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Home My WebLink AboutElevation CertificateR- FVFM U.S. DEPAR7MENT,OFHOMELANDSE URI TI . N CERTIFIQ, ,,. _, OMB No. 1660-0008 (%�� .1�'"Expires February 28, 2009 Federal Emergency Management Agency Natlona[Flood Insurance,. Program Important Read the instructions on pages 1-8... PROPERTY INFORMATION ?for in ric Cie pax!y. A1.. Building Owner's Name... ..I�If.�: dumber` .............. R . T. 1vifZ5 : Paow::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: A2. Building Street Address (including Apt, Suite, and/or Bldg. No.) or P.O. Route and Box No. :FCiiptiyNRICliuiritier:'•,:;€'si€ia€€. . .................................. city -- FsEo►C4 state�L: ZIP Code 3 49 S7 Number, A ate\ mC A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) F-5 I >>Er,t T IA L A5.' Latitude/Longitude: Lat. Long. Horizontal Datum: ] NAD 1927 [] NAD 1983 A6. AttachI'at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. , A7. wilding Diagram Number_. A8, por a building with a crawl space or enclosure(s), piovlde: A9.. For a building with an attached garage, provide: a) Square footage of crawl space or enclosure(s) sq it a) Square footage of attached garage sq It b) No. of. permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage _ -^eRdosure(s}wails wfthin.l .0-foot.above adjacent grade walls within 1.0 foot above ad)acent grade c) Total net area of flood openings in AB.b sq in c) Total net area of flood openings rn A9 b. sq in SECTION B -FLOOD INSURANCE RATE.MAP (FIRM) INFORMATION. R1 NFIP nnmmundv Nama & Communfir Number I B2. County Name ► B3. State I . UKi 1 t,1e_0 KP ! Z- o -L s S I L v c, ti. . I ' t— L. - I B4. Map/Panel Number B5. Suffix 56. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood,Elevations) (Zone Date 1 Effective/Revised Date Zones) AO, use base flood depth) IZD2S .t73tI 04 AS I.0 B10. Indicate the source of tV Base. Flood Elevation (BFE) data or base flood depth entered in Item B9. Q FIS Profile Community. ] Ocher (Describe) B11.. Indicate elevation datum used for BFE in Item B9: JJf NGVD 1029 Q NAVD 1968 . []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 REQUIRE% C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' 9FiNshed Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2.- Elevations —Zones Al A30, AE, AH, A (vft BFE), VE, V1 v30, V.(wM BFE), AR, AR/A, AR/AE, AR/A1 00, AR/AH, AR/AO. Complete items C2.a-g below according to the building diagram specified in Item A7: Benchmark Utif¢ed. Vertical Datum Conversion/Comments Check the measurement used. a) Top of bottom floor (including basement, trawl space, or enclosure floor) Meet D meters (Puerto Rico only) b) Top of the next higher floor Zones N .' El feet JJ Ufeet 0 meters (Puerto,Rico only) ❑ meters (Puerto Rico only) ' c) Bottom of the lowest horizontal structural member (V only) d) Attached garage (top of slab) 1 #4 .__O f et __ ❑ meters (Puerto Rico only) e) Lowest elevation of `machinery or equipment servicing, the building feet 0 meters (Puerto Rico only) (Describe type of equipment in Comments) f) Lowest adjacent.(finished) grade (LAG) refeet ❑ meters (Puerto. Rlco; only) g) Highest adjacent (finished) grade (HAG) �S .Q (feet meters (Puerto Rico only) information. I certify that the information on this Cerdficate represents my best efforts to interpret the data available. I understand that any false statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001., Certifier's Name License Number # EARL>- QQ 4 4 S9 R- S-rAK14.F.� - 7- IMPORTANT:. in these spaces, COPY the-avn I City information from Section A. %, .) or P.O. Route and Box No State �- SECTION D tSifRVEYOR, 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 Sl Date D s_ 3 — d (0 ❑ 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-ES. 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. E.1. __ Provide elevation infonnatlon 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 oftiottomRfoor mduding Wsemerd, crawl space, or enclosure) Is _ ❑feet ❑meters ❑'above or ❑ belowthe 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 SectIQ1LA Items 8 a d/or 9 (see e 8 of Instructions), the next higher floor (elevation CZb in the diagrams) of the building is _ �], feet meters 1] above or U below the HAG. - E3. Attached garage (top of, slab) is �— ❑feet ❑ meters ❑ above or ❑ below the HAG. E4.. Top of platfomn 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) CERTIRCA71ON The propeity owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA4ssued 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 Owners Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments SECTION G COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordnance to aktministerthe community's floodplain management ordinance can complete Sections A, B; C (or E), and G of this Elevation Certificate. Complete the applicable items) and sign below. Check the measurement used In Items G8. and G9. G1'. 0 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.-GO.) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate ofCoinpl'rance/Occupancy Issued I G7. This.permd 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 On Zone AO) depth of flooding at the building site: ❑ feet Q meters (PR) batum Local Official's Name Title Community Name Telephone . Signature [ate Comments ❑ Check here if attachments