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HomeMy WebLinkAboutElevation CertificateU.S.LkEPA�RTMENTOFHOMELAND SECURITI' ELEVATION CERTIFICATI", OMB No. 1660-0008'P r Expires February 28. 2009 Federal Ednergency Management Agency Na bnel Flood Insurance Program Important: Read the instructions on pages 1-8. SECTION A - PROPERTY INFORMATION For Insurance Company Use: Al. Building Owner's Name G.W. Purucker Homes Policy Number A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number 4844 WATERSONG WAY City FORT PIERCE State FI ZIP Code 34949 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 42, WATERSONG PUD PLAT NO. ONE A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential A5. Latitude/Longitude: Lat. 27* 23' 27.7" N Long. 80* 15' 38.0" W Horizontal Datum: ❑ NAD 1927 ® NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 1 A8. For a building with a crawl space or enclosure(s), provide A9. For a building with an attached garage, provide: a) Square footage of crawl space or enclosure(s) n/a sq ft a) Square footage of attached garage n/a sq It b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage enclosure(s) walls within 1.0 foot above adjacent grade n/a walls within 1.0 foot above adjacent grade n/a c) Total net area of flood openings in A8.b n/a sq in c) Total net area of flood openings in A9.b n/a sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP Community Name & Community Number B2. County Name B3. State UNINCORPORATED AREAS, 120285 1 ST LUCIE I FL B4. Map/Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone Date Effective/Revised Date Zone(s) AO, use base flood depth) 12111 C01 94 G 06/30/99 11/4/92 AE 8.0' B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe) B11. Indicate elevation datum used for BFE in Item 139: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑Yes ®No Designation Date ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ® Building Under Construction* ❑ Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations -Zones Al-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-g below according to the building diagram specified in Item A7. Benchmark Utilized LOCAL Vertical Datum NGVD 1929 Conversion/Comments Check the measurement used. a) Top of bottom floor (including basement, crawl space, or enclosure floor)_ 8.72 ® feet ❑ meters (Puerto Rico only) b) Top of the next higher floor N/A. ® feet ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) N/A. ® feet ❑ meters (Puerto Rico only) d) Attached garage (top of slab) N/A. ® feet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building N/A. ® feet ❑ meters (Puerto Rico only) (Describe type of equipment in Comments) f) Lowest adjacent (finished) grade (LAG) 6.96 ® feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade (HAG) 7.15 ® feet ❑ meters (Puerto Rico only) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. i certify that the information 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. .Jr ® Check here if comments are provided on back of form. Di. r E- jai r Certifier's Name James A. Fowler, P.S.M. License Number 3435 Title Professional Surveyor and Mapper Company Name Culpepper & Terpening, Inc t Address 2980 South 25th Street City Ft Pierce State FI ZIP Code 34982 Signatu Date 1/22/2009 Telephone 772-464-3537 FEMA Form 81J31, February 2006 See reverse side for continuation. Replaces all previous editions WKORTANT: In these spaces, copy th" rresponding information from Section A. For Insurance Company Use: Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number 4844 WATERSONG WAY L City FORT PIERCE State FL ZIP Code 34949 Company NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments Latitude/Longitude was obtained from LABINS web site. Signature Date Er -Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items E1-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawl space, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawl space, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9 (see page 8 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8. and G9. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued or community -issued BFE) or Zone AO. G3. ❑ The following information (Items G4.-G9.) is provided for community floodplain management purposes. G4. Permit Number I G5. Date Permit Issued I G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: _❑ feet ❑ meters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ metiers (PR) Datum i Local Official's Name Title Community Name Telephone Signature Date Comments i ❑ Check here if attachments FEMA Form 81-31, February 2006 Replaces all previous editions � 7�FJil�J'L-_ U.S. 4�'t�'ARTMENTOF HOMELAND SECURITY., �, ELEVATION CERTIFICAT `l ederal Emergency Management Agency ` National Flood Insurance Program Important: Read the instructions on pages 1-8. OMB No. 1660-0008 Expires February 28. 