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0� E: NATION CERTIFICATE
Important Read the instructions on pages 1 - 7. ,
SECTION A - PROPERTY OWNER INFORMATION I For Insurance Company Use:
LDINC� OWNER'S E dTz 1 /� Noisy Number r G t l ,f� 0 !`!I _ r
WING Ti EZTT DDRE lnclu l � Un taS ndior Bldg. No.) OR P.O. ROUTE ANC BOX NO. I Cosany NAJC Number • --r 4 1, 4 ,0 17-1:t l ig2:43 E
DPER DESC t ON (Lot and zi •Ck .Nu hers T.- - arrzi Nurr Legal Description, etir.)
Ir.IN >t a— - - ante!, Non aid— =1, ACC um, Accessory, etc. Use a Comments area, rt necesaary.J
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TUD ONCITUDE (OPTIONAL) HORIZONTAL DATUMt SOURCE: L) GPS (Type): 1
a - Mte -*kW or 4#40144°) L.J NAD 1E27 I J NAO 1983 LJ USGS Quad Map L doter
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
NFIP U�Y E & COWL PIITt, N ER 82. COUNTY NAME 1 83. ST.ITE
4. MAY ANL) PANEL E5. EL'F-FIX BS. F$FIM INL3tX 157. t•It-iM PANEL. us. FLOOD Bs. E FLOOD ELEVATIONS)
NUMBER CATE ZONE(S1 e AO, use depth offooding)
;964 c z. C 6/17 t 6 � Fi6 A e / 7
Indicate the source of the se Food Elevation (8 FE) data or base flood depth entered in Be.
I I FIS Profile 1001 I [Community Det fined Li Other (Describe):
Indicate the elevation datum used for tre EFE in B9: ! NGVD 1929 1 i NAVD 1988 L Other (Describes: . .. __., _
Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (DP. \)? I,_[ Yes ? 1
Designation Date:
•
SECTION C - BUILDING ELEVATION INFOJ;i;MATION (SURVEY REQUIRED) 1
Building elevations are based on: LIConstructIon Drawings' IJBuilding Under Construction' L . Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
Building Diagram Number C (Selectthe building diagram most similar to the building for which this certifa3ze is being completed - see
pages 6 and 7. Inc diagram accurately represents the building, provide a sketch orphctagraph.)
Elevations - -Zones Al 430, AE, AH, A (with EFE), VE, V1 - V30, V (with BFE), AR, ARiA, AR/AE, ARJA1 A30, ItR(AH, AR/AO
Complete tterns C3.s - below according to the building diagram specified in Item C2. State the datum used. If t tie datum is different from
the datum used For the BFE in Section 8, convert the datum to that used for the BFE_ Show field measurement}s� and datum conversion
caicuJation. Use the space provided orthe Comments area of Sermon D or Section G, as 8ppropriate, to deo (mentthe datum conversion,
pat= A/6yr) el Conversion/Comments - _ -_ _ __ II
Elevation reference mark used Does the elevation reference mark used appear on the FIRM? i_J Yes I_
Q a) Top of bottom floor (including basement or enclosure) R .a ft.(' t) t
Dr b)Top cfnext higher floor - . . _- J fl.j
(.. . 1 . • ,. _ .' 0 R ` .• _
Q. c) Bottom of lowest horizontal structural member (V zones only) h )rte • f ft(m) 9 � G G $ f � T "
O d) Attached garage (top Of slab) - >' ft. j . E +
4- C
0 e) Lowest elevation of machinery and/or equipment W o
servicing the building (Describe in a Comments area.)
- . _ ft_(m) . ro * 4.49
0. f) Lowest adjacent finished grade (LAG) g, �' `n''
Q g) Highest adjacent (finished) grade (HAG) e .7 ft(m) t" 1 0- •• 4 . _'z' " >a _
0 h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade �► 11 RN ,�`
' `-- y trLE`i � _.--. ❑ I} Total area of all permanent openings (flood vents) in C3.h sq. in. (sq. cm)
SECTION 0 SURVEYOR, ENGiNEER,.OR ARCHITECT CERTIFICATION
s certification is to be signed and seated by a land surveyor, engineer, or arohltectauthorized by law to certify levation information.
rrtf! that the information in Sections A. E, and C on this certificate represents my best effart5 to interpret the d to available,
rderstand that any false statement maybe bun fine or imprisonment cinder', 8 U.S, Code. Section 1 01.
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