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Home My WebLink AboutElevation CertificateO.MA. NO. 3067-0077 Glp ELEVATION CERTIFICATE Expires May 31,1996 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM I 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 floodplain management 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). Instructions for completing this form can be found on the following pages: SECTION A PROPERTY INFORMATION I FOR INSURANCE COMPANY USE I BUILDING OWNER'S NAME I POLICY NUMBER Unit, SuZe and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER I COMPANY NAIC NUMBER OTHER DESCRIPTION (Lot and Block Numbers, etc.) o r 9oGa 0661ruIE av T CITY STATE ZIP CODE .ems .Fee c f/ r4 004A SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM (See Instructions): 1. COMMUNITY NUMBER 2. PANEL NUMBER 3. SUFFIX 4. DATE OF FIRM INDEX 5. FIRM ZONE 6. BASE FLOOD ELEVATION J.'JS%19� (in AO Zones, use depth) %2//eco 313 F' JITT 1 E 8.0 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ❑ NGVD '29 ❑ Other (describe on back) 8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate the community's BFE: I I I I I I .L_I feet NGVD (or other FIRM datum —see Section B, Item 7). SECTION C BUILDING ELEVATION INFORMATION 1. Using 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 d' 2(a). FIRM Zones Al-A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation oil I I 1110 . feet NGVD (or other FIRM datum —see Section B, Item 7). I (b). FIRM Zones V1430, 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 I I I I I I,LJ feet 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 W .0 feet above ❑ or j below ❑' (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 W . U feet above ❑ or below ❑ (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 ❑. No ❑ Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations: 21.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 71, 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:.® Yes ❑ No (See Instructions on Page 4) 5.•The reference level elevation is based on: ® actual construction ❑ construction drawings. j (NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor -in place, in which I 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 .tlie building is: I II . .feet NGVD (or other FIRM datum -see Section B, Item 7). / SECTION D COMMUNITY INFORMATION 1. If the community official responsible tfor 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 management ordinancg, the elevation of the building's "lowest . floor" as defined by the ordinance is: U .feet NGVD (or other FIRM datum —see Section B, Item 7). 2. Date of the start of construction or substantial improve&''ent FEMA Form 81-31, MAY 93 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION r . a 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 floodplain management information, may also sign the certification. fry 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. l certify that the information in Sections B 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. CERTIFIER'S NAME LICENSE NUMBER (or Affix Seal) T�nrSt TITLE COMPANY NAME .Sye cJ Q C' I 7"2 �9.Sy1_ e !'_.9Sr" ZegAj.v sae,,).e v O,e, ADDRESS CITY STATE ZIP 3 Z So rJ E. �0c E �-- o,c H3 .j t j i, d- t3 S SIGNATURE DATE PHONE Copies should be made 044is Certificate for: 1) community official, 2) Insurance agent/company, and 3) building owngr. COMMENTS: r ON WITH ON PILES, SLAB BASEMENT PIERS, OR COLUMNS A V A ? ZONES ZONES ZONES A V ZONES• ZONES REFERENCE REFERENCE LEVEL BASE I LEVEL REFERENCE ' FLOOD LEVEL ' ELEVATION •�i.,;•i^:[;:'r?i "'':': anti BASE :..... • .: r'•:.. , FLOOBASE D ""' •'''" .'ADJACENT :' ' •,,�i REFERENCE ELEVATION ••' 7; LEVEL REFERENCE ADJACENT GRADE FLOOD ELEVATION '? 'LEVEL GRADE ° 17 NT �`.%�:• r.:: :.:.•:-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 the of reference level floor. Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member. Page 2