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Home My WebLink AboutELEVATION CERTIFICATEAar ELEVATION CERTIFICATE CANNfOKplresMay3r, t993 Aid 3067-0677 FEDERAL EMERGENCY MANAGEMENT AGENCY By NATIONAL FLOOD INSURANCE PROGRAM St. �fj CIP,C,�ls��ip FTENTION: Use f this certificate does not provide a waiver of the flood insuranoe purchase requirement .This form is used only to Dvlde elevation i ormation necessary to ensure CmIlAmrice vAth appliicabte.commu ifq-floodplain management ordriances; to '• itetmine the pro r-insurance.premium rate, andlor to, support a request for a' Letter of Map.Am4ndtiient or Revision (LOMA or LOMR). Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE UILOI ER'S I POLICY NUMBER TREET ADDRESS (1' udug dune 2nd(6r Bidy- NumberI OR P.O. AND BOX NUMBER COMPANY NAIC NUMBER THER OESCRIPTIO' (Lot and Block Numbers. eta) O fTY STATE ZIP CODE SECTION B FLOOD INSURANCE RATE MAP FIRM INFORMATION wide the followi �g from the proper FIRM (See. Instructions): 1. COMMUNITY N il)ABER 2 PANEL NUMBER & SUFFIX 4. DATE OF FIRM INDEX S. FIRM BASE FLOOD ELEVA - I�� 9a ,9 .��Ao u� ) Indicate the ele t'on datum system used on the FIRM for Base Flood Elevations (BFE)- NGVD'29 _ d back) For Zones A or ,where no BFE is provided on the FIRM, and the community -has established a BFE farthis building site. indicate the community' BFE: ► I I I I I -(J feet NGVD (or other FIRM datum -see Section 8, Item 7)- SECTION C BUILDING ELEVATION INFORMATION'. '. _ I Using the Elev on Cent leate Instructions, indicate the diagram number from the diagrams found on Pages-5 and 6 +hat best describes the - 1 jest building's reference level 1 t). FIRM Zones 1-A30. AE, AH. and A (with BFE). The top of the reference level floor from the selected diagram is at an -elevation Of .(J feetNGVD (or other FIRM datum -tee Section B. Item 7). �). FIRM Zo(tes, 1430, VE, and V (with BFE). The bottom of the Iowesthorizontal structural member of tfiIi a ence level from the.selected iagram. is at an elevation of (I I I I I,U feet NG_ VD {or other FIRM datum -see Secdon B; Item �. - :). FIRM Zone (without BFE). The floor used as the reference level from the selected diagram is W .0 feet above ❑ or below ❑ ( iI one) the highest grade adjacent to the building. _ Q. FIRM Zone O. The floor used as the reference level from the selected diagram is W .0 feet above ❑ .or below ❑ (check one) the hig grade adlaciint to the building. If no hood depth number is available, is the buildittgrs lowest floor (reference " level) elevat in accordance with the community's floodplain managementordinance? ❑ Yes • ❑ No,[] unknown Indicate.the ele, tion datum -system used in determining the above reference level elevations: R NGVD'29 ❑ Other (descn"be ender Commend 'on. Page 2)._ (NOTE If the elevadmi datum used in measuring the elevations is drlferent than that used on Hte FIRM (see -on f3, Item'71, then convert fnevations elefo,the datum system used on the FIRM and show the conversion equation under mmerits on Page A) Eevation refer ce mark'used appears on FIRM: ❑ Yes Q No (See Instructions on Page 4) Fhe reference 1 vel elevation -is based on: � actual construction4'• ❑ ,construction drawings !NOTE: Use o nstruction drawings is only �d if the but7ding does not yet have the reference level floor in place; iri which ase this eerie{ a will only, be vard for the bulkiii duang the course of construction: A post -construction Elevation Cewricate sill be required nce construction_ is complete_) I Fhe elevation o the- lowest grade immediately adjacent to the building is: LJI I I`l iection 8,'Item I -j!Jfeet NGVO (or other FIRM datum -see ). SECTION D ' COMMUNITY INFORMATION f the communi l official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1 s not the "Lowe t floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest loor" as define by the ordinance is: 1 IJ-U feet NGVO (or other FIRM datum -see Section B. Item 7). )ate of the staf of construction or substantial improvement VIA form 81-31, AAY 90 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION SECTION E CERTIFICATION This certification is to be •s'igried dy-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 l 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'unfirkhed area Feature(s), then list the Feature(s) �ot- included in the certification under Comments below. The diagram number, Section C, Item 1, must still be entered. I 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) -Ti. TITLE ` COMPANY NAME A - / C t-e.� C � •�o..at-�� Cw9�� . ti �l o`�'� ,n w � � IytJ �i � 'CV Q'",G tom- � '' I I AnnRFRR l:iTV CYATC - "o Copies should be made of this Cectiticate.for:1) community official, 2) insurance agent/company, and 3)-building ownea COMMENTS: I - cm V4111 'ON PILES, SLAB BASEmEw •. PIERS, OR COLUMNS, A v A A v I I F: ZONES ZONES ZONES ' ZONES' ZONES REREMWE ASE BASE .. ..... LREL LEVEL FLOW ERENCE R 'tem II . flEVAT10N _ - I I 1.1 _ ._ `� ,.sC ,%}M1 :iL �.•}. ' 1 ' BASE REFERENCE FLOOR •••:y"-;r;. AOJACElIT -' GRADE LEVEL' BASE � i � _ FL000 ELEVATION .. t i ELEVATION RED ADJACENT LEVEL GRADE ' - >;hi:, �'- ;',•` . III 7•F ' q!. : ) • : _, • 7��• ADJACENT •• 7"::R'-=... ... �f • -•r GRADE I: The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones. ' I Elevations for all A Zones should be measured at the top of the reference level floor. I IJ Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member. • I Page 2