR P,O, ROUTE AND BOX NO. I Pflitrilffier-i
CITY STATE ZiP
SECTIOI4 D . SURVEYOR , t - OR R ECT CERTIFICATION (CONTINUED)
Copy both sides of this Sev ion Cie for (1) community official, (2) Insurance agent/oommy, and (3) building owner. 5
COMIVENTS T rct t S G7 Ai citzr r tr n c.' ti': (4 1 .
d-eY- 7 k ►'.s Rio, C. ' t
LJ Check hens if attashm is
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT Rte) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zone AO and Zone A (without BFE), complete Items El through E4 If the Elevation Car ate is intended for use as suiting intonation for a LOMA or LOMR -F,
Section C must be completed
E1. Bunldlrg Diagram Nun er _(Select the W i l d i n g dagrarn most sirrr to the bulling for which this oardicate is being completed - see pages 6 and 7. tf no dagrarn acciarateiy
represents the bsiiidng, provide a ske ch or .)
E2. The top of the bottom floor (inducing basement or osure) of the buildng is a ti.(m) ,_in.(cm) 0 above or 0 bow idled( one) to highest adjaoent grate. (Use
natural grate, if available).
E3, For Bufldrxl Diagrams 6 -with openings (see page 7), the next higher flax or floor (elevation b) of the building is — ft(m) _in. (an) above the highest adjacent
grade, Complete rteerr a C3.h and C3J on front ditm, - r - ti
E4. The top of the platform of machinery and/a equipment servicing the buidng is — f1(m)Lin) 0 above or 0 below (check one) the highest adjacent grade. (Use
natural grade, if available).
E5. For Zane AO only If no flood depth number is avoid*, is the top of the bottom floor elevated in aocorda oe with the community's floodpiain management ordnance?
0 Yes 0 No 0 Unknown. The local official must certify this infonne at Section G.
SECTION F - PROPERTY (AR OWNERS REPRESENTATIVE) CERTIFICATION
The p r o p e r t y owner o r owner's authorized representative who completes Sects A, B, C (Items C3.h and C3,ii only), and E for Zone A ( w i t h o u t a FEMA or community-
issued BFE) or Zone AO m u s t sign h e n : . T h e statements i n Sedions A. B C , and are correct to the bed ofmy
PROPERTY OWNER'S OR OWNER'S AUTHORED REPRESENTATIVE'S NAME
ADDRESS cm ' STATE ZIP CODE
SIGNATURE DATE TELEPHONE
•
COMMENTS
C? Chi here if attachments
SECTION G - INFORMATION (OPTIONAL)
a COMMUISTY
The local pidal who is authorized by law or ordnance to administer the cnorrmmunfty's floodplain matagement ordnance can complete Sedlons A, B, C (or E), and G of this Beratio n
Convibte the a0 le itent(s) and sin tom.
G1.0 The information in Section C was taken from other dojjmertation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state
or loaf law to dertify devotion information. (indicate the source aid ate of the elevation data in the Carr a nts area below.)
G2.0 A community official completed Section E fa a Ong located In Zone A (w thout a FEMA -Issued or Cannurr>ity"issued BFE) or Zone AO.
G3.0 The following infan>ati (Items G4-G9) is provided for commun4 floockblein management purposes.
04. PERMIT NUMEER I G5. DATE PERMrT ISSUED I G6. DATE CERTIFICATE OF ANCY ISSUED
G7. This pert has been issued far: 0 New Cateductbn 0
G8. Bevation of as-bull lowest floor (including ) of the biding is: — ft,(m) Datum:
G9. BFE or (in Zone AO) depth of fkmdng at the budding site is: ft.(nm) Datum:
LOCAL OFFICIAL'S NAME TITLE r
COMMUNITY NAME TELEPHONE a
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SIGNATURE DATE
COMMENTS
Check here if attachments
FEMA Form 81 -31, January 2003 Replaces all previous editions