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Home My Public Portal AboutTaylor St_27 O.M,B. NO, 3067 -0077 ELEVATION CERTIFICATE txpires May 31, I 0 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGfAM ATTENTION: Use of this certificate does not provide a waiver of the flood Insurance purchase requirement, This form Is used only to provide elevation Information necessary to ensure compliance with applicable community ftoodptatn Management ordinances, to determine the proper insurance premium rate, arid /or to support a request lot s'< Letter of Map Amendment or Revision (LOMA or LOMR). Instructions for completing this form cell be found On the following pages. • • SECTION A PROPERTY INFORMATION Pon INSURANCE coMPANY U5E BUILDING OWNER'S NAME POLICY NUMBER STREET AOURESS (Including Apt., Unit, Suite and/or Bldg, Number) 011 P.O. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER X 2 7 TA no R- T- OTI IEn DESCRIPTION (Lot and Block Numbers, elc.) _ Lo 7-3 7r_2 -t 3 � --f _ � Lcc 4 z- J Po /1--7" S c 2E VE tit 4J4 rc.2> CITY STATE ZIP CODE 7 Yi3E e. / S L A A/A , y4- . 3 13o SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following front the proper FIRM (See Instructions): 1. COMMUNNY NUMBER 2. PANEL NUMBER 3. SUFFIX 4. DATE of FIRM INDEX 5. PRAT ZONE 8, BASE FLOOD ELEVATION In AO Zones, use depth) /3SJ64- oa / c .//7186 Ag 14 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ®NGVb'29 ❑OlhtIr (describe on back) 8. For Zones A or V, where no BFE Is provided on the FIRM, and the community has established a BFE or this building site, Indicate the community's BFE: i I i U.0 feet NGVD (or other FIRM datum —see Section 13, Item 7), SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Paget 5 and 6 that best describes the subject building's reference level 5 . 2(a), FIRM Zones Al -A30, AE, AN, and A (with BFE). The top of the reference level floor from the selected diagram Is at an elevation of LLL__1211J,u feet NGVD (or other FIRM datum — see Section 5, Item 7). (b). FIRM Zones VI -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 LL I 1 1 1.11 lent NGVD (or other FIRM datum —see Section 5, Rem 7). (c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is 1 1 1.LJ feet above LI or below U (check one) the highest grade adjacent to the building, (d). FIRM Zone AO. The floor used as the reference level from the selected diagram is LU.0 feel above ❑ or below [1 (check one) the highest grade adjacent to the building. II no flood depth nurnber Is available, Is the building's lowest floor (reference level) elevated In accordance with the community's floodpiain management ordinance? ❑ Yes ❑ No [1] Unknown 3. Indicate the elevation datum system used In determining the above reference level elevations: El NGVD '29 0 Other (describe under Comments on Page 2). (NOTE: If the elevation daturn used in measuring the elevations is different than that used on the FiRM (see Section B, hem 7J, then convert the elevations t� 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 ® No (See Instructions on Page 4) • 5. The reference level elevation Is based on: IA actual construction ❑ construction drawings (NOTE: Use of construction drawings Is only valid If the building does hot yet have the reference level floor in place, in which case this certificate will only be valid for the building during the course of construction. A post- construction Elevation Certificate will be required once construction is complete.) 6. The elevation of the lowest grade lrmnedlately adjacent to the building Is:1 1 1 1 1 J .teal NGVD (or other FiRM datum - see Section 5, Item 7). SECTION D COMMUNITY INFORMATION 1. II the community official responsible for verifying building elevations specifies that the reference level Indicated M Section C, Item 1 Is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest floor" as defined by the ordinance is: I I I i I I , Ll feet NOVD (or other FIRM datum -see Section 5, Item 7). 2. Date of the start or construction or substantial Improvement TEMA Form 81 .31, MAY 93 REPIACES Ali t'REViOUS Eb1T10NS SEE REVERSE SIDE FOR CONTINUATION 09/08/1999 08:08 9122347256 CHATHAM HOME BUILDER PAGE 04 SECTION E CERTIFICATION This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local raw to certify elevation information when the elevation information for Zones Al —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, p lay also sign the certification, In the case of Zones AO end A (without a FEMA or community issued $FE), 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 b breakaway /non-breakaway wall, enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not included in the certification under Comments below, The diagram number, Section C, Item 1, must stilt be entered- ! certify that fhe information in Sections 6 and C on this certificate represents my best efforts to interpret the data available. i understand that any false statement may be punishable by fins or imprisonment under 18 U,S. Code, Section 1001, GENIPIEKS l ok -1 Fr s � E NUMBER (or Affix Sea1) . K TITL� ` a I,�i COMPANY NAME f /� At�oaess ° �j`1. Y S. I��/ R" . STATE ZIP P. 15(71 1 ll nnai t - 3t4J1 .. SIGNATURE "' � i sa<;- = l `7I G 1 `f " `t CJ 0 Copies should be made of�s rtlflcete for: 1) community official, 2) insurance agent/company, and 3) building owner. COMMENTS: DN WITH ON ROM, BLAB BASEMENT PIERS, OR COLUMNS A V _ A A V ZONES ZONES M ZONES ZONES ZONES r� -'� REFERENCE 1l�tl REFERENCE BAS I lEvo, -serto +IC FL LEYEI �I 11 ELEVA , -,rr lEVfl • enact •`:'� •'; A'14 6ABE er∎te " ' 1 • • AbNc40 , T i . REFERENCE V FLOOD FLOM ELEVATION REFERENCE AOJACENT GRADE ' ';�, LAVEL LEvEL GRADE 1 ELEVATION _ P• ,'' {li i • 1 •` .fir;; .; Y 'r >i• ��'' ;4' 9 ADJACENT ..,.... 1111_ . :% ;I .. .....':y {•.nr+:•. GRACE The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones, 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. Page 2