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ELEVATION CERTIFICATE E,cpite>' Ma/ 31, 1990
J " / i f FEDERAL EMERGENCY MANAGEMENT AGENCY
f' '.. , -r rn. y M NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: U8 of thin certificate does not provide a waiver of the flood insurance purchase requirement. This Corm Is used only to
provide elevation information necessary to ensure compliance with applicable community ftoodplain management ordinances, to
determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or vision (LOMA or I.OMR).
Re
Instructions for completing this f orts► can be found on the following pages,
SECTION A PROPERTY INFORMATION i FOR INSURANCE COMPANY USE
Wilt OWNER'S N� - _ -- - POLICY NUMBER
MEET D RESS fli •• . Apt, U }, Suite mod/ . Number) OR P.O. ROUTE AND BOK NUMBER COMPANY NAM NUMBER
. A. r � . . .�,,�.. ..
OTt1 R DE3CRis•T •t and 1 u_ rsLstc _ ,...__ ..
_ 1 ? (rLlt , .,. ZIP000E
0/
SECTION 8 FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions):
1 1, COMMUNITY NUMBER 2. PANEL NUMBER 3. SUFFIX 4. DATE OF Fl INDEX Si S, FIRM !ON; BASE FLOOD ft
/5 / j c 6/786 1 4e t t AO d.pri
I
7, Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BBFE): GVD'29 0 tither (describe on back)
U. For Zones A or Y. where no BFE is provided on the FIRM, and the community has established a BFf: for this building site, indicate
the cttt ttutll1Y's 14004. i hil other FIRM datum -sear Section B, Item 7
ooN Di l L Ii9Tt INFORMATION -
i f, �thrmg the: liatibrr nificate instructions, indica the di ram number horn the diagrams found on Pages 5 a It • tl*be ' X 71
descr the subject building's referee -R0 SAC) • 0 E �T t -4' ;.,
2(a), FIRM Zones M •A30, AI;, Ail, a W P m oR $Ark p ,the selected diagram is at on elevation
A 7 4 r - oft 14.-qc1 14(oti N b (or 0 0100.4104 2 f1tIMPAP149 1 0.41SATO PROGRAM- A Mtki �Zp> ittYPOrt;VEattn� w V ncfaodorrX #ib:levva tuiaontal s u srrsrrbOt.of flie reierdnc 1 s fret
V `' 3� a 9 d �v a '� i t
a i iF i ' (w � , ,iitf � ,t r ra � c 8 ) 9 1 } di rt _ .0, t i t
,cl€tl < Y Y .. J Dr
._.,._.< the- • era 1; 8n t'tQ r w 1-1. 1 it s 2.S.r' c, 4 0Yuwet t.iriF may
I
� � �� yF «�(i$Btt'aS b, voi...a"�Vet°trW n N lb ivoiectsotteagra'm ;8 1_ j Tent( f AlSt, b&i w E 1 (chock
`' ` r e r ki , n, to the building. if no flood depth number is available is the builder`g's lowest Door (reference i
, � �'�� n' Yes 7
3
1
i
,,'n /= i,y ,... t� ng the above re elevations'. VV D Zit D Other describe
...
g ins - level elev - 0 N
► j { t�C ifi R `,_ `w �_? e i lee ono to n d at u m used i n rn th elevati is d than used on
Q 7 M i $ 6 J B4 f a tired 7if € of.x5.
4. secs on i:IRM 0 Yes No (See Instructions on 1
5. The reference level Nevatiortatetifitt d r: t . area a rfl, r trfir rirl i liATIO
_-INS• eteonstructton is�vnly valktit `herbasldlnfrdoesnot`ge`t 8°'thrrelererforlpt>i� e; rerpta Yirvhictr """ "
i"` weasi hi lt/tlaWiellfbilijv 11Yeitbt r7ttriirfdar the Course of construction. A post - construction Elevation Certificate
t -mil, ;..€R9 i fit, `r t'n . r. . I?
