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I mportant: Read the instructions on pages 1 - 7.
SECTION A - PROPERTY OWNER INFORMATION I Forinsurance:CompanyUse:
BUILDIN WNER'S NAME Policy Number:
BUILDING STREET ADDRESS (Includin pt., Unit, Suite. and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. I Company NAIC.Numoer
7 -- Ali Ai 7T-- C 7 7'z�Q =< 7
CITY STATE ZIP COD
PROPER ESCRI TION (Lot and Blo bers T Par I N� Legal Description, etc.)
7/1 - r vA ,, !7, ate►. 7 .
BUILDIITG it(e. R sidential, Non- (sidential, Addition, Hxessory, etc. Use Comments section if necessary.)
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: LJ GPS (Type):
( #t° - 4' - 4#.#40' or ##.n#### h NAD 1927 IJ NAD 1983 L_j USGS Quad Map IJ Other.
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B7.FiUNI ' _COMMUNITY g NUMBER 82. COUNTYCAME 83. STATE
' 84. MAP AND PANEL B5. SUFFIX 36. FIRM INDEX I 87. F PANEL 38. FLOOD 39. BASE FLOOD ELEVATION(S)
2 � NUMBER D� TE EFFECTIVE/ IS DATE ZOME(S) (Zone AO, use depth of flooding)
I T 716� c ) G &a-7 /M I6, , 6/l7 � /4 /
B10. Indicate the source of the B e 1food Elevation (BFE) data or base flood depth entered in B9.
II FIS Profile 1-'F RM J__j Community Determined J_j Other (Describe):
811. Indicate the elevation datum used for the BFE in B9:1 VD 1929 )J NAVD 1988 J___I Other (Describe):
812. Is the building located in a Coastai_Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? J Yes ham'
Designation Date:
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
01. Buiiding elevations are based on: 1 1 Construction Drawings* J__121 Under Construction* 1_jFinished Construction
*A new Elevation Certificate will be required when construction of the building is compiete.
C2. 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 C3a -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 8, 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 AJ(7Uk/1 Z Conversion /Comments
Elevation reference mark used Does the elevation refer ripe rk used appear on the FIR '. I Yes i
❑ a) Top of bottom floor (including basement or enclosure) e , ft.(m) /' 0 H
• b) Top of next higher floor _ ft.(m) v) .„, /
Q c) Bottom of lowest horizontal structural member N zones only) ift.(m)
n / n' / � G..STE ' ` ,\
❑ d) Attached garage (top of slab) ) Z . ft, m D a
❑ e) Lowest elevation of machinery and/or equipment B. * No. 22
servicing the building . _ft.(m) ? c q \ a�
CI f) Lowest adjacent grade (LAG) / r1 . ft (m) z . �,, L P\ �y /
❑ g) Highest adjacent grade (HAG) i Z. . .(m) 1, ` S ��y
❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade . ' - El
❑ i) Total area of ail permanent openings (flood vents) in C3h sq. in. (sq. cm)
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.
1 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 /
\,I f If � ,{ / /7 2 G % / , LICENSE NUM7
TITLE COMPANY NAME t
ADDRESS % / �..r �r CITY yet ZIP CQPE (
4/ ' - J C 7/ff J
SIGNAlU J //� i DATV ?� J TELEPHONE l.� �/
FEMA Form 8,Y -3?; AUG 99 `E REVERSE SiDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS