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Home My WebLink AboutELEVATION CERTIFICATE`��O6eY sZ O.M.B. NO. 3067-0077 ELEVATION CERTIFICATE//y�n,�e�Expires May 31,1996 � Cl"c �1 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to provide elevation information necessary 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). Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION BUILDING STREET ADDRESS (Including Apt., Unit, Site apd/or Bldg. Number) r�R P.�. ROUTE AND BOX NUMBER OTHER DESCRIPTION (Lot (LootQand Block Nu 9bers, etc.)` ` �'Y Cx.C.CLoc L�Li- V F 1CSU lnr' �vV UJ CITY � �I n A STATE' SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM (See Instructions): FOR INSURANCE COMPANY USE POLICY NUMBER COMPANY NAIC NUMBER o- 0 3-3 -P3 1. COMMUNITY NUMBER 2. PANEL NUMBER 3. SUFFIX 4. DATE F FI INDEX 5. FIRM ZONE 6. BASE FLOOD ELEVATION 4(in a �� ag 1 �- l� �� AO Zones, use depth) 7. Indicate the elevationdatum system used on the FIRM for Base Flood Elevations (BFE): GVD'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 I I .II feet NGVD (or other FIRM datum —see Section B, Item 7) SrAa.,. SECTION C BUILDING ELEVATION INFORMATION 14VVLIC 1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 tha_MRIP cp1j,,t describes the subject building's reference level 1 y 2(a). FIRM Zones A1-A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation ofl 1 1211 . U feet NGVD (or other FIRM datum —see Section B, Item 7). (b). FIRM Zones V11430, 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 I .LJ 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 W . U 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 W . U 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? ❑ Yes ❑ No ❑ Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations: ® NGVD '29 ❑ Other (describe under Comments Ion 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: ❑ Yes ❑X No (See Instructions on Page 4) 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: .feet NGVD (or other FIRM datum -see Section B, Item 7) I 1 SECTION D COMMUNITY INFORMATION 1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section CJtem 1 is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest floor" as defined by the ordinance is: I I I I I . U feet NGVD (or other FIRM datum —see Section B, Item 7). 2. Date of the start oflconstruction or substantial improvement FEMA Form 81-31, MAI Y 93 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION ' •-' ' I. 1e1•I�:fi:;i i%"' :.uJ4.t�� .. •:l SECTION E CERTIFICATION �' s This certification' is ta,be signedby a land surveyor, engineer, or architect who is authorized by state or local law to certifyseleyation informatlon'when tlie:elevation' information for Zones Al-A30, AE, AH, A (with BFE),V1-V30,VE, and V (with BFE) Is requited. Community officials who are`authorized by local law or ordinance to provide floodplain management information, may aiso;sign the certification: In -the case bf. Zones AO and A (without a FEMA or community issued BFE), a building official, a property pGVner, or,,an owner's'reoresentative 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:`;:.,;;.,, F / certify that the information in Sections B and C on this certificate represents my best•efforts to interpret the data,av, ijj b/e. - I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 100=. - CERTIFIER'S NAME LICENSE NUMBER (or Affix Seal) 6EORGE M. AYLOR, JR. 4015 TITLE, COMPANY NAME ADDRES CITY STATE 4933_S. Pine Knoll Way Stuart Florida ZIP .., .-.34997, SIGN ATU DATE PHONE, 7-25-97 .281-b664- • Copies should be made of this Certificate for: 1) community official, 2) insurance agent/company, and 3) building owner. COMMENTS: ON' WfTFt ON PILES, SLAB BASEMENT -PIERS, OR COLUMNS A V A A V ZONES ZONES ZONES ZONES 'ZONES - -REFERENCE REFERENCE BASE LEVEL','. REFERENCE 'LEVEL - FLOOD LEVEL:, ' + ELEVATION "•� • '?ft'. '"'•` ;`, _ BASE . BASE.'. ., A• REFERENCE .r - � - '=- ADJACENT :°. '+; `FLOOD FLOOD "• ". - - 1,s 'LEVEL ELEVATION ' ELEVATION REFERENCE i ADJACENT, - ' 'LEVEL; GRADE .,.� w E _ '-, _. _ - — - --, .... !rr�l::i.:.{i'brt}':: ii i,`.j::;i:'. '+•�:i ADJACENT:} . ` - ,.a. .,. ,.. t•:.ti {••i ;Y{a7•}.,.. r:},.,rI GRADE The. diagrams above illustrate the points..at which tf a elevations should'be measured.in A�Zones.and V,,Zones:" .Elevations for aII'A Zones should,be measured at the top.of the ref erence.level floor. 'Elevations for all V Zones should be measured at the bottorri of the lowest horizontal structural member. Page 2