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Home My Public Portal AboutFifteenth St_603 FEDERAL EMERGENCE MANAGEMENT AGENCY O.M.R. Na. 3067 -007 (34?77 NATIONAL FLOOD INSURANCE PR Expires July 31, 2002 ELEVATION CgRTIFIcATE Important: Read the inetrUcttone on Pefiee 1 • 7. SECTION A - PROPERTY OWNER INFORMATION pf It ursnce Company tom t3ttlLt U111�1ETt5 . 12 -7" i ` ' -. le 8LrlL �N_ /ADi /4S (t Api., U ' uite, andto No.) Ott P.O. Rt?U AND BO P�• iy NAIC Nor CITY . /4—La _ dir PROPER , •/ 3 71ON (L .- `.., Nu re, Tax aront • ,, , • .., . . n, eta) +• . p 1 .1 A .. bU(WD[ e.g. fte rtentia , an- a&dentia , d , _ • , a Comments step, a .) I •" DE (OPTIONAL) HORIZONTAL DATUM: SOURCE: 1--.1 G { Ca tT1tp•1 ( "- Mir - tu3.ifir or tt#. °) 1_1 NAD 1927 1._.-1 NAD 1983 u ue5G4 r 1 1J ( Aar SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNI NAME & COMMUNITY . Be. C,OUNTT ► , $TATS r I ( - .T A i 134. MAP AND ANSI t35. attrl`iX tilt, ri IrV4t It al. t t►tlldl t'lit`it� ttir. fl-tAlt.1 ui!_ tikuE rct=O EIA O ) NUMBER V • TE EFFECT • IJATE Z • ($ (Zone AO, us ih of flooding) /1976 4 Oa) / `' 310, Indicate the source of the ase Flood Elevation (t3FE) date or p • se flood depth entered in 0% I_J FIS Prate F_„ FIRM L_{ Community Ue1e Mad Li Other (Describe): 811. indicate the elevation datum used far the OFFE In B9: GVD 1920 LI NAVR 1014 LJ O1119r (D9Stxibo); B12. Is the building located in a Coastal Barrier Resources System (CBRS) Area or Otherwlee Protected Ame (OPA)? 1._:_i Yes 1.,d Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (swim R iRED) - C1. t3uliding elevations are based on: 1__ 1Construction Drawings" jJBupdinq Under Cpe ftr'octien° inishad Construction °A new Elevation Certificate will be required when construction of the building le complete. C2. Building Diagram Number i (Select the building diagram most aimitar to the building fat which thle certificate le Ming completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) G3. Elevations - Zones A1-A30, AE, Alf, A (with BFE), VE, V1- V30,1/ (with BFtr), AR, AR/A, MAAE, Ati1A1 -Mo, AR/Atl, AR /AO Complete Items C3.a - below according to the building diagram specified in item C2. Stafp Me don fi ont Of the datum b different from the datum used for the DFE in Section B, convert the datum to that used for the BFE. Shaw fioI4 Ineelleifehlente and datum conversion calculation. Uae the space provided or the Comments area of Section 0 or Section G pm ti(0. #p document the datum conversion DUltirrr a iv A . Conversion/Comments r Elevation reference mark used Does the elevation reference mark used eppeer on the FIRM? 1.___I Yee ) i C3 a) Top of bottom floor (including basement or enclosure) .a ., film/ U b) Top of next higher floor • �,� _____ (1.(111) U c) Bottom of lowest horizontal structural member (V zones only) tt•(m) I 0 1, U d) Attached garage (top of stab) _film) 1 t► ` eRito U e) t.owest elevation of machinery and/or equipment k 0 I servicing the building (Describe in a Comments area.) . / ftd s _ V 11 U f Lowest ad)acent(fieished) grade (LAG) '--'7` 11•(t . * . y) Highest adjacent (finished) grade (HAG) - 7 ft'(�}' fi U le) Nu. of permanent openings (flood vents) within 1 ft. above adjacent grade ; ' ' yy 1 U ij l utai area of all permanent openings (flood vents) in G3_h at In. (sq, cm) ' V SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERT l r WCA This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by 1ti+w to turttiy elevation information. i certify that the information in Sections A, 8, and C on this certificate represents my best OWN to 'P fpWSff data available. 