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ELEVATION ;CERTIFICATE 0.44.0. No3067 -0077
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FE.OERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does not provide a waiver of the flood Insurer= qyU chase requirement, This font is used only to
provide elevation information nary to e.isctre compliance with applicable community munity B lain management nicknames, to
determine the proper insurance premium rate, and/or to support a request for a Lulte• of M . Amendment or Revision MAMA at LOMR).
hatrvctlnns for completing hits fomr can he torrid on the tollawing pages-
SECTION A PROPERTY INFORMATIQN FDA ICECouPANYUSE
nunDlNG oWNER's WANE _ Foxy NISII EN
at REEr ADDRESS Dndluell0 Ap.. ma. S4.4[6 anzCix F ti vA'a ` 1 OR PO, nOUTE AND B7$ NUMB - ornovwe talo4TUOADEFI
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Ito EGta r.lQ Y `VS APL-
°7tiER DESCRIPTtON (Lot all alea Nrrrberi..)
- _
STATE 2)7 COM
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SEGUOf 8 FLOOD INSURANCE RATE MAP (F1 F1FORRAIICf4
Provide the following (ten) poper FIFO I (Sea instructions):
- 1 cotrwrOrarrY miitriersi 2 - f,,;t EUFFix 4. RATE OF PIMA INDEX s, vox/ZONE vox/ZONE urea. FIC7o0 ELEVAMN
ei47i �m+e@y ene dsnthl i ;
7, Indicate they slev . +n datum system am. 1 rEr FIRM for ye Flood Elevations (WE): 0 NOVD 29 DOther (describe an hack)
S. For Zones A or V, were no ti FE Fs, pit ra !he RIlEM, a1 -t to community has eked a BFE bu Mis building site, indicale
the community's EWE: L11_1,1_1.1 _ NZ3 VD (iv nth-sr r"=3P fd tunz -see Section 15, Item 7),
t ,. T '
' fk- -71; ,1 r; d lu'�.I! kG �,�Il nTAIN INFORMATION
1. ti ing the Elevation Certificate cZk �G i +.l q ,eu crumb _ r Lana the diagrams loured on i s 5 , tt 6 that best
describes the select bulldi r s roteve ^ ei __ 2(a). ARM Zo ws Al - A30, Fes. Ali, a.Ta.rd !A (.T, ,I 1 ha 1 ;•, cI reweave uiel fig - fm ;f a Y 9 r , r rl dial/rain is at an elevation
of 1 1 1,..1 /1,/ fe NGVD (arc : FEINP ?sa ;--'sue S c r , item 7 /,
(b). FIRM Zones V1 - V30„ 'VE, and V (with lib° ). The tglAZoin erma !: + +,° =r c3 7 hoiavrtital stti 'tunas nuarnber 05 Pre referwsce level trcwrtt
the selected dttagra m, is at an elevation 041 1 1 . Ll• I,L.1 feel NGVD (or other a:;l1f4t3 datum --see Serlion II, Item 7).
(c). FIRM Zone A (without BFE). The fbacw used as tie 11•MeTz ba level from the selected a > flram is LU .L-i beet above Et or
below 0 (check one) the highest v a ` ra m v ,1a ( Pilcl rag.
