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Home My Public Portal AboutVan Horn_41 ELEVATION CEFITIFI s e O .M,B, No. 3067 -0077 FEDERAL EMERGENCY MANAGEMENT AGENCY Expires July 31, 1999 NATIONAL FLOOD INSURANCE PROGRAM ATTENTION: Use of this certificate does not provide a waiver of the flood Insurance purchase requirement, This farm is used only to pro- vide elevation information necessary to ensue compl iance with sppficable community floodpialn managemen ordinances, to R). determ ine not the proper insurance premium rate, and/or to support a uest for a Letter o(Map Amendment or 109visice (l aMA or LQPA You required to respond to this collection of Information unless a valid OMB control number le displayed in the upper right corner of this form. Inetruetlons for completing Ihis form can be found on the following EagOs, SECTION A PROPERTY INFORMATION I FOCI iNSURANQE COMPANY ' USE BUr of NE); NAM .. . .. - -. - _._ 4//9 POLICY NUMBER 67PEiT D REBB (I pc rg Apt,, Uni ._.,- ..._......,,..... - - -- --. dQ, Number) OR RD, ROUTE AND BOk NUMBER (..'r. r, Pmv Mlc NUMBEti OTH£Ft D 8CRION t. d Block re, " I etc.) / J) / . ..2 . � ". / /L/ 4Y . r, - o/ ,y 7a .te ._....._.. ore- 1 el :. ATE 7 C.Cyp SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM (See instructions): r�1MUNIrY NUMBER P. PANEL NUMBER - - 3. SU, F 1. GO ° ° IX 4. DAT EE F FFIRR M Iry DDEX 5. FIFl M I /c7 1 � C (1 CJ 7, Indicate the elevation datum system uses on the FIRM for Base Flood Elevations (BFE): a'vc) '29 DOther (describe on back) 8 For Zones A or V, where no 6FE is provided on the FIRM, and the community has established a BFE for this building she, Indicate the community's BFE: L_ I : ' , tees NUVD (or other FIRM datum -see Section B, Item 7), - SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, Indicate t diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level 2(a). FIRM Zones Al -A30, AE, ,4H, and A (with BFE), The top of the reference lever floor from the selected diagram is at an elevat,er. Of L..1, i,_ i/ te .2feet NGVD or other FIRM datum -see Section B, 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 `._1., LLi ,! J feet NGVO (or other FIRM datum -see Sector E3, item 71. (c). FIRM Zone A (without BFE). The Sider used as the reference level from the selected diagram is __ i I. i feet above ' or below �i (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 L_i_.(....1 feet above 0 or below ED ;check one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference level) elevated In accordance with the community's floodplain management ordinance? ❑ Yes '.1 No L✓ Unknown 3. indicate the elevation datum system used in determining the above reference level elevations: 7 way() r � ' 29 Other (describe under Comments on Page 2). (NOTE; It the elevation datum used In measuring the elevations is different than that used an the 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: i. Yes Piv (See frstrUGtiona on Page 4) 5. The reference level elevation Is based on; 1 construction ❑ construction drawings (NOTE,' Use of t:onstrtJCtion drawings is only valid if the building does not yet have the reference level floor in piece, In which Me this Certificc'to will only be valid far the building during the course of construction. A pcat•construction Elevation Certificate will be required once construction is complete.) 6, The elevation of the lowest grade immediately adjacent to the building is: I 1 I 1 ,'0 feet NGVO (or other FIRM eatum - see Section 8, Item 7). - SECTION P COMMUNITY INFORMATION 1, If the community official responsible for verifying building elevations specifies that the reference 'ever indicated in Section C, Item 1 is not the lowest fioor as defined In the community's floodplain management ordinance, the elevation of the building's lowest tfoor" aS defined by the ordinance i s: I 1 (.;. Lj.Li feet NOV0 (or other FIRM datum -see Section 8, item 7). 2. Cete of the start of construction or substantial improvement _ -- FEMA Form B1.31, AUG 96 REPLACES AU. PREVIOUS EDITIONS SEE REVERSE Slue FOR CONTiNUATION SECTION E CERTIFICATION This certitic.ation is to be signed by a land surveyor, engineer, or architect who Is authorized by state or local law to certify elevation information when the elevation Information for Zones Al —A30, AE, AH, A (with BFE),V1— V3o,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 EFE), a building official, a property owner, or an owner's representative may also sign the certification, Reference ievet diagrams 6, 7 and 8 - Distinguishing Features —It the certifier Is unable to certify to breekaway!non- breakaway wet, enclosure size, location of servicing equipment area use wall openings, or unfinished area Feature(s), than list the Feature(s) not included in the certification under Comments ba►ow. The diagram number, Section C, Item I , must still be entered. I certify that the information in SeCtions 8 and C on this certificate represents my best efforts to Interpret the data avaitavie, 1 understand that any false Statement may be punishable by fine or imprisonment under fa U.S. Code, Section 1001. ° / ! _.._._..._ or Atli. Snal) • /m ��I '' GEflTIFI R�' Y....../ � � . r'�tfd />��...._ —... LICENSE NUMBER i �� `��"_— /. ... ..... TITLE COMPANY , COMPANY NAME . ADDR „,...---"s CI7 y 'Sr Z __, te..9 , , _ , 4 ( I : 61 / k , .. p, (7 / L-.7 $iONATU - t cipies �If$t be ( C tart t} cermmuntty Official, 2) to),(‘ agent/company, and 3) building ow M /jeC��E�c O / MENe : . .... __ . .. •. . —... .. ON WITH ON Pl at SLAB BASEMENT AISAS, O' COLUMNS A v A A V ZONES ZON €S ZONES ZONES ZONts5 -• .� • RErEANU $ IEVE f At rP.RENCFI FL000 REFERENCE BASE f IFVEI i ELEVATION ..-, - :721.1'4 } BASE BASE 1 FE ' fl aD.i.KENT L .t'. RE "INC ' FLOOrJ n. EF , `� N vA`ION EtkiAtteA /VERVE° ADJACENT •^-.°�° 1 OO) . Lbeet (MAUL '' 1 RAUE iM� ;, 11 1 .; AOJACTHT 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 Oki measured at the top o1 the reference level floor. Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member. • Page 2