Z . , : r ix 0 xE FT INDEX r , 0 , get F4A a VA w: .,..�
6.)Th i lovAest gradeprimediatety adjacent to f A : id ,11 l VD f or o tti i it f� ` 1:a 1
a! ..wad ti "t73 k.g. .i3 m ogg,„%r :9,ysi44.) iti',' a3 r'4 ' W ! t` H ,O sy , 7r _. e .44'0.1 V'zsr ' z... emirs . �y s-vc ax.+V 4.,f OA 1
r� AV r
,; r -: „r �.��,.s: +� rxr af sa'i:�asc� c5t? L„Pi” R� £1rf7a::v'i�a� ,;u s, a t s F,�c�$ itig #� .z 41 .n,isiIrft cy ,:; ir
ti.: It the.ourtnf nil to lrG nirit)li rota sty b p:<ale inefepesililes ti the refetenattievel Indicated in Section C, stem 1
t
cs- not4he lowestfloor" as• defined -in f 11 cornmeRitffe°i►oeap rna t(Ottfkfhia-buildrr+g west- - %-
lairr3 er►t�ei tNe°9ltrva
floor" asdefined 01 the ordineince is: �.i tn, • i ° en r _lL
_ ,; x t �: Section 8 Iram , �..- ._._.,w..,
' e rg ®g f ' '
sQ ? Qr '" ss! Y ,a _
In i d t,s C:rx s L am, I Ott sq l €a asu <::aamas rt a ,t4 [ 6, , ., 4 . ; n ' , d e ,fit a
u f o p r 1t" f t u • ' r 7 i rieri 4 .- �{ � a [y �y�
..1 ;5idR�La `rte 1, • l A MR u " Ems§ a' 2 tt k c�+ ��TS. .+��
y AI a as i , . o t o z€3fi r. j' f oorr a. e S s� a n, +' t t
i feat iN •.zr 013744: Ft a Ma Ca, u'r stle Simon 8, tern 7). .
to;. FIRM $; V14, kVE. }n V (wit PE) The boifor* o' tt k7 -Went ih 9rizort6i s•ii'il a,.1ik'as` t'm- s'ail8 7 'ttio•t``Ol itfp' ' F ' ' 4 f'1 «'' « io ,
'4.,e 14047016d Oro iY2: is art: ri r,te oo.t.t of : . .._.a i ; .J 1 (e;ut NGV ,(ol ab A;'i€€ "stru .,set c 4 - - -; ,,FiGE. el 40.
- 1- °4 x! e e?. (wishC t PE f; i'; tiodi U mia aw t ie: r' 9"t tern loved ,:.)m O o ,c . uci adirli arrt 'f #.... i ■ feet? :ass t .. ' of
bei »; . ) fl : p1 toe i 5. 9s a 5 i C eht to f i Willing .
c.d; F AM Zwie AO., Itto Hoof Lived : the reference fevei :torn e e +i'nie diary am is L :' 1.i # feet a .98'tt ^s',.. s f of befow 1 E 1 „+€oi.:I':
. - - _ •- .•.4.••...v ....,,,,I,, o ✓>isrse nP Pe: th kia t£tif'te if no rood th.toth ri &,.b'-''aa 1 is ;-`.'t'2kiaa er, is . 90 bailtiin 2 iouv8 t i!DQ` valet e iCik
** L7.21' 3Ddd 1k1101 **
— _ SECTION E CERTiF(CA
Tit1N
This certification is to be signed by a and surveyor, engineer, or architect who Is authorized by state or local law to certify elevation
information when the elevation Information tor Zones Al -A30, AE, AFi, A (with BFE ),V1-- V30,VE, and V (with BFE) Is required.
Community officials who are authorized by local law or ordinance to provide floodplaln Management Information, may also sign the
certification, In the Case of Zones AO and A (without a FEMA or community Issued BFE►, a building official, a property owner, or an
Owner's representative may also sign the certification.
Reference level diagrams 6, 7 and 8 ' Distinguishing Features -If the certifier is unable to certify to breakaway /non - breakaway wnfl,
enclosure size, location of servicing equipment, area use, wag openings, or unfinished area Featute(s), then list the Features) not
included in the certification under Comments betow. The diagram number, Section C, Item 1, must stle be entered.
t cerlrfy that the information In Sections a and C on this certificate represents my best efforts to interpret the data available.
r understand that any false statement may be punishable by fine or Imprisonment under f 8 U.S. Code, Section 001.
GrnT1Fl S117 t10EN5E NUMBER {o M s It
TZ.0 SOiM1,1.
TITI COMPANY NR1�AE
AD D C Af' �j� ATE l lie
siar4;TURE7 l ? PHON p O
/ s! � �y
Copies she dd de e s c ate for community official, 2) tnsurencd agent/company, and 1) building owner.
(CO NTS: . ,a
ON WITh ON NUM,
sLAI! RAIMENT pKgE, OR =WRNS
A V A A V
ONES ZONES ZONES
ZONES ZONES ,
pnrERE L r
rtr
�.,_ u E��[�rc.
nErtnEme t + ft000 uEt Il _..� ENE
tEVEI It's 'A'
4CC' r2 EIEVIViga
:4 I Sr< t dr, • l 3 .14i •
SASE
' ADJACENT I1ff ERENr.E KW*
Mot stoop pt " ;? LEVEL , VAT1
ELEVATION gr fEREter AtUgEttT
tEV'EL r.RAOE '
r ti4i{�S-'`i". ` ' i
mot
The diagrams above illustrate the points at winch the elevations should be measured in A Zones and V Zones.
Elevations for aft A Zones should be measured at the top of the reference level floor.
Elevations for all V Zones should be measured at the,bottom of the lowest horizontal structural member.
Page 2
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