(d), FIRM Zone AO. TP glare( used wr tirm d s'feF arfc fav; 1 rorra the - ,_ +- « • ,+ diagram is L __ 5 _fl.. -..1 lest aho•re 0 or balm* [ ivh;erk
one) the highest gr. ^s k •nt oh9a 'he drlryF ad; . GI ;.l, ba'urs•tr w;er I number is available, i the bui' 5,7i)':s. kr 'omit flow (rofeven e
level) elevated In accordance witt'a the comm sni s fiolxi airs man ,. Tent ordinance? Ej Yes L.PAs Ll Unknown
3. Indicate the elevation cilium system wed in -ticf rttz ing t daxsve refers nc a level elevations: ® ;,;+? I 0 Other (describe
under Comments on rage 2). (NOTE: 11 the elevation Paean used in measuring the .tepr r s is aa'c-rrant twin that used on
the FIRM (see Seaton 8, ltevn 7), then cxirwert the .. ,.. :lions to ,r u•° datum system us don he y FBA r thswir f ° = rr tiertsion
equation under Comments on Page 2 )
4. lrtevat or mileranoo matic lased appears on FIRM: 0 Yes 0 No (Sea instrucrion age 4g
5_ The rekt e ^ >e • etc - riratian is bated on: P..1 actual construction 0 constructan drawintP
(NOTE' r. ":s -, (r I' construction r6'avvings is arty varid If the bung doffs not yet ttawe the riffirnmorr Fuel tioer ht ,.::cis, in which
case thLs certiLicata will only ter v+a!rl for the Nailing during the dowse vl witstruction. ,A1 c efi cn Elevation M1C ifica:
will ba as t ire ' err • construction its tolrrete)
6. The ele�raV: : us ti? s a T
vaest grade immediately ad(ael �� its ar�i r , r is:1 1) 1 I fset H 'i r1 (("r tiflea I 'I[r1 IJ ,• • -
Se7ctiQfl . 4, i ? o s. '�3a
SECTION U CODLAIK1r17 NrOEIRMVOR
1. if the oomrrlunity ntfi i for verifying building elevations °a+cra P ),,hei theme erase level it .rte 3sv Se don C, Item t
is not the "lowest float as defined in the community's tity's 1loodptain man amerit odnance, alit elevation of trio building's "Ivtrest
Boor as defined by the ordnance is: I. Li legit NGVf3 (a 'r i 'that° l ll Ati datum Section l , Rein 7).
2 - Data of the start of construction or substantial improvement
$ E r *vt14t u r FOR tXAMM AT
FIEtiAA; Form VI-31 r NM SO REPI ACES Al4 PteEaPlcD�15 t t?iit4AeS 14t,1
,;Hf I G ^ ' 1,J ell unr.5w 5 u •., �'�• • . . -
1
f SECTION E CERTIFICATION
•
his certification is to be signed by a Jared surveyor, engineer, or architect who is authorized by state or local law to certify elevation
rtr+mnativn when the elevation information 1101' Zones Al -A30, AE, AH. A (with nFE=),Vt-- V3O,VE, and V ;(with BFE) is required_
Community officials who are authorized by local taw or ordinance to provide floadpisin management inforrfitation, may also sign the
ertification In the rase at Zones AO and A (without a FiEMA or cc rm'nunity issued s , E), a bung official, a property owner, Or On
M13ter's representative may also Sign the certificelion.
leterence level diagrams 6, 7 and 8 - Distinguishing Features -If the certifier is unable to certify to breakaway/non-breakaway wall,
nclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then fist the Feature(s) not
tcluded in the cartrtirtcatian under Comments below. The diagram number, Section C, item 1, must still be entered.
citify that the information in Sections 6 arrd Con this certificate represents my best efforts to interpret the data available.
understand that any false statement may be punishable by fine or imprisonment under 18 U.& Cade, Section 1001.
B I-'1' 13. 8' 4 I rig , S' s Ai # 2 .'" 3
ErrTIFIER'S NAME UCEr8SE !MASER (or Affix So*
1 , L—. 'r 4 _11.A_&4 r -- LA Q c 0 a ..r' 1''1 4 6, __ / Ai _C ,
i.E C 3041PA Y NAME �_
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P . , e o 1'C l c O c ( . t/rd r ., Ad - (c' "'t1'. 3 Y z---
DORMS rry STATE ZAP
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niaATURE `SATE PHONE
■ IBS Shen +;! be may • of this Certificate _ter: 1) community official, 2) insurance agent /company, end 3) building
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ZONES Z MJEa +£INE$ 4z,i.NES ZONEs um.
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rtormiort AWAG�iAT RARE 9
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The di. • rams above illustrate the points at which the elevations shoi.Ilti be measured In A Zones and V Zones.
Elevations fir all 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. ,