The URL can be used to link to this page

Home My WebLink AboutElevation Certificater:- o ��U �I . ,FR D E C 2 9 999 1 �r..� . a ` . , of i Lic Wort BU DING OWNER' NAME ?%W-0 r 3nm ud Aol' BUILDING STggEET ADDRESS (Including i t LUU DERAL EM La�"C MANA E NT AGENCY O.M.B. No. 3067.-0077 . NATIONAL FLOOD INSURANCE PROGRAM Expires July, 31, 2002 ELEVATION CERTIFICATE Read the Instructions on wades 1 - 7. SECTION A - PROPERTY OWNER INFORMATION 35<4, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. STATE ZIP CODE BUILDING USE (e.g./ Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.) iPSiC�P/11�i a/ LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: U GPS (Type): ( ##° - ##' - ##.##" or ##.#####' U NAD 1927 Ll NAD 1983 U USGS Quad Map U Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER 62. COUNTY NAME B3. STATE B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVMEV ED DATE E(S) (Zone AO, use depth of flooding) B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. JJ FIS Profile LJ FIRM LJ Community Determined LJ Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: L NGVD 1929 LJ NAVD 1988 LJ Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? LJ Yes LJ No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: LlConstruction Drawings* LJBuilding Under Construction' IQFinished Construction `A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 5 (Select the building diagram most similar to the building for which this certificate is being completed -see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations — Zones Al-A30, AE, AH, A (with BFE), VE, VI-V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO Complete Items C3a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B,- convert the datum to that used for the BFE. Show field measurements and datum conversion. calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum Conversion/Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? 1J Yes IJ No ❑ a) Top of bottom floor (including basement or enclosure) ft.(m) m ❑ b) Top of next higher floor _ ft.(m) ❑ c) Bottom of lowest horizontal structural member (V zones only) _ ft.(m) a c ❑ d) Attached garage (top of slab) _ ft.(m) E ❑ e) Lowest elevation of machinery and/or equipment W m servicing the building _ ft.(m) E ❑ 0 Lowest adjacent grade (LAG) _ ft.(m) z' y ❑ g) Highest adjacent grade (HAG) ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade ❑ i) Total area of all permanerit openings (flood vents) in C3h sq. in. (sq. cm) 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 in Sections A, 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 orimmisonment under 18 U.S. Code. Section 1001. ELOL.3 1 1! FEMA Fbrm 81-31, AUG 99 C/ SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In these spaces, copy the corresponding Information from Section A. For InsuranceoCompar� CITY STATE ZIP CODE _Compamy,f.Itrmt�au" L.'... 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 I —I. Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (VATHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. El. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed — see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2. The top of the bottom floor (including'basement or enclosure) of the building is L-1-1 ft.(m) I-1Jin.(cm) 1-1 above or 1-1 below (check one) the highest adjacent grade. E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is I-1—I ft.(m) I—I-lin.(cm) above the highest adjacent grade. E4. For 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? 1_1 Yes 1_1 No 1_1 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. -PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME "ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS J—I 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. G1. 1_1 The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. I —I 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. 1J 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. IJ New Construction 1_1 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: _ ft.(m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: _ ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE 1 COMMENTS JI Check here if attachments FEMA Form 81-31, AUG 99 REPLACES ALL PREVIOUS EDITIONS