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Home My Public Portal AboutTenth Ct A&B_1 ELEVATION CERTIFICAI. O.M.B. No. 3067 -0077 FEDERAL EMERGENCY MANAGEMENT AgENGY 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 form is used only to pro- vide elevation information necessary to ensure compliance with applicable community floodplain nmanngement ordinances, to determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR). You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. Instructions for completing this form can be found on the frAQwift9 pages. SECTION A PROPERTY INFORMATION I FOR INSURANCE COMPANY USE BUILDING OWNER'S NAME POLICY NUMBER - STREET ADDRESS (Including Apt. Unit Suite and/or Bld Number) R .O. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER OT HER qE� TI�(Lot an � Numbers, etc.) L 61-62 ` W4a CITY (e) COD / 5 z / SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORM (rovce the following from the proper FiRivi (See instructions): 1 COMMUNITY NUMBER 2. PANEL NUMBER 3. SUFFIX 4. DAT OF FIRM INDEX 5. FIRM ZONs 6. BASE FLOOD ELEVATION /5-76d � 7/1� vq (in AO Zones use depth) 7. In the elevation datum systerr used on the FIRM for Base Flood Elevations (BFE): L"I tVGVD'29 ❑ Other (describe on back) 8 Fc Zones A or V, where no B E .s dxovided on the FIRM, and the i :ommunity has establisi:d a rFE for this building site, indicate s : community's BFE:`_ _1 _ I _ . i- 1.1 _i feet NGVD (or other FIRM e.tum see Section B, Item 7) • SECTION C BUILDING ELEVATION INFORMATION t 1.:11y 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 - _.Q_ . 2(a) FIRM Zones A1-A30, AE, AH, and A (with BFE). The top of the referente level floor from the selected diagram is at an elevation of E 1 1 L .❑ feet NGVD (or other FIRM datum —see Section 8, Item 7). (b). 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 1 1 Vjeil,ilifeet NGVD (or other FIRM datum —see Section B, Item 7). (c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is I I LI_J feet above L.i or below Li (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 I I I . ❑ feet above El or below L-] (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? 1 j Yep ❑ ,No ❑ Unknown 3. Indicate the elevation datum system used in determining the above reference 'revel elevations: I 1 NGVD '29 ❑ Other (describe under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than that used on 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: El Yes ❑TNo (See Instructions on Page 4) 5. The reference level elevation is based on: L actual construction ❑ construction drawings (NOTE: Use of construction drawings is only valid if the building does not 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 immediately adjacent to the building is: ❑__1 I l . L feet NGVD (or other FIRM datum -see Section B, Item 7). SECTION D COMMUNITY INFORMATION 1 If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1 is not the "lowest floor" as defined in the community's floodplain manag'ment ordinance, the elevation of the building's "lowest floor" as defined by the ordinance is: feet NGVD (1-Dr other FIRM datum —see Section B, item 7). 2. Date of the start of construction or substantial improvement _ 5 >\- • __ • FEMA Forrn 81-31, MAR 97 R EPLACES ALL ri ''1OUS E DI�{^ki ��, 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 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 floodptain 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, 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 still be entered. 1 certify that the information in Sections 8 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. CER71F R'S N M ....-• 4-- NUMBER �` fi x S t TI COMPANY NAME - - ADDR S .J I jf&1 J _ r !, _ -- Th t ` CITY V c ST E ZIP SIGNATURE / ;. 7 D 6 / � _� � 4 I PHONE g Q /�/ Copies sho d made of t ertifi for: 1) community official, 2) insurance agent /company, and 3) building owner. CO NTS: - ___ - -- - ON WITH ON PILES, SLAB BASEMENT PIERS, OR COLUMNS A V A A V ZONES ZONES ZONES ZONES ZONES ' ^^,' REFE RENCE ` fi_ Rit Ft EN ��rrrllf - - BASE LEVEL RE lon LEVEL u� - FLOOD h Y LEVEL i/ ELEVATION �� BASF BASE ADJACENT REFEREFCE FLOOD FLOOD GRADE LEVEL ELEVATION • ELEVATION REFERENCE ADJACENT LEVEL GRADE ` ' ... .. ....r: . ,! '. .' ADJACENT . GRADE 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. . i a g e 2 I I ■