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FEDERAL EMERGENCY M. _ __ _
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Important; Read the Instn l
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SECTION A - PROPERTY 04 t
BUILDi NER'S NA Fax N ,? •- IFax s
BUILD NG ST EC DRESS ndudlnp t„ iris, anther Eidg. No) PR . -..._ _ _ , .. _
—
GfTY . �..� /�A !� ST TE/3� jI� C�QQE
PROPER L�
CR)PT1ON L and el.- N • rs Tax Parcel lumber I j�,^r ) S C I !�
4
eUILDING Reaklerr 'TM" A. •. ion, Acc sery, etc 6o Comments section anecessary.) _ —
LATf7UDEAONGITUDE ( ' ONAL) HORIZONTAL DATUM: SOURCE, 1_1 GPS jTypl)._
( OW • YF - 1R1.#1Mt or ON **WI 1 _I iVAD 1927 Li NAD 1983 i —.I U$GS Quad Map i —1 Other._ __ - - -
SECTION 113 - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
8. NF1P CO�hN
1� Oa �� �3' E 62, COUNTY t1f/ 7A 1 83. STATE /: ____I
84 MAP AND PANEL 95. SUFFIX tie. FIRM INDEX 1 87. FIRM PANEL es. FLOOD Te9. BASE. FLOOD F.tE`J'1tfGN
N DATI�. EFFECTIVE EVIS DATE ! Z E( f (Zone AO, uw ier;ll nt tine ling)
B10. Indicate the source of the (ION Flood Elevation (BFE) data or base flood depth entered In R.
U PIS Profile 1_:_rriRIMI !-__1 Community Determined LJ Other (Describe). __ _ ______ _ _ _ ___ _
811. Indicate the elevation datum used for the 8f`E In 89: L jSIGVD 1929 L__J NAVD 1988 1' Other tDescribe); .
812, Is the building located in a Coastal Barrier Resources System (C8RS) area or Otherwise Protected Area (OPA)? ► _I Ye 1 .stn
Designation Dee
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are t.ased on: LJConstruotion Drawings° L,IHutiding Under Cons.trucUon' 1!TFinistred ConcSrrrction
'A new Elevation Certifl':ata�`°iII be recurred when construction of the building is complete,
C2. Building Diagram Numb'ar , l (Select the building diagram most , imilar to the building for which thus certificate is being comrieted • see
pages 6 and 7 if no dltBrern pocurefeiy represents the building, provide e sketch or photograph.)
C3. Elevations -- Zones A1-A:30, AE, AH, A (with FIFE), VE, VI-V30, V (with SPE), AR, AR/A, ARIAS. ARfA1 - A3Q, AR(AH, ARIA C`
Cor ptes Herne C3a - heroes according to the building diagram specified In Item C2. State the datum used. If the d is dit(eie fir from
the datum used for the HEE In Section 8, cohVert the datum to that used for the 9FE, Show field measurements and datum rnnvarslr,n
cafcttiatikn, tine the a ace provided or the Comments area of Section D or Section G, as appropriate, to document the data n converi inn
Datum IILLatfil Y Conversion/Comments __ - ____ _ _
Elevation reference mark used __ Does the elevation refelprp mark used appear on the FIRM? 1 - 1 Yes 1-Tao
O a) Top of bottom floor (inCludk'tg basement or enclosure) / _L ft (m) ..--- -
O b) Top of next higher floor ___ ft (m) ' ' 0 Fl 0
• 0 c) Soft= of lowest hrtizontel structural member (V zones only) T ft -(fin) ' ' 7 e - SST ER -I •
O d) Attached garage (trp of slab) (
, ti (m) E p C7 Q 4. `' O
❑ e) Lowest elevation of machinery and /or equipment w v * .I
servicing the building / 4 . ( ft.(rrm) i .>r r
i.io 2`A e? ) ,
h cr o
0 I) Lowest adjacent grade (LAG) ,� fl.(m) z ti ' �, q n d •
O g) Highest sd cent grade (NAG) __.�. 1 1 . '_,fl.(rn) t '.4 � U -� 4 Z4'
O h) No. of permanent openings (flood vents) Within 1 ft above adjacent grade ._ . ,s ,...,_e__....--,,,.(4. )1'1f,Ttri =l '
Q f) Total area of all pvIrianent openings (flood vents) In C3h r sq. in (sq. emi
.
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This mrtificatton is to be signed and sealed bye land surveyor, engineer, or architect authorized by law lo certify elevation infcrmalinn
I certify that the lnlbrmat}on in •Section. A, )3, and C on this certificate represents my hest efforts to interpret the data available.
1 understand et fs)se stafem '1 ma D punishable by fine or imprisonment undo, 18 U S Code, Section 100f. _
CERTIFIERS 1C LICENSE NUM JER - - —
TITLE COMPANY NAME ( � _ —
ADDftESSc i - --- i�if . r Ctly r V �� _� ZIP CODE Tom' +
SIGNAT /' - (�ko - �i fJ TTLEPHCNE /� —,-
FEMA For1.31, AUG 99 SEE REVERSE SIDE FOR CONTINUATION REP! ACES ALL PREvtOUs FN 1 ,ONS