HomeMy Public PortalAboutSixth St_7B U.S. DEPARTMENT OF HOMELAND SECUR■, ELEVATION CERTIFICATL 1 C No, 166C.1-0008
Feder:et Emergency Management Agerzy Exbaree Februarre 28, 20()O I
Nu aortal Fkxxl Insuranoto Plegntm Troportiirli: Rasa the instructions on pages 1-8.
SECTION A - PROPERTY ORMATO L FOt lotrumnoeConasimy Use
Al_ . L 4 40„ 4.. ie 7 75
„.,... ......0 Ptatcy Number
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-- A - 2. Building Sheet • • roes (including Apt., Unit %AM, andini aildg. No.) or P,O, Route and Box No Company RAMC Number
fif 7 4 rli $TRE'Pr P/41
City ZIP Code ' e c ,.... 6 8 '
Tr' 8 CA -27. slin
A3. Propeppetrieponi.Lci sted/ock NurnhArr T ri Ptum
a Legal i ----,. n ---- ,
til zr 4 - 000 5 - e/T-00 4- e- :l Z licfibr .4 14 8txs low. orzA R5-4, 4z 144
A4, Building Use te.g., Rosiderrdal, Non-Residential Addition riccoresery. etc.) 46 /D4 r/A 4 .....___
A. Latitudro/Lorgitude: Lat. _____ Long. Honzontal Di(li117 0 NAD 1927 0 ND 13
At3 Attach at best 2 photographiot the buriciMg tf Ma Gar:Inca* is berg used to obtain flood inuurenori.
A7_ Building Diagram Number 42
A8. For a budding with a crawl specs or enclotturtt(sL provide A. For a bukifig v.491 an enactind gange, provide;
a) Square footage of crawl apace or encbsure(s) .4.46; ar ft a) Square footage of attached gamy, -- *AO
8) No. of permanent hood openings in the =me apsos or -- h) No_ of pismiurcent flood openings in Me attached wage
erocioeure(s) wells within 1.0 foot SOC acbecent grade . - -.- 1 walls within 1 0 Mot above ticfpeounr. guide _
c) Totel mei ante of flood c4osninge in AS b rd SQ in c) 'Total rout area of flood openings in Ag.b
sEcnoti a - FLoota spsim*Atict it_i_ii itiftre oRmittokseamos _
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al. NFIO Corrinety NOSS a Numbe r -, - . I Ea, Ottaity Mann .
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5 / 4 0 co 2.5 i Cs_. ict 1 f 4,44 1
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7 - 64. t:tin Mane! Number I Be,. Suffix Be --- ir'21•1 index I BT. FIRM Panel --- iitri"-liv.xi 1 199 Fl;;;:i Efernaticri(s) (Zote
Delp
1 /35/640001 1 (...e.g Zr°2") ! A511* tassi"":1 41./Xh)
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810. 1 ndlcat* the lourcs of the Baas Flood lemilon (BFF.) cella or bat* flood wain entered in Hem 89.
HS Prollie ErFIRM Community ,
i i
0 Other (Deacribe)
81 I, indicate elevation dean useq for BP B In lent 89 t1 NGVD 1129 0 NAVD 1909 0 Other
812. le the bading loaned in a Comdal Barrier Resources Syslern (C RS) arse orpthemase Protected Area (OPA)" II Yes Er No
Dssignetion Done ...------ 11 CMS rjj OPA
SECTION C • SUILDiNG ELEvAnom INFORMIATION (SURVEY REQUIRED)
0i. Building elevations am based on; El Corittruction itnowsgs• 0 Building Under Conetruction° 0 FiNalwiel Consouction
'A new Elevation Certificate mil he required when coneriction ve the buiteling io oomptete.
C2 Elevations - Zones A1-A3-0, AE, AN. A (with 3FE), VE, •,, 1430, V (with SFS), AR, Aft/A, AR/AE. ARiAl -A30, AR/AH AR(AO Complete tonna 02.to--o
Wow scoorttlng to that bui specified In :Urn A?.
