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HomeMy Public PortalAboutMILLER AV_612 NATIONAL FLOOD INSURANCE PROGRAM Expire I Jul suc/-u i Expires July 31, 2000 2 ELEVATION CERTIFICATE Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION I For Insurance Company Use: BUILDING ER'S / A � +Policy Number BUILDING STREET ADDRESS (including Apt., Unit, quite, /or Bldg. No.) OR P.O. ROUTE AND BOX NO. I Company NAIC Number ©© ��j-� , CITY , 7— ._ teu1ip SM S!,zg PROPERTY DESCRIPTION (Lot and Block • - , Tax Parcel Number, Legal Description, etc.) 4-07" /17 d /P BUILDING USE (ee4dential,,IGon- residential, Addition, Accessory, etc. Use a Comments area, if necessary.) LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: I_I GPS (Type): (##° - ## - ##.##" or ##.#0#4°) 1J NAD 1927 1_I NAD 1983 I_I USGS Quad Map 1_I Other: SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. COMM NAME & COMMUNITY NUM�R B2. COUNTY NAME i � 163. STATE �� B4. MA P AND PANEL B5. SUFFIX B6. F IRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) / ? NUMBER �! 6 ��� 1� �6 EFFE �IV�� VySE� DATE ZQJyI (Zone AO, use ,/ depth of flooding) B10. Indicate the source of the se Flood Elevation (BFE) data or base flood depth entered in 69. II FIS Profile I_I FIRM I I Community Deterrn'ned I I Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: .l-N VD 1929 II NAVD 1988 I_1 Other (Describe): BI2. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Yes I—`(No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: I_IConstruction Drawings* I }Building Under Construction* I-'(Nnished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 7 (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.) C3. Elevations - Zones A1-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR /A, AR /AE, AR /A1 -A30, AR /AH, AR /AO Complete Items C3.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 D or Section G, as appropriate, to document the datum conversion. Datum 1 Conversion /Comments . Elevation reference mark used Does the elevation reference mark used appear on the FIRM? I I Yes (-f' ll�o ❑ a) Top of bottom floor (including basement or enclosure) 7 .6 ft.(, tj ❑ b) Top of next higher floor /e5 . ft.(a4-' `' Q R 1 \ :I c) Bottom of lowest horizontal structural member (V zones only) _ ft.(m) m V �/ `, ❑ d) Attached garage (top of slab) (p ft.(+7R-}-E . 0 <-4-_G'S I EgF.. 4, . \ ❑ e) Lowest elevation of machinery and /or equipment W ► servicing the building (Describe in a Comments area.) / 3. O ft.(I r} E * No. 224 1:1 f) Lowest adjacent (finished) grade (LAG) q . L t ft.i j- z ' .p < , . p 1 t� ca g) Highest adjacent (finished) grade (HAG) C i . L� -.ft.( }- *, • SUR� � cr � ❑ h) No. of permanent openings (flood vents) within 1 ft. above ad' cent grade A— ti , � �. / ( ID t i P P 9 ( ermanent enin s Total area of all o flood vents) in C3.h / sq. in. (sq. cn,j `` !TLE`I-4 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information in Sections A, 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. CERTIFIER'S NAME) v j ii . A7 !G/ �_ j , ,M LICENSE NUMBER z TITLE �ft GG7 " COMPANY NAME " ADDRESS 6 , 4 , CITY f ` ,SC AT, ZIP CODE C� /`T`� SIGNATU /� � r -'^ r{'(/r � 1 / J � 7 TELEPHONE i ( LE EP f6 ( FFAAA Fn M1_g1 .11 1144 r SPP PEVPPSP CIf1F1=(1F? C:C NITINII IATInKI PPPI A(:FC Al 1 PPPVIfI IS PIlITI(Th1S BUILDING S1REET ADD EIS Including Apt., Unit, uite and/or g. No.) OR P.O. ROUTE AND BOX NO. Policy Number a CCTY 79065 ` B�, �� Si d Company NAIL Number SECTION -- 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 1 1 Check here if attachments 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 1 -1I ft.(m) 11 1 -1 above or 1_1 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 1_1_1 ft.(m) I_l _Jin.(cm) above the highest adjacent grade. Complete Items C3.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? Yes 1 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, B, 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 AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS • I Check here if attachments 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, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. The The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (indicate the source and date of the elevation data in the Comments area below.) G2. 1 1 A community official completed Section E for a building located in Zone A (without a FEMA- issued or community - issued BFE) or Zone AO. G3. 1 1 The following information (Items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED 1 1 G7. This permit has been issued for: 11 New Construction 11 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: _ ft.(m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: _ft.(m)Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS J - _ . J Check here if attachments FFMA Fnrm R1_11 .11 II nn PPP! £CPC Al 1 PP VICII I. Pnrri 1NIR