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Home My Public Portal AboutMoore Av_3 V.IVI u. lru..'J1 -VW l NATIONAL FLOOD INSURANCE PRO( NM �� Expires July 31, 2002 ELEVATION CE TIEIC®, fE , Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION I For Insurance Company Use: BUILDING WNER'S Policy Number BUILDIN EEC• ADDRESS (pt , (Including A Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. I Company NAIL Number , CRY 6de3 2g 1 74411/1 - 62 30/-5Ze3 ZIP CODE Aj/0 PROPER 'b C ,Lot and - Tax Parcel Numbegal Des Le) 7 �1 �,� Blo Num er, L ,lam ` on, etc) ,0�� .6 BUILDING U� 4 ential, Non -re. denfial, dl n, Accessory, etc sea mm tnts area, if necessary.) IATITUDE)LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: Lj GPS (Type): ( ##° - ## - ##.##° or ##.#####°) LJ PLAID 1927 Li NAD 1983 LJ USGS Quad Map Lj Other. • SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFIP COM NAME & U�jY NUMBER 62. COUNTY �� 1 { B3. STATE � �� rte! • /(' 6 ( B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) /79 NUMB FR A 6 EFFEC R S ZO E DATE (Zone AO, use depth of flooding) 810. Indicate the source of the se Flood Elevation (BFE) data or base flood depth entered in B9. i_1 FIS Profile lzrFIRM 1_1 Community Det fined 1-1 Other (Describe): 611. Indicate the elevation datum used for the BFE in B9: I NGVD 1929 I1 NAVD 1988 1_1 Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1_,1 Yes LA-Kr Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) - 01. Building elevations are based on: 1}Construction Drawings* 1__1Building Under Construction' 1 finished Construction `A new Elevation Certificate will be required when construction of the building is complete, 02. 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.) 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 C2. 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 e pace provided or the Comments area of Section D or Section G, as appropriate, to documentthe datum conversion. Datum Conversion/Comments . Elevation reference mark used Does the elevation reference mark used appear on the FIRM? l.-_J Yes 1_-1 o I:1 a) Top of bottom floor (including basement or enclosure) 17 . 4ft.(m) d ❑ b) Top of next higher floor k./ (1X _ ft.(m) 4 ❑ c) Bottom of lowest horizontal structural member (V zones only) t/11 B\. ft.(m) N ® CI d) Attached garage (top of slab) i'Ve),� _ft.(m) B b C c,,.. STE- O ' ❑ e) Lowest elevation of machinery and /or equipment \' servicing the building (Describe in a Comments area.) /6 _t_ ft.(}- E Irk i N. " CI f) Lowest adjacent (finished) grade (LAG) '7 .2. ft.(trr) z g `p 0 2 ®/ CI g) Highest adjacent (finished) grade (HAG) Al . / f t•(3 - ® \ • + sU ``� iQ, 'I v y r � ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade O L {f. v ❑ i) Total area of all permanent openings (flood vents) in C3.h sq. in. (sq. cm) y fT .EY R I SECTION D -SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION ' This certification is to be signed and seated by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information in Sections A, 8, 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. CERTIFIER'S NAMC / y'� LICENSE NUMBER oz TITLE s ' - U COMPANY NAME s - A ADDRESS U ' e nC Y� ,, -r ZIP C / SIGNATURE,/ / / lti ` � TE/ 7 / TELEPHONE V/C° ® 1 6 J FF i l e . e n r r n R1_ / II ' rr CFF PPVPPS C trp FCIR C`C1NT1■I IATICIN PFPI Ar.FC pt 1 PP VIClIIR AT: In these spaces, copy +' orresponding information from Section A For Insurance Company Use: A ,eG EET AD RESS (Including A, , nit, Suite, and/or Bldg. No.) OR P.O. ROUTE ANL _A NO. I Policy Number J i ,,) ` e DE Company NAIL Number 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 CZ e " — /: �`� II 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 I - J _ J ft.(m) I_,,Jin.(cm) 1_I above or 1_j 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 1J R(m)1 1 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? I I Yes 1 111 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 C3.1 only), and E for Zone A (withouta FEMA- issued or community-issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and Eare correct to the best of my knowledge. PROPERTY OWNERS OR OWNERS AU I HORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS IJ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) _ The local offidal 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. G1. L_1 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. LJ 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. I I 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 COMPUANCE/OCCUPANCY ISSUED G7. This permit has been issued for: JJ New Construction 11 Substantial Improvement G8. Elevation of as -bunt 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 OF-EICIAL'S NAME 1 CI`LE CCMMUNfTY NAME TELEPHONE SIGNATURE DATE COMMENTS I I Check here if attachments PPP/14 Fnrm A9_Z1 .11 II M PFPI aC.FR m 1 PP VICII IC Pf1IT nNic