Benchmark Ublizerl _ 9: fc•°:‘, Vertical Datum
-,—
Conven/Cornments
Chock ihe mestramment used.
a) Top of bottom floor tincludirg bamemant, crew; oAlice. or enctosurs floor) L: leet r c-.1 meters (Puerto Rico ohlY)
b) Top of the next higher floor .--.21F---- feet L. meter" (Puerto Rico only)
0) Bottom of the lowest horizontal structural member (V Zones only) --- --
'/.0 feet 0 riveters (Puerto Rico onsy)
d) Alleched garage (top of slab) E feet 0 mews (Puerto Rico only)
e; Lowest eltivetbn of machinery or equipment servno de bull:dap A,..... Errest 0 moiler* (Puerto Rico only)
(Describe type of equipment in Commenm) 4 R: CI, t przalsoir
f1 Lowest adjacent (fInisiteci) grade (LAG) / 5 gsz R meter* (Puerto Rico only)
g) Highest *Ow* (finioned) grade (HACS, — t 0 molars (Puerto .co only)
SECTION D - SURVEYOR, picoaftaR, On ARCHITECT CERTIFICATION
TN e to be Ngneci and sealed by 8 surveyor engineer, at enrMiect siaticrizad bi/kew to -Sitlfy elevation 4:0". Q j_
nfomew; !certify Mai It informatton an dna Ceraficate remnants my bon frOorfs fo interpret Me dam avaliabet.
I untlaratend mad any fain statement may be pun/shah* by Are xenprlactimen1 under 18 U. S Code, Swaim 7001 0 61. 1 . ,.0 P A Ore 4
O hate a COMTISM' are provideakaillialtend Ione,
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CA:Mlles Nsmerk, ac er C,.„__ A 1 /AC 1 i(e4 4 - I _ Warm: Number /5-e4 / ol V
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FEW Form 81-31, February 2000 Si reverse me for canbnuation. Replaces ail previous exlitiorte
ye 1
IMPORTANT: In theme spaces, copy 1. ,:orviteponclhavatormaftlon from Section A: Pee *swarm Company the: •
"litg kiln° S rresiditwegirluding Ursa. Suite ancito? No ) or F i.DAtirtiN irks te.ti;i ko.
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SECTION D - suRygYcFL ENG ER, OR ARCHITECT CiAtueicAnow (CONTINUED)
Copy tx^.311 sidits of Elevation Csatfle-ate for (1) co nem sm ofc
ity fiial, (2) Insurance ageritrocanaany, and (3) bLiCiing Owner eZt2
_
Kc pa5eci c vle 1 f a' yi ... .........._
EX vo, .6 r . a ia 7 ` . i 4,046 D' /
. qc • ,-, Cz.6= /9.4
-4
1 .o C Z -i x ' .7 , a C 2 - 7 or = / p , .. -- -ti47K itu ( 4N,peg 4 Lt,/). givo
Signature 0. - . 1 ---
..........ock. here If ittatchinertbs
SECTION E LHLDING ELEVATION INFORMATISURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT ELE
For Zones AO and A (without BFE), complete /tem El-E tt the CorirlicaSe is Intended to support a LOMA or LOMR-F resouoit, complete Sections A, B.
and C. For itoms EI-Eri, ,1.48 naturoi grads, it einstable :::lissii3e in inewaraiornent uarcs In Poen° Rico only, enter ma'am
Et
Prop* oNvalfon information for tt klotweht en* zttoscA tsy eVareenete coxes to show whether ino alinstIon is above or below the highest iiidnicent
grade (HAG) and the lowest adjacent grade (LAG).
a) To of bolters flour (including bummers?: crier■ spair, or towbars) le 1,D, lost 0 mews above or Ei below the HAG.
b) Top of botiont floor (including baterismoril. v 1.-.J
ine epics, or encinsuro) ie — feet C motors 0 above or below the LAG.