2009 ilding Owner's Name G.W. Purucker Homes SECTION A - PROPERTY INFORMATION For Insurance Company Use: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. I Company NAIC Number I 4844 WATERSONG WAY City FORT PIERCE State FI ZIP Code 34949 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) � r n v y w LOT 42, WATERSONG PUD PLAT NO. ONE A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential A5. Latitude/Longitude: Lat. 27* 23' 27.7" N Long. 80° 15' 38.0" W A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. AT Building Diagram Number 1 Z3- 2oO Horizontal Datum: ❑ NAD 1927 ® NAD 1983 A8. For a building with a crawl space or enclosure(s), provide A9. For a building with an attached garage, provide: a) Square footage of crawl space or enclosure(s) n/a sq ft a) Square footage of attached garage n/a sq It b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage enclosure(s) walls within 1.0 foot above adjacent grade n/a walls within 1.0 foot above adjacent grade n/a c) Total net area of flood openings in A8.b n/a sq in c) Total net area of flood openings in A9.b n/a sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name B3. State UNINCORPORATED AREAS, 120285 ST LUCIE I FL B4. Map/Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone Date Effective/Revised Date Zone(s) AO, use base flood depth) 12111 C01 94 G 06/30/99 11/4/92 AE 8.0' B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe) B11. Indicate elevation datum used for BFE in Item 69: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑Yes ®No Designation Date ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ® Building Under Construction* ❑ Finished Construction *A new Elevation Certificate will be required when construction of the building'is complete. C2. Elevations -Zones Al-A30, AE, AH, A (with BFE), VE, V1430, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-g below according to the building diagram specified in Item AT Benchmark Utilized LOCAL Vertical Datum NGVD 1929 Conversion/Comments Check the measurement used. a) Top of bottom floor (including basement, crawl space, or enclosure floor)_ 8.72 ® feet ❑ meters (Puerto Rico only) b) Top of the next higher floor N/A. ® feet ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) N/A. ® feet ❑ meters (Puerto Rico only) d) Attached garage (top of slab) N/A. ® feet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building N/A. ® feet ❑ meters (Puerto Rico only) (Describe type of equipment in Comments) f) Lowest adjacent (finished) grade (LAG) 6.96 ® feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade (HAG) 7.15 ® feet ❑ meters (Puerto Rico only) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. 1 certify that the information 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. I .� ® Check here if comments are provided on back of form. y E' Certifier's Name James A. Fowler, P.S.M. License Number 3435 Title Professional Surveyor and Mapper Company Name Culpepper & Terpening, Inc i\ Address 2980 South 25th Street City Ft Pierce State FI ZIP Code 34982 < �1 Signatu �� e 1/22/2009 Telephone 772-464-3537 { ; FEJOA-Forma 81-31, February 2006 See reverse side for continuation. Replaces all previo _J" IMPORTANT: In these spaces, copy th rrespondling information from Section A. For Insurance Company Use: Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number 4844 WATERSONG WAY City FORT PIERCE State FL ZIP Code 34949 Company NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments Latitude/Longitude was obtained from LABINS web site. q,", a . fl` Signature Date (L I heck here if attachments SEC ON E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR'ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items E1-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawl space, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawl space, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. F9 For Ruildinn Diaorams B-8 with nermanent flood oneninas nrovided in Section A Items 8 and/or 9 (sere Daae 8 of Instructions). the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Sectii ❑ below the HAG. ❑ above or ❑ below the HAG. with the community's floodplain management n G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. a FEMA-issued or community -issued BFE) Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8, and G9. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued i r community -issued BFE) or Zone AO. G3. ❑ The following information (Items G4: G9.) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement i G8. Elevation of as -built lowest floor (including basement) of the building: _❑ feet ❑ meters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters (PR) Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑ Check here, if attachments F,rm 81-31, February 2006 Replaces all previous editions i!