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Home My Public Portal AboutSolomon Av_28 ELEV" T10N CERTIFICATE I I Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION I For Insurance Company Use: BUILDIN ER'S NAM 1 Policy Number BUILDING ST ET ADD iSS Iudi, Unit it e/or Bldg. No.) OR P.O. ROUTE AND BOX NO. I Company NAIC Number .CITY SEE 7°s //D Se 7 , , PROPERTY DESCRIPTION (Lot and Bock Numbers, Tax Parcel Number, Legal Description, etc.) ' BUILD1 , mac., Residential, Non - residential, Addition, Accessory, etc. Use a Comments area, if necessary.) LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: LJ VPS (Type): ( ##° - ## - ##.##" or ##.##### °) L. NAD 1927 LJ NAD 1983 1J USGS Quad Map L1 Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIE MUIVflT & COMMUNIT�,Ni�vi�00 62. C OUN TY NAME I B3. STATE6A j 64. MAP AND PA NEL rf v� . BB5. SUFFIX LL�J B6.. FIRM INDEX Bf.. FIRM B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER ATE EFFECTIVE/V EVIS D DATE ZON ( (Zone AO use depth of flooding) i c /r /$ a/ / 76' / 310. Indicate the source of the se Flood Elevation (BFE) data or base flood depth entered in B9. 1_1 FIS Profile 1 .■111RM 1 Community Determined 11 Other (Describe): 311. Indicate the elevation datum used for the BFE in B9: 1 -TGVD 1929 11 NAVD 1988 11 Other (Describe): 312. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1_1 Yes 1 Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) :1. Building elevations are based on: 11Construction Drawings* 1_IBuilding Under Construction* 1 wished Construction *A new Elevation Certificate wii be required when construction of the building is complete. ;2. Building Diagram Number (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.) ;3. Elevations - Zones A1-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR /A, AR /AE, AR /A1 -A30, AR /AH, AR /AO 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 t e space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum 1f,l�� OGonversion /Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? 1 1 Yes 1 -in IZ a) Top of bottom floor (including basement or enclosure) /2 . ft.( r}- ❑ b) Top of next higher floor f ?, . ! ft.(ai} -II g _ ft. Q ❑ c) Bottom of lowest horizontal structural member (V zones only) — ft.(m) o o V G/ ` ❑ d) Attached garage (top of slab) tif_CA,, (m) E 0 Q �G\S I E/4'0 IT , \ r ❑ e) Lowest elevation of machinery and /or equipment W Q servicing the building (Describe in a Comments area.) ft.(m) 4 I ; * . N. 49 , - 1 ❑ f) Lowest adjacent (finished) g (LAG) �`.� ft.( } 9 ¢- p ❑ g) Highest adjacent (finished) grade (HAG) 7 • CI ft. m - . fie suRV� O �w ( 1 1, f 41 ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade d \ . J , U S Rti �! ❑ i) Total area of all permanent openings (flood vents) in C3.h sq. in. (sq. cm) •f SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION Phis certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to ct-frtify elevation information. certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. understand that any ;alsostatement may be.punishabie by fine or imprisonment under 18 U.S. Code, Section 1001. ;ERTIFIER' rNA,E / j am J , •. . . „ // y e � LICENSE NUMBS � "1TLE / � i / - �C /(� COMPANY NAME • kODRES w4 �(, ,,�^ T l / / / . /SI TE ZIP ` CODE J/ �^ c"--- iIGNATU /lJ / (�� y J` /G1 r L- (� TELEPHONE � L r r i i y y r f •, CJ :MA P _q1 .11 II4 SPP RF\ /FRCP CIr1P Fr1P r:(1NT1N1 la - rInN RPPI Ar'.PC Al 1 DRF \/ICII IC PrIlTI(1NC in these spaces, copy the corresponding information from Section A. I For Insurance Company Use: .y 'T ET ADD S (Includigg Apt: Unit, de, t/or Bldg. No.) OR P.O. ROUTE AND BOX NO. 1 Policy Number CITY - Z— _ L /0 STA � p / E Company NAIL Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. COMMENTS 11 Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zane A (without BFE), complete Items El. through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR -F, Section C must be completed. El. Building Diagram Number (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.) E2. The top of the bottom floor (including basement or enclosure) of the building is II I ft.(m) I 1 - I above or 1 - ) below (check one) the highest adjacent grade. (Use natural grade, if available.) E3. For Building Diagrams 6 -8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is lin.(cm) above the highest adjacent grade. Complete Items C3.h and C3.i on front of form. E4. For Zone AO only. If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? 1 I Yes I I No I I Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, C (Items C3.h and C3.i only), and E for Zone A (without a FEMA- issued or community- issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are correct to the best of my knowledge. PROPERTY OWNERS OR OWNERS AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STAYE ZIP CODE SIGNATURE DATE TELEPHONE COMMENT'S LJ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Cer Complete the applicable item(s) and sign below. 31. I I The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) 32.1_1A community official completed Section E for a building located in Zone A (without a FEMA - issued or community - issued BFE) or Zone AO. 33. I_j The following information (Items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER ' G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED 37. This permit has been issued for: New New Construction I Substantial Improvement 38. Elevation of as -built lowest floor (including basement) of the building is: ft.(m) Datum: 39. BFE or (in Zone AO) depth of flooding at the building site is: ft.(m)Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS I I Check here if attachments Fnrm R1_R1 .1111 nn PPP1 Ar..FR Al 1 P RPvini IS FliT1r1hiS