HomeMy Public PortalAboutMILLER AV_110 U .S. DEPARTMENT T OF HOMELAND s cuRt1 v ELEVATION CERTIFICATE Expires ae. 2009
Notional Flood Insurance Prognosis Important Reed the instructions on pages 14.
/ f [/ SECTION A A. PROPERTY INFORMATION 1 For
Al. Owne?s Name - ]� " i ce w iiiA/m��4. T4C ' NyiMlliat
A2 ,( • Apt . m, Suite, and/er as . so.) or P.O. Routs and goo No.
®amafepsi rBR Nurabsr '
a
T a x'$ A® 3r
A3. lsnopmty d y! Pk rct olbers, Tax Pa Number. Legal DM al
r rxtptbn, e.)
U. Buildm Use (e.g.. Residential, Non•Raaldenti I, Addition, Accessory, etc) st (Ai Ti4
A t Mdl I photographs of the building If CsiU al. !s being used lo obtain flood Haim* Dipum M�1D 1927 0 HAD 1 �!3
Al. Buwdmg Diagram Number. a _
At For a building with a creel apace or enclonae(a), provide: AC. Fora buldIng with an attad
a) 8"P re footage or aatM apace or endonue(e) fl a) Sown Wage or prep e0 ft
b) No. of permanent flood openings In be crawl epode or ' d� b) No.*? permanent wraw 1.4 tact ad}awarit Breda stleched gouge
embers(,) walls within 1.0 foot above Meant grade ' / f
c) Toil net area of flood openings in A81 : ;TT; • in C) To not area tot fkmd in A9,b es ►n
SECTION D • FLOOD INSURANCE RATE NAP (FIRM) INFORMATION
�Cz�nnrmut�l hr� I &t �Narw r o i l 44 } I t33. Stela ...:
84#1wAsplPenel Number' 95, Suffix St `- index 97. FIRM Panel 88. Flood t I9 base Flood mss) (Zone
I � e} 7SebOddSPth) / 3 s t /X�. 7
5C� � c
814. Indicate s oume of the Base Hood ENrsdon ? E) dads or bees Hood depth in qsm 99.
0 FIS Proles ED4RM O Cornmuraty ®aaar (Dsaoabe) . .
911 indicate elevation delimit used for BFE in lrn B? ler NOVD 1929 0 NAVD 1998 0 Other (Describe)
912. Ism to a Coaling earner Flo wums System (C S) )a a r , , * wine Protected Anus (OPA)7 0 Yes aro
SECTION C • BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
.
C l . Building elevations am based oh Construction' 0 Construction Drawi Drawings' ❑ Building Under 1►s Finished Construction
'A new E.tewaelon Certificate will be nquiad when con eiiuolion or the building le oormpla e.
C2. Elevations - Zones A1-A90, AE, AH, A (wwith BFE), VE, V1-V30. V (with 8FE), AR, AR/A, ARJAE, AR/A1-A30, AR/AH, AR/AO. Campfela Items C2.11-p
below according to the bilifiangegrarn speeded k+ Item Al.
Banolwmart Uwaed 0 WAfoat Datum
tCheckk be mrea used.
a) Top of bottom floor (ind raesmr
udi g bent, crewx apace, or anUcsurs (Mar) be '0 Ica feet A meters (Puerto Rico only)
b) Top of it ox mud higher floor • 1a t meter* (Puerto FIN* only)
c) Beam of the lowest hortomtal snucbret rmamber (V Zones only) - 11 bet 0 meters (Puerto Rico only)
d) AMsdnd gerrpe (top Pleb) . I tom 0 maws (Puerto Moo oily)
a) i ow.at lie i flan of r moths r Or allollionsol aafwdoIng the building 1i 0 mwObrs (Puerto Rico oy)
(Oaooatea we ',equipment In Cmuhenite)
f) tm el erg ere (~hidu) ends (LLG) mein (Piterio Rico only)
g) MOW *Raeerwt Meshed) grata (HAM _, Y , - - ....1 J s.r El fl% (Puerto Rico only)
!(ETION D - SUPRIIMO1t, rlSIMMOR, OR ACT COMINCATION
VIM •rasaeaerr to to be elpted w misled eye Unit aernogar. anvil er. so smolt 11111111111Mil War to •attllderotion
ieewwillm. ra emrseei ea awiallairo uyr Wet aloft lip aINs rrriellak
r amem__ Oct ow**, wfthuh
of may as istallaib tap Nice or il Pew N Mot U.S. Coda Row o R i
e els* here it aariumnle ere severed on best liter n. .
