HomeMy Public PortalAboutSixth Av_10 P mu �a err, 6.5UI1...0"0VI ®1 ®V 1 IHlIRIliRVGH®AGH® 1 f"A96A°01.0 1 0.M .B. No. 3067-0077
NATiliikiAL FLOOD INSURANCE PROGRAM Expires July 31, 2002
ELEVATOM CERTIFICATE
FICATE
Important: Read the Instructions on pages 1 - 7.
SECTION A - PROPERTY OWNER INFORMATION ! For Insurance Company Use:
BUILDING OWNER'S NAME,, /� I Policy Number
AdA-r/ h4 Cr /a 77,14 4/,, C.,.
BUILDING S TREET AeDRESS (Including t., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. 1 Company NAIC Number
cry ATE ZIP CODE
� �� � 3.11 ;Ze
PR R DESCRIPTION (Lot and ;lock Numbers Tax Parcel Number, Legal Description, etc.)
Cam? ZZZ 4. _12. A
BUIL (e.g., Re - ':enti- , on- rest.ential, Addition, Accessory, etc. Use a Comments area, i` necessary.)
SE
LA (OPTIONAL) HORIZONTAL DATUM: SOURCE LI GPS (Type):
( #tt° - ##' - ##AN' or ##.###/##°) LJ NAD 1927 LJ NAD 1983 LI USGS Quad Map Ll Other:
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
7M NAME � cry /NUMBER B2. COUNTY Cw4- Ai I B3. 6;4
B4. MAP AND PANEL 85. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD 139. BASE FLOOD ELEVATION(S)
NUMBER PATE EFFECTIVE/ EVIS D DATE ZO , E(S (Zone AO, use depth of flooding)
� q't6 01:19/ C &t 17 ig' 6 /'7 s • // z_
B10. Indicate the source of the se Flood Elevation (BFE) data or base flood depth entered in B9.
1i FIS Profile I FIRM 1 - ' Community Determined IJ Other (Describe):
811. Indicate the elevation datum used for the BFE in 89: +.GVD -1929 1_1 NAVD 198f., I 1 Other (Describe):
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? {_j Yes j
Designation Date:
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: 1 Drawings* {!(Building Under Construction* 11Finished Construction
*A new Elevation Certificate will be required when construction of the building is complee.
C2. Building Diagram Number 6 (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 A1-030, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR /A AR /AE, AR/A1 -A30, AR /AH, AR/A0
Complete Items C3.a -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 B, 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 e4W) Z' Conversion /Comments /
Elevation reference mark used Does the elevation reference rrark used appear on the FIRM? jJ Yes j 1No
D . __ a) Top of bottom floor (including basement or enclosure) _ ft.(m)
D b) Top of next higher floor /'7 . <4 ft.( ' ' R
D !r' c) Bottom of lowest horizontal structural member (V zones only) "' - ft -(m) W -- D d) Attached garage (top of slab) ft.(m) f ���,�STER�
D e) Lowest elevation of machinery and /or equipment W
servicing the building (Describe in a Comments area.) e/'L . ft.(m) W ' ; Na...!.
D f) Lowest adjacent (finished) grade (LAG) 4 ft.(nrj z og ,
CI g) Highest adjacent (finished) grade (HAG) �_ ftj ��� . 0 6 A1
D h) No of permanent openings (flood vents) within 1 ft. above adjacent grade _ SUR � ?, 1
D i) Total area of all permanent openings (flood vents) in C3.h sq. in (sq. crr) `'.,� /AEI -. t
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,
I 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.
CERTI E r7 iV R6> 49-e-n� COMPANY NAME LICENSE NUMBER �p j�j�
TITLE " C• �'(
ADBRESS We fr ` x , e C STA ZIP CODE c,'
S7IUUR / /� _________/ _____ ____/ - (c_____ DE E ( /® TELEPHONE �� o 4/4
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