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Home My WebLink AboutElevation Certificate/ O.M.B. No. 3067-0077 0,1;6l<5( EVATION CERTIFICATE EDERAL EMERGENCY MANAGEMENT AGENCY Expires July 31, 1999 NATIONAL FLOOD INSURANCE PROGRAM ATTENTI ?N!se of this certificat es not provide a waiver of the flood insurance purchase requirement. This form is used only to pro- vide elevation information necess 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). 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 following pages. SECTION A PROPERTY INFORMATION I FOR INSURANCE COMPANY USE I BUILDING OWNER'S NAME MC2 - L_ /k l I o H STREET ADDRESS (Including Apt., Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER POLICY NUMBER COMPANY NAIC NUMBER OTHER DESCRIPTION (Lot and Block Numbers, etc.) I-c� � Ce 5L. oV. , I R \v r; GZ W,atTG ; CITY STATE ZIP CODE �. I�UG l � � V . SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM (See Instructions): 1. COMMUNITY NUMBER:- 1.2. PANEL NUMBER 3. SUFFIX FIRM INDEX 5. FIRM ZONE 6. - E FLOOD ELEVATION rDATEOF .(in AO Zones; use depth) " 60 �� r a A6 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): PlNGVD'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.0 feet NGVD (or other FIRM datum -see Section B, Item 7) - SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, indica a the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level 2(a). FIRMS 1 Zones 1 -r1A1-A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is gran elevation 1 of I -1, l..fibeet. NGVD (or other FIRM datum -see Section B, Item 7). 1 (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 I I I I I .❑ 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 L-❑.❑ feet above ❑ or 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 ❑J . ❑ 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? ❑ Yess No ❑ Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations: S? 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: LYes ❑ No (See Instructions on Page 4) Lam" 5. The reference level elevation is based on: 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: I Qeet NGVD (or other FIRM datum -see Section B, Item 7). SECTION D COMMUNITY INFORMATION I 1. If the community official responsible for verifying building elevations specifies that the refere b e�e el in Ica a trSeetie d 1 is not the "lowest floor" as defined in the community's floodplain management ordinance, the lUhtio�n�nof the building's "lo g floor" as defined by the ordinance is: �h. feet NGVD (or ther FIRM datum-s -SMtiokWRt45).1999 L 2. Date of the start of construction or substantial improvement r FEMA Form 81-31, AUG 96 REPLACES ALL PREVIOUS EDITIONS 6UD61 &NNATION r f 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. 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. 1RTIFIER'S NAME ' � LICENSE NUMBER ( 46 -1al) TITLE COMPANY NAME CITY STATE ZIP ,5 'ATURE DATE PRONE coct/J Copies shoulde de of,this Certificate for: 1) community official, 2) insurance agent/company, and 3) building owner. ON WITH ON PILES, SLAB BASEMENT PIERS, OR COLUMNS A V A A V ZONES ZONES ZONES ZONES ZONES �, REFERENCE j—RE—FE-RTENCTEI BASE LEVEL REFERENCE LEVEL FLOOD LEVEL ELEVATION . BASE REFERENCE BASE FLOOD "• ADJACENT.''; FLOOD GRADE LEVEL ELEVATION ELEVATION REFERENCE ADJACENT LEVEL GRADE :� ,•:: r:'.{:):::: i.:::i::::,.,,�I:: •'.:: ADJACENT?: m; .. ....'.ITV/ I":'':`. .... ...... . '::JIf 11`.'.::•: 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. Page 2