1 umlerxtu /flat any false siatememl Wray he punishable by fine or knorisonment under 10 1 . S. Code, Section 1001. CERTIFIER' ' , . ,%y . ' R L_i t si/..Ll 4 dJ ._ Ct71E_ .. COMPANY NAME P.DbRES / } 1 ^ --m Ci3Y ZIP GO0 „5/4°C-- _.. +, i �sc•, �✓ �1�/ V G DATE .. *� I mo! � ° C�� siGHATuRE t hi /02— ors clPtiPPAP AinP met i-xienlee ra7iniei RFPI Al"IFS Alt APFUanr a'R i rm-rinnts MPORTAA . ; In,.these spaces, copy the corresponding Informauon rrom aeeuum tllil tyNe ADDRESS , : AL, • ; 'r Bldg. No) OR P.O. tiOUTE AND BOX NQ Pocky Number T.. ; Zryp orr 1 uornpany i1 : iVUrriber SECTION 13 - SURVEYOR, ENGINEER; OR ARCHITECT CERTIF1 T1OPT(CONTINUED) :opy both sides al this Elevation Certificate for (1) community official, (2) Insurance agent/company, and (3) building owner. ANYMENTS - 1 Check here If attachments SECTION E • BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT 0FE) or Zone AO and Zone A (without BEE), complete Items El. through E4. It the t:Ievatlon Certificate Is Intended for uee as supporting iformation for a LAMA or LOM2 -F, Section C must be completed. :1. 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 diagram accurately represents the building, provide a sketch or photograph.) :2. The top of the bottom floor (including besement or enclosure) of the building Is LI ft.(m) L,J_lin -(cm) i.l above or ( below (check one) the highest adjacent grade. (Use natural grade, tf available.) .3. For Building Diagrams 6-8 with openings (aee page 71, the next higher floor or elevated floor (elevation b) of the building is 1 -1__1 ft(m) ) _ 1 _ 1M.(cm) above the highest adjacent grade. Complete items C3,h and C3.1 on front of form. =4. For Zone AO only: If no flood depth number Ill avattabte,ls the top of the bottom floor elevated In accordance with the communliy'a floodpialn management ordinance? LJ Yet; 1 1 No I 1 Unknown. The local official must certify this Information in Section G. SECTION P -PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, 8, C (items C3.h and C3.1 only), and E for Zone A (without a FEMA- issued or community- 1eeuEM BEE) or Zone AO must Assn here. The statements In Sectk ns A, B, C, end E are correct in the best of my knowledge. s. : _ r'htil ti r r UV W4 cr< s Urt L►Vt rrcn o MU11 nURlLWU KtP HtSr_iV i A 1 1111 NAME Aw)t]RESS C i t o ipin ciw t i1�1k SIUNAIURk uwra J L.ePt1UNt COMMEN r5 Check here if attachments SECTION 0 - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by fewer ordnance to administer the community's floodpiatn management ordinance can complete Sections A, 13, C (or E), and G of Oita Elevation Certificate. Complete the applicable item(e) and sign below. 01 .1_1 The information in Section C wadi taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who le authorized by state or local law to certify elevation Information. (indicate the source and date of the elevation data in Ina Comments area below.) 02. 1_1 A community official completed Section E for a building located In Zone A (without a FEW or community Issued BFE) or Zone AO. 03. L_I The following Information (items 04 -39) it provided for community Rom/plain management purposes_ . l _ ...:. tJeitt r2t , ... _ 15511.4 .._.. �YI ---- . Nkl<H i itlI 1Y t.: (7S. 1V NtlNrdtrt ib_ UIF1 r C ZWf i wtii�ttl �. a.�. c h.Cr` �N � � Vr' 1.1� i Y� t r1.l�WtitJUt;IJr'/11: T t GT. This permit has been issued for: j_I New Construction 1_1 Substantial Improvement Ge. Elevation of at-bulft lowest floor (Including bailment) of the building is: ft.(m)Datum: G$. BY or (In Zone AO) depth of flooding at the building alts Is: ___ n. (m)Detum: LOCAL OF1=ICIAL'13 NANrt Hitt • COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS , j Check here if attachments PPM A rnrm 81_11 . M 11 1111 alt F�r?K� /ir>I tG r ni rtnt ��