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Home My Public Portal AboutHWY 80_1124 r ELEVATION CERTIFICATE 0.M No 3057 -0077 Expires May 31, 1993 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM rTENTiON: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to ovide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to rtermine the proper insurance premium rate, and /or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR). Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE WILDING OWNER'S NAME POLICY NUMBER fTREET ADDRESS (Inclu ing Apt, Unit, Suite angierBldg. Number) 0R P.O. RJUTE AND BOX NUMBER COMPANY NAIC NUMBER /) ? 2 j i /2114 rB S )THER DESCRIPTION (Lot and Block Nurnbors, etc.) UITY 5e 4-iV2 / <-f' E r. .32 6 SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 'rovkde the following from the proper FIRM (See Instructions): 1. COMMUNITY NUMBER 2. PANEL NUMBER 3. SUFFIX 4. DATE OF FiRM INO 5. FIRM ZONE 6. B ASE FLOOD ELEVATION ( AO Zones, use depth) �� 3° /z 2 C/1 g/ A1 13 r. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ❑ NGVD '29 L Other (describe on back) 3. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate the community's BFE: LL-- i__I._.- l_i.Li feet NGVD (or other FIRM datum -see Section B, item 7), SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrarns found on Pages 5 and 6 that best describes the subject building's reference level _ 5 _ . 2(a). FIRM Zones Al -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation of 1 1 1 11 1$l .0 feet NGVD (or other FIRM datum -see Section B, Item 7). (b). FIRM Zones V1 -V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from the selected diagram, is at an elevation of L 1 1 1 1.LI feet NGVD (or other FIRM datum -see Section 9, Item 7). (c). FiRM Zone A (without BFE). The floor used as the reference level from the selected diagram is L_ I .Li feet above El or below ❑ (check one) the highest grade adjacent to the building. (d). FIRM Zone AO. The floor used as the reference level from the selected diagram is LL1 .LJ feet above ❑ or below ❑ (check one) the highest grade adjacent to the building. If no flood depth number Is available, is the building's lowest floor (reference level) elevated in accordance with the community's floodplain management ordinance? LI Yes No L_.] Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations: NGVD '29 ❑ Other (describe under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different Than that used on the FIRM (see Section B, Item 7), then convert the elevations to the datum system used on the FIRM and show the conversion equation under Continents on Page 2.) 4. Elevation reference mark used appears on FIR ( CI Yes No (See Instructions on Page 4) 5. The reference level elevation is based on: i_ /actual construction ❑ construction drawings (NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which case this certificate will only be valid for the building during the course of construction. A post- construction Elevation Certificate will be required once construction is complete.) 6. The elevation of the lowest grade immediately adjacent to the building is:1 1 I 1 171. feet NGVD (or other FIRM datum -see Section B, Item 7). SECTION 0 COMMUNITY INFORMATION 1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, item 1 is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest floor" as defined by the ordinance is: L-1 1 1 1 feet NGVD (or other FIRM datum -see Section B, Item 7). 2. Dale of the start of construction or substantial improvement . FEMA Form 81 -31, MAY 90 REPLACES ALL PREVIOUS EDI1iONS SEE REVERSE SIDE FOR CONTINUATION SECTION E CERTIFICATION This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation information when the elevation information for Zones A1—A30, AE, AH, A (with BFE),V1— V30,VE, and V (with BFE) Is required. Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the certification. In the case of Zones AO and A (without a FEMA or community issued BFE), a building official, a property owner, or an owner's representative may also sign the certification. Reference level diagrams 6, 7 and 8 - Distinguishing Features — If the certifier is unable to certify to breakaway /non - breakaway wall, enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not included in the certification under Comments below. The diagram number, Section C, Item 1, must still be entered. I certify that the information in Sections 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. , -- �% k5 B� ,E,e 7T cie__ cA ,.zcs 2z2- CERTIFIER'S NAME ! LICENSE NUMBER (or Affix Seal) 2._s 8 (42,e -7 24AZ1P SUS ✓ -- !f riG //i- TITLE COMPANY NAME' AODRES�� CITY ) / STATE ZIP SIGNAIURE ----` (DAt v PHONE Copies should be made of this Certificate for: 1) community official, 2) Insurance agent /company, and 3) building owner. COMMENTS: ON WITH ON PILES, SLAB BASEMENT PIERS, OR COLUMNS A V A A V ZONES ZONES I ZONES ZONES ZONES n REFERENCE REFERENCE LEVEL BASE LEVEL --�� REFERENCE) IN A FLOOD I LEVEL III ELEVATION BASE 1.Y;;c ... }:-j. '. . ; #• FLOOD `' ADJACENT p:�t' REFERENCE FLOOD El EVATION REFERENCE ADJACENT GRADE 3 ±�a BASE : LEVEL ELEVATION I EVEL GRADE $.' �I I Rail ';•'. _' r' ADJACENT .:'• : :.:.: ......::.. .::.::...:. GRADE The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones. Elevations for all A Zones should be measured at the top of the reference level floor. Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member. i Page 2 r r' ELEVATION CERTIFICATE O.M. B. No 3067 -0077 Expires May 31, 1993 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM 7TENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to ovide elevation information necessary to ensure compliance with applicable community tloodplain management ordinances, to Itermine the proper insurance premium rate, and/or to support a request tor a Letter of Map Amendment or Revision (LOMA or LOMB). Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION Iron INSURANCE COMPANY USE IUILDING OWNERS NAME POLICY NUMBER STREET ADDRESS (Including Apt., Unit, Suite an Bldg. Number) R F.O. RPUTE AND BOX NUMBER COMPANY NAIL NUMBER /9 /J / d S )THER DESCRIPTION (Lot and Block Numbers, etc.) D , ( 7 r 7 A 1 v . ) of Z.9 2 2 1 6 - Z 8 i 6 E - N2 /,- :ST i pi'3),t" r :ATV 7-�e Al2 l J4 4.31. 2a SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 'rovide the following from the proper FIRM (See Instructions): 1. COMMUNITY NUMBER 2. . / PA NUMBER 3. S IX 4.� OF FIRM iNDk FIRM ZONE 5. BASE A A Z ones, use d ELATION Z Y/ 9/ Ae '. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ❑ NGVD '29 Li Other (describe on back) 3. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate the community's BFE: LL.I__I.- _.L].LJ feet NGVD (or other FIRM datum -see Section B, Item 7)_ SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level _a_ . 2(a). FIRM Zones Al -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation of i 1 L 11 i81. i feet NGVD (or other FIRM datum -see Section B, Item 7). (b). FIRM Zones V1 -V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from the selected diagram, is at an elevation of I I I 1 1 I .L_I feet NGVD (or other FIRM datum-see Section B, Item 7). (c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is L_LJ.LJ feet above LI or below 111 (check one) the highest grade adjacent to the building. (d). FIRM Zone AO. The floor used as the reference level from the selected diagram is l i I .LI feet above El or below ❑ (check one) the highest grade adjacent to the building. 9 no flood depth number is available, is the building's lowest floor (reference level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes No L] Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations: NGVD '29 ❑ Other (describe under Comments on Page 2). (NOTE: if the elevation datum used in measuring the elevations is different than that used on the FIRM (see Section B, Item 7], then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) 4. Elevation reference mark used appears on FIR ' Ill Yes No (See instructions on Page 4) 5. The reference level elevation is based on: L a ctual construction ❑ construction drawings (NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which case this certificate will only be valid for the building during the course of construction. A post- construction Elevation Certificate will be required once construction is complete.) 6. The elevation of the lowest grade immediately adjacent to the building is: 1 1 I 1 171.1) feet NGVD (or other RAM datum -see Section 8, Item 7). SECTION 0 COMMUNITY INFORMATION 1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, item i is not the "lowest floor" as defined in the community's floodptain management ordinance, the elevation of the building's "lowest floor" as defined by the ordinance is: 1 1 1 1 1 1.0 feet NGVD (or other RAM datum -see Section B, Item 7). 2. Date of the start of construction or substantial improvement . FEMA Form 81 -31, MAY 90 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION • SECTION E CERTIFICATION This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation information when the elevation information for Zones A1-A30, AE, AH, A (with BFE),V1- V30,VE, and V (with BFE) is required. Community officials who are authorized by local law or ordinance to provide fioodplain management information, may also sign the certification. In the case of Zones AO and A (without a FEMA or community issued BFE), a building official, a property owner, or an owner's representative may also sign the certification. Reference level diagrams 6, 7 and 8 - Distinguishing Features -If the certifier is unable to certify to breakaway /non- breakaway wall, enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not included in the certification under Comments below. The diagram number, Section C, Rem 1, must still be entered. I certify that the information in Sections B and C on this certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ,a'? � ?I �� c�,� A _5 2zz . CERTIFIER'S NAME 1 LICENSE NUMBER (or Affix Seal) TITLE / �j > � COMPANY NAMEr 2 J � ADDRES / . 7 1 — \\ CITY STATE ZIP SIGNAl ( ( ) ( DATE PHONE Copies should be made of this Certificate for: 1) community official, 2) Insurance agent /company, and 3) building owner. COMMENTS: ON WITH 011 PILES, SLAB BASEMENT PIERS, OR COLUMNS A V A A V ZONES ZONES ZONES ZONES ZONES n REFERENCE L I '- - J LEVEL REFERENCE I REFERENCE 1 \ , yl I ROOD I _ LEVEL LEVEL , \i BASE I ELEVATION oyosnil ..f . >: ?�� 4 }iii ' BASE BASE , REFERENCE ' FLOOD ADJ FLOOD GRADE `A LEVEL ELEVATION El EVATION REFERENCE ADJACENT 'I',K. n r I EVEL GRADE ;..ri;. • � . .:;: ADJACENT •• f _I .. ' '•.. "i,:.,•.1 ^, GRADE The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones. Elevations for all A Zones should be measured at the top of the reference level floor. Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member. Page 2