62. For Building Migrants 6-8 with permareint itod openings providediriSicrelipLA Theme 8 3aiOtor 9 tees gwe 8 of Instructions), the next higher floor ...
(elovation C2.b in the diervams) al Ole !MON * Lj feet Li mews (...j above or U below tho HAG
.
E3. Attached gim (top 01 stab)* _ .. 0 fest 0 !mom 0 Marmot 0 bola* this HAG.
Ea. Top of platfonn of machinery sisidior squiprnert servicing !ha building al _ • -___ 0 feet 0 meters 0 above or (j below the HAG.
E5. Zona AO onV if no flood depths number ir aveitabie is the top of t. baton Soar **voted in smiridance wen the community's Itociplain reerragemen,
ordinance? i_ j Yes 0 No 0 Unknovas. The toe* r"ficel must catty that Information in Section G
SECTION F - PROPER.TY OWNER IOR OWNER'S RSPRESENTATIVE) CERI1FICATION
The properly owner CH owners authorizad inapresiontatios whirl compliant Sections A., 0, and E for Zone A (tithout a FEMAood Of OCOVIION1y-issuec+ BFE)
or Lane AO must sign ?tore. no aiaternerata In Secti:srPs A, B, and E ire mime to the beet of rny knowledge
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ProportyOwnors or Ownor's Authodz-4 Ropornentaivel Nomo
Moire aa CAty Stan ZiP Code
Signature Oats Telephone
C.:ammonite
...—resarCilitilialiartLigagena
SECTION ci . cookware twpovomiow (OPTICINAL)
The iocial OthiCiiii who IS iiiuthOrizoia by law ciiOnani to assetiOnter tha 011y'S ffroadolain man agerr onanance con compErn Ser•AOTIS A, 03, C (cor E),
and G of thirst Elevation Certificate Complebe the applicable item(*) arid Nan boteaw Chock in measurement used in kerns G8 and GO
Ge 0 The inforreataxl in Section C Ve614 taken from cotteser oosiumerstiabn OW floe oven signed and stand by a Satirised surveyor • angineef, or arrasftet who
la authonziod by law to civilly ellevabon information (Indigo* tbe source and data of tn. elevation data in the Comments area Wow.)
I
02. t-i A community official compistod Ser:tion E tor a haling ioicarbiel in Zona A (without a FEMA-issuerd or carrimunity-issued BFE) or Zone AO
G3, 0 The following information Otems 04 - )1sprovidod for tzar amity Acceptorrs management proposes
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1 Ge. Psernelt Number -1- 65. Dow, Promit issued os Onto Coda-awn O4 CompllioncalOccuponcy Issued i
I _ i
_......,_
( 37 Thlf permit has been issued for . 0 New Corearsatiors 0 Siatelientiol Irrearosoment
G8 Elevation of as IO**11t floor (including beelament) of the boikiinci., ... _. 0 fun 0
G. BFE or lin Zone AO) depth of flooding at the btetertg site: - 0 Not 0 mesons (PR) Datum
LOGII3 Offlain Name Pie
Comity Name Telephone
Signature Delo
Owe:manta
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FEMA Form 811, February 24106 Rep;aces aii previous editions
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Su liding Photog ,,
See Instructions for item A6.
i For ingowsivbes Cortroit 1
rikildiTY,4 Address (including Apt ,Cnit,Slirie7andior Bldg, No.) Of P.Cl. RouteWI8 fai 4 ----
i V 7 TY/ / r 1 1
City State e ,,-- ZI_Pe i 400
If using the Elevation Certificate to obtain NriP flood insurance, affix at least two building photographs below aocording to
the instructions for kern A6. identify all photographs with date taxer), "Front View and 'Rear Mew': and, if required, "Right
Side View" and 'telt Side ifievii.' if submit more piwitraphs than will fit on this page, use the Continuation Page,
folkawing.
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