• U,S bi OARTMENTOFHOMELANDSECURITY,--, ELEVATION CERTIFICATE- �> OMB No. 1660-0008 Federal Emergency Management Agency Exoires February 28.2009 National Flood Insurance Program important: Read the instructions on pagesd. SECTION A - PROPERTY INFORMATION For Insurance Company Use: Al. Building Owner's Name SEABOARD HOMES Policy Number A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number 4844 WATERSONG WAY City FORT PIERCE State FI ZIP Code 34949 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 42, WATERSONG PUD PLAT NO. ONE A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential A5. Latitude/Longitude: Lat. 27° 23' 19" N Long. 80° 15' 37" W Horizontal Datum: ❑ NAD 1927 ® NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood Insurance. A7. Building Diagram Number 1 A8. For a building with a crawl space or enclosure(s), provide A9. For a building with an attached garage, provide: a) Square footage of crawl space or enclosure(s) n/a sq ft a) Square footage of attached garage n/a sq ft b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage enclosure(s) walls within 1.0 foot above adjacent grade n/a walls within 1.0 foot above adjacent grade n/a c) Total net area of flood openings in A8.b la sq in c) Total net area of flood openings in A9.b n/a sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name B3. State UNINCORPORATED AREAS, 120285 ST LUCIE FL B4. Map/Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone Date Effective/Revised Date Zone(s) AO, use base flood depth) 12111C0194 G 06/30/99 11/4/92 AE 8.0' B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe) _ B11. Indicate elevation datum used for BFE in Item 139: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ®Yes []No Designation Date 1983 ® CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: 0 Construction Drawings' ® Building Under Construction" ❑ Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations -Zones Al-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, ARIA, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items,2a-g below according to the building diagram specified in Item A7. Benchmark Utilized LOCAL Vertical Datum NGVD29 �io Conversion/Comments PID AF6610194 77 A 16 FLDT: 3.91 V IN NGVD29 0 n 0 Check the measurement used. v"' 00 a) Top of bottom floor (including basement, crawl space, or enclosure floor)_ b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest,elevation of machinery or equipment servicing the building (Describe type of equipment in Comments) f) Lowest adjacent (finished) grade (LAG) g) Highest adjacent (finished) grade (HAG) 10.20 ® feet ❑ meters (Puerto Rico only) n/a.n/a ® feet ❑ meters (Puerto Rico only) n/a.n/a ® feet ❑ meters (Puerto Rico only) n/a.n/a to feet ❑ meters (Puerto Rico only) n/a.n/a ® feet ❑ meters (Puerto Rico only) §.44 ® feet ❑ meters (Puerto Rico only) 8.63 ® feet ❑ meters (Puerto Rico only) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify ele% information. I certify that the information 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. ® Check here if comments are provided on back of form. Certifier's Name James A. Fowler, P.S.M. License Number 3435 Title Professional Surveyor and Mapper Company Name Culpepper & Terpening, Inc Address 2980 South 25th Street City Ft Pierce State FI ZIP Code 34982 Date 51151200E Telephone 772-464-3537 FEMA ForV 81-31, February 2006 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the n ,,responding information from Section A. For Insurance Company Use: Building Street Address (including Apt., Unit, Suiie; and/or Bldg. No.) or P.O. Route and Box No. Policy Number 4844 WATERSONG WAY I City FORT PIERCE State FL ZIP Code 34949 Company NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments Latitude/Lonaitude was obtained from LABINS web site. r:hat-k horn if allochmantc SwECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items El-E5. If the Certificate is intended to support a LOM I or LOMR-F request, complete Sections A, B, and C. For Items E1-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawl space, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawl space, or enclosure) Is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided In Section A Items 8 and/or 9 (see page 8 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is ❑ feet [--],meters ❑ above or ❑ below the HAG., i E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A'(without a FEMA-issued or community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge,. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management and G of this Elevation Certificate. Complete the applicable items) and sign below. Check the measurement G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed is authorized by law to certify elevation information. (indicate the source and date of the elevation data G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued or G3. ❑ The following information (Items G4: G9.) is provided for community floodplain management purposes. ordinance can complete Sections A, B, C (or E), used In Items G8. and G9. by a licensed surveyor, engineer, or architect who in the Comments area below.) community -issued BFE) or Zone AO. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Eleviationi of as -built lowest floor (including basement) of the building: _❑ feet ❑ meters (PR) Datum G9.13F'E or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters (PI ) Datum Local Official's Name - Title Community Name - __ Telephone Signature _ Date Comments 1 ❑ Check here if attachments FEMA Form 81-31, February 2006 I Replaces all previous editions