Cartllre „ �:. License Number _ * y - 110' . 1582 `
0 MO _ .: e . r
W. Foam 11 -31, a
FE
FsbftathY ?A0�1 See mom sloe fir oontintellort Raphteoaa M phswibua seNbfe �
IMPORTANT in thew speoss, copy the correspondInp Infantalion from Ssclion A. I ;: fa '; °'
8utdnp, Ad�r}}�( Apt.„ . S! '; aMlor Bldg. No.) or P.O. Route and Box No
ClY 7 ..744 teA
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy bath sides of this Elevation ewe/Sane for (1) community °Moist (2) kaurance . and (3) bylidkrg owner
C o n w n w n t e e (Z' V C,
e t IllMe r: ad n " rtZ% jej Spa ce.
Signature l v it! . �- . vit I el n Check hem lalsohnistits
SECTION E • BUILDING E ATION INFORMATION (SURVEY'NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AO and A (without BFE), cornpleie pens El-ES. lithe Cenilicate is Intended to support a LOMA or LOMR_F request, complete Sections A, B,
and C. For earns E1-E4, we neturai grads, if svieiebls. Check the measurement used. In Puerto Rico only enter meters.
El . Provide elevation Moenebon for the following and check the appropriate boxes to show whether l ha elevation Is above or below the highest adjacent
grade (NAG) and the lowest adjacent grade (LAG). (including _
a) Top of bottom floor b) Top of bottom floor (Including besan% rot. crawl space. or enclosure) ie „ het molars above or 8 below below the LAO.
E2. Fat Building Diagrams 6-8 with pen'insnt toad openings Drovi 8aecq� Items 8 g or S (see gigs 8 of Instructions) the next higher floor
(elevation C2b In the diaper's') of the building is _. fe el. L,J metiers U above or d,_J below the HAG.
E3. Atoned garage (top of el.bi is __r: 0 hat ❑ maws ❑ above or ❑ be the HAG.
Es Top of paths, of machinery a dlor equipment servicing the building is — 0 feet ❑ meters ❑ above or Q below the HAG.
E5. Zone AO If no flood depth mber is imitable, is the top of the bottom Soar elevated M accordance with the community's loodpiain immanent immanent ordinance? nu Yes 0 No 0 Unknown. The local Adel must certify this Information in Section G.
SECTION F . PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B. and E for Zone A (without a FEMAMlssued or community - issued BFE)
or Pone AO met sign hers. The afifernenhr N Sectors A, 8, and E are wrote to the bar of my knowledge.
Properly Owner's or Owner's Authorised Rapessr dative Name
Address y State ZIP Code
Dam TelepAOe
Comments
SECTION 0 N A) -.
- COirMJIM7Y INFORMATION i; )
The local otilcW who is authorized by law or ordinmaw lo administer the conarwritzes Soodplain management ordinance can complete Serra ns A. B, C ( or E),
and 0 of this Etsvatbn Certificate. Complete the applicable ilsm(s) and sign below. Check the messtaemarit used In wens (3. and 138.
G1. ❑ The information in Section C see token from otter documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who
Is authorized by law to °say elevation Information. (Indicate the soiree and date of the elevation data in the Comments area below.)
02.0 A oorimunllyr official completed Section E fora building located in Zone A ( wahout a FEMAissusd or carmhuntty -used BFE) or Zone AO.
03, ❑ The following orsestron (glens 04. -09.) Is provided for community hoodplain management purposes.
04. Parnell Number I 05. Dale Peen* 1Mued C18. Date Csrtllcale Of ComplencaeOccupancy Issued
07. Thb peewit hes been teemed for ❑ New Consbudien ® tiubseehnsel f t
0b. El.raren of ae4ullt lowest Hoot (including beseasent) of to budding. 0 fest 0 mire (FR) Datum
(38.OFE or (In Zan. AO) depth of eseding at ur lode Ms: 0 feet 0 melee (PR) Deem ewh
t.00er Gftwtals Marne Tile
Community Name Tal.phOM
Signelore Oar
_ __
Cammenle _.
CIANNIUmallartamo
FEMA Form 81 -31. Fellniry 2008 rapimeee aft pervious edkons