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Home My Public Portal AboutMILLER AV_505C a..... v u L+v.s71t um..1A. 1 1r1V9'1 1 L. Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION 1 For Insurance Company Use: BUILDING OWNERS NAME I Policy Number L 4yi TC-t.- I U n i t , and /or Bldg. No.) OR P.O. ROUTE AND BOX NO. 1 Company NAIC Number CITY - 7 _ 7 eve ( 3 PKUt'tK ` tr DESCRIPTION (1,7d Blo,k Nt; , Tax Parce Number, Legal Description, et.) - BUILDING U (e.g., Residentia r Addition, Accessory, etc. Use a Comments area, if necessary.) LATITUDE1LOI ITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: IJ GPS (Type): - ( ##° - ##' - ##.##" or ##.114414/4P) JI NAD 1927 j_J NAD 1983 1J USGS Quad Map LJ Other. _ SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMB 82. COUNTY NAME 1 B3. STATE 84. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD 69. BASE FLOOD ELEVATION(S NUMBER SATE EFFECT R ED DATE Z E(Si (Zone AO, use depth of flooding) / get day C b/r7 6 fi 7 � /2 _ B10. Indicate the source of th ase Flood Elevation (BFE) data or base flood depth entered in 89. I I FIS Profile J FIRM I I Community Det:gxonined II Other (Describe): _ B11. Indicate the elevation datum used for the BFE in 89:.- NGVD 1929 II NAVD 1988 I_I Other (Describe): _ 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? J) Yes (_-- Designation Date: _ SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) _ 01. Building elevations are based on: I!Construction Drawings* I_(Buiiding Under Construction* f ---trinished Construction `A new Elevation Certificate will be required when construction of the building is complete. C2 Building Diagram Number 6 (Select the building diagram most similar to the building for which this certificate is being completed -se pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations -Zones A1-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR /A, AR /AE, AR /A1 -A30, ARJAH, AR/A0 Complete Items 03.a -i below according to the building diagram specified in Item 02. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section 0 or Section G, as appropriate, to document the datum conversic Datum AAUP Z9 Conversion /Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? I-J Yes J Cl a) Top of bottom floor (including basement or enclosure) . , ft.(f O b) Top of next higher floor AC . Q ft.( 4A-} O R Ol c) Bottom of lowest horizontal structural member (V zones. only) • _ft (m) o :Ti f' elb \STB' R ■` 1 CI d) Attached garage (top of slab) /7/4,.. _ ft,(m) t 2 f -G F � ` `.' 0 e) Lowest elevation of machinery and /or equipment * servicing the building (Describe in a Comments area.) 6_. . O ft. Erni ; * No. 9 ra [a f) Lowest adjacent (finished) grade (LAG) 4. • ft.(mrt z . ' '` 1 o , O g) Highest adjacent (finished) grade (HAG) .---- . 6 ft.( \ � p S UR ` I &y O / O h) No. of permanent openings (flood vents) within 1 ft. above ad' nt:grade Z o 1 � .., i UP R ti O i) Total area of all permanent openings (flood vents) in C3.h Z sq. in. (oq. cm).. '� SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed: by a land surveyor, engineer, orarchitectauthorized by law to certify elevation information_ . I certify that the information in SectionsA, B, and C orr 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. - CERTlFIER'S.NAME , /�jr j )//V®�� LICENSE NUMBER ��y/�a - TITLE / �'�/ n COMPANY NAME - ! ADDRESS 6.51r--0 / 1 i h „ . . ' , /- �'t/7" CITgw ZIP CODE �� SIGNA7RE //' DATE /Z„7./19 TELEPHONE ? Z -.0 off' GFMkFnr 1_11 .1111 nn . FP' RF \ /GRCFCIr1F RPPI A(:1^C.nii PPPVIniisPf1TInl 1 , ,19 _ 22.8 ►d � P >q Y 5 L _ , e 9 S T A A / VE Company NAIL i■umber SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. • COMMENTS �e C 4/ C 1_,1 Check here if attachment SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete items El. through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR -F, Section C must be completed. El. 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.) E2. The top of the bottom floor (including basement or enclosure) of the building is iJJ ft.(m) I 1__Jin.(cm) 1 -1 above or 11 below (check one) the highest adjacent grade. (Use natural grade, if available.) E3. For Building Diagrams 6 -8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is I ft.(m) J_J_Iin.(cm) above the highest adjacent grade. Complete Items 03.h and C3.i on front of form. E4. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? J I Yes J I No I 1 Unknown. The local official 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, 8, C (Items C3.h and C3.i only), and E for Zone A (without a FEMA - issued or community- issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are correct to the best of my knowledge. PROPERTY OWNER'S OR OWNER'S AU I IONIZED REFREStN IAIIVES NAME ADDRESS CITY STATE. LIP CODE SIGNATURE DATE TELEPHONE COMMENTS jJ Check here if attachment SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, 8, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. 31. i J The information in Section C was taken from other documentation that has been signed and embossed by a licensedsurveyor, engineer, orarchitect who is authorized by state or local law to certify elevation information. (indicate the source and date ofthe elevation data in the Comments area below.) 32. jj A community official completed Section E. for a building located in Zone A (without a FEMA - issued or community - issued BFE) or Zone AO. 33. J The following information (Items G4-G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED I G6. DATE CERTIFICATE OF COMPLANCE/OCCUPANCY ISSUED 37. This permit has been issued for JI New Construction j_J Substantial Improvement - 38. Elevation of as-built lowestfloor (including.basement) of the building is: ft.(m)Daturn: 39. BFE or (in Zone AO) depth of flooding. at.the:building is: ..__ft:(m)Datum: LOCAL OFFICIAL'S NAME 1ITLE. COMMUNITY NAME TELEPHONE SIGNATURE. • DATE :;OMMENTS - I I Check here if attachment =AAA Pr rrtt 5:11...11 .11;11 1111 PPP( AC`.<=S Al 1 PP \I!C 1 1S Pr1(TIl1N