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Home My Public Portal AboutShipwatch Cir_8 O.M.B. NO. 3067 -0077 ELEVATION CERTIFICATE Expires May 31, 1996 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM UT11)IT1ON: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to Ifee refine the proper insurance premium rate, and /or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR). Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION __ I FOR INSURANCE COMPANY USE OWNER'S NAME . POLICY NUMBER Eric E . 1-aan ADDRESS (Inclg Apt., Unit, Suite and /or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER 1I ChOakh CitYCI Q AE< in01l04 li.M e Num�bsit, .) P " 15 , �Shl pt cxtith L ries Si" b ciliti )4 TATE ZIP CODE t erf jJ 'PF 1SJ (2h f ,.1..37P) - SECTION B FLOOD INSURANCE RATE MAP (FIRM) Poffeede the following from the proper FIRM (See Instructions): I i It. COMMUNITY NUMBER 2. PANEL NUMBER 3. SUFFIX 4. DATE OF FIRM INDEX 5. FIRM ZONE 6. BASE FLOOD ELEVATION 000 I C (in AO Zones, use depth) -- 1lrlirate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): —I NGVD '29 ❑ Other (describe on back) I$. fir Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate rig community's BFE:1 I I 1 I I . H feet NGVD (or other FIRM datum -see Section B, Item 7) SECTION C BUILDING ELEVATION INFORMATION L ig the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level (O . FIRM Zones Al -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation 01 ! I i 1 hi ,1(ol feet NGVD (or other FIRM datum -see Section B, Item 7). 1D-s FIRM Zones V1 -V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from the selected diagram, is at an elevation of 1 I I I I I.1 I feet NGVD (or other FIRM datum -see Section B, Item 7). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is I 1 I .0 feet above J or below ❑ (check one) the highest grade adjacent to the building. FIRM Zone AO. The floor used as the reference level from the selected diagram is 1 I I . U feet above ] or below _ (check one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference Pavel) elevated in accordance with the community's floodplain management ordinance? 1 Yes U No ] Unknown • ttrOcate the elevation datum system used in determining the above reference level elevations: NGVD '29 Other (describe ender Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than that used on Os FIRM [see Section B, Item 7], then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) 4 Elevation reference mark used appears on FIRM: Yes �o (See Instructions on Page 4) f, The reference level elevation is based on: a construction ❑ construction drawings SMOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which CMS this certificate will only be valid for the building during the course of construction. A post- construction Elevation Certificate oil be required once construction is complete.) /� 1 "Mt elevation of the lowest grade immediately adjacent to the building is: I 1 1 1 1�1, 0 feet NGVD (or other FIRM datum -see Section B, Item 7). SECTION D COMMUNITY INFORMATION +I 0 the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1 s not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest Saar as defined by the ordinance is: 1 1 1 I I I , U feet NGVD (or other FIRM datum -see Section B, Item 7). t Daft of the start of construction or substantial improvement . ffil4A form 81 - 31, MAY 93 REPIACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION SECTION E CERTIFICATION This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation I information when the elevation information for Zones A1—A30, AE, AH, A (with BFE),V1— V30,VE, and V (with BFE) is required. Community officials who are authorized by local law or ordinance to provide floodplain 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 wall, i enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not 4 included in the certification under Comments below. The diagram number, Section C, Item 1, must still be entered. i I certify that the information in Sections B and C on this certificate represents my best efforts to interpret the data available. I I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. C RTIFI R'S (NAME , LICENSE NUMBER (or Affix Seal) MI 1 \. 1 )6Oi r 2555 TITLE COMPANY NAME C Pei,. Laid aveocr John S - )2eyn PE; P. o . AD DRES V V CITY STATE ZIP PO. •Y_ I tio. ,,,, ;;: r Ud n n (ii6 , ,51(1 110 SIGNATURE ��\/ '� 2 / I �j J !t. r.��. _ DATE lei � E 35 1 - 0700 f Copies should bi mide 0thlytg. atEfor: 1) community official, 2) insurance agenVcompany, and 3) building owner. F s CI'. l �r ' (5' : e Z. COMMENTS• • V / /1!l7tililllo i ON WITH ON PILES, SLAB BASEMENT PIERS, OR COLUMNS - A V A A V ZONES ZONES t ZONES ZONES ZONES In, 1L' REFERENCE REFERENCE BASE LEVEL REFERENCE }. LEVEL I 1, I' FLOOD I _ J ` ELEVA7IQN :::i::V'• �y `•. BASE BASE •...' :i R FLOOD FLOOD ''' ADJACENT ? GRADE :�r }? LEVEL ELEVATION ELEVATION REFERENCE ADJACENT ' LEVEL GRADE *'Ni `,? r :. m i.• :.: : : :.:: :.. r.. • . GRA The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones. i Elevations for 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. i Page 2