HomeMy Public PortalAboutFifth Av_3 • NOOK IMIEVIENCYNANAOIMENr MENCY • 0.M.. No. 3067-0071
NATION& ROOD RINEWCE MOM/ Expires December 31. 200f,
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• SECTION A• PISCPIRTY COUR 114FORSIMON I !krill/IMO CatiarNUNk 1
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SECTION II. ROOD INSWEICE RATE IMP INIVIEINFOIMATION
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• 111001 0 .1111INEYON 11111111111111, CRANCTITICT CIRTIFICATEIN
Al cellrodon is to be signed end sued by send sump, enginw sr etasclaulhodald by to to oily dwelion inforinetion.
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CIPIMIRS NAME
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SEC'TON 0 - aRVEPOR, EN SK OR ARCHITECT CEPITIFICATION (CONTINUED)
Cagy boy, Nese mho, seam ONtiefflott mune* Plots, Misr:ante , . „[. arid (3} buiSng owner. ; z •„. 7 ;;;
COMMENT
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SECTION E WILDING ELEVATION INFORMATION puma NOT REQUIRED) FOR ZONE AO AND ZONEX WITHOUT EFL')
Fce Zone AO and &flea Out oonotree El Piro* E4. lithe Bevan Cereals is Wended for WO as supporting intension ba LOMA or LOMR-F,
Seaton C mutt* carastad.
El. Butting Otamen Nurnter _Pied the butting divan most tinier to Ow buidne tratich tie oentoste is being competed -see pecese and 7. no Oren aocuraMy
repasts the bating, maids a Oath or pheitgaplt)
E2 Met* di* hotter, ttocilindsing basement or enclosure) of the bukks _igng 21.47n) 0 dote ot De) IA, allitet pa gab
neureperfa.avakiiit).
E3. For EmIlditg Diagrams SS vatoperings (see pip 71, the noc NO% foor elveriedloor (eivotion V) of the bulking is t(m) _ir..(cm) abate the highest atiaomt
gnat Cameo nen CD and MI an *citations.
E4. The top cf (Mtn ot fiechinery sax equiptimnrstrActng buktriiii; ' t.(mLin.(cre) 0 abcjia bk4ilthed(one) highest iriscent pos. (Use
neural weak avaratie).
E5 Fa Zone AO reirlf no laza deoth norrizeris mee, is ti pdthebnoorde soed exonlanos vitti the consrmikys ot: tzsmaaeonsa ornance/
Yee ID OUntavon. The Wei rr,jasv t inkentelion emllon G.
SECTION F PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTFICATION
The m o o d y o w n e r C r a i n : V S a n k a b e d . 1 4 1 0 9 : 1 1 1 0 1 1 k I N $O W S kit C C O N I I S C 3 1 1 C a l i : f l y ) , a n d E t o r Z o n e A * g o u t a F E M A . t e m e d c o n y e u n e y -
k e y e d W E ) orZone A D m u s h * has ThwAki S A it and E conecnothe big of nv knotwadelit
PROPERTf OY*ERS OR OMER'S AUTrIORVED FeRESeirATARS NAME
ADDRESS CITY STATE 73P CODE
SIGNATUFE OATE TELEPHONE
COMMENTS
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ar:CTION Q - CORIUM IfOliklATION (OPTIONAL)
lot* sultodsid* tishrotenanceb adnireler the ounmanWelbadalsin . osiesnos can complete Sedans A 8 C (or El and 0 Of les Beraion
CalickiW thesictoebletenis) dam beim
Gi. Entiekikeimeice MSpoifnC Ise ttett tom oiler dapananterion thefts been epee ani entailed by ablated sunover, engineer, or archtect who is authorized by Mate
tirioad jek!lokifty Mallon inbingloti (India Ma ore all Mad tie swim das in te Commis )
G2. 0 A COARYSI*citeld setiptiedroollon E sbullimptoseid in Zane A tsthout R3Orleeued or cortemnity4esUed BM or Zone AO.
03.0 The killaditlekehalion (1Isms 640) it prodded ix cenetwitylisodgitis surtigemest moles.
G084),IT *JM 06. ClikTiFIENSITISSUED 01 DATE CiRTFICATE CP COMVANCEIOCCUPANCV IEGLED !
GT. This gore has been issiedlor 0 Nee Cavimalon Sublimate! arpmeinvi
G8. Eimelice of WWI beset faxen:id% bamment) el the fakirs IE. DAM
Gt. LIFE ctlin Zona AO) dupii claming it the lading die It tfrtl) Coe"
LOCAL °MOW'S WM TITLE
COMMUNRY WYE ••• • TEL.EPH�E
SIC3NATURE DATE
COMIENTS
0 Check here If attachments
FEMA Fenn 51-31, Jimmy 2003 1 100 1 4011$ at PrivIOUS editors