HomeMy WebLinkAboutFEMA Application 2003-8-21
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AUG-2~-200~ TUE 09: 36 r\.BRANCH ENG I NEERING 5417460389
o Z (~ ;) V EDERAL EMERGENCY MANAGEMENT AGA
NATIONAL FLOOD INSURANCE PROGRA'P'
ELEVATION CERTIFICATE
P. 02
,l'
-;'"
O.M.B, No. 3057-0077
Expire$ July 31, 2002
Im~ortanl: Read the instructions on J"'!i!'51 -7.
SECnON A - PROPEJ:lTY OWNER INFOKIIA'fION
Fot lniurance Cornpal1Y U"';
POhC'/ Nul1'tler
BUIL.DING OWNER'S NAME
-- _.......
8UIL01~ ~TRE:r ADDRESS (Incl\;ding AQt.. Unit. Suite.lII'IdIor Bldg. J1a..) OR P.O,~U 1 ~ Am:I kJOJ( ~ " ConlJany MIC Numblr
ZOIU- \--\~....k>,..,v'" 'Drl\le..- (JJ~!-ll c..:z.....~i:r'^"'If""1\
CITY c- . r: l bIA/c,.., ~ . liP CODE
,Or"""",,-rie- ~ ' U _ Cf71j.').7
I-lHUPI:H.ry CE;SCRlp.-nON",Lm ill1d BIodr.N\lmoe~. Tax Pateef Nun1~r, ...ag:I1 De5c1ption, 1lIte.} .
"Tv..~~n Itl-o"l-!I-?,'Z... L..t 4LtOQ ~--r..~IH-(J~-a2-~3 ",L,l!.t 8~olJ
BUILDING u .,~, RMId.n1i4l. NQn.raId.ntiat.AdCIlJoll,.~..le. Use sedonl~l"f.)
LAT,ruD",LoNci~~bAt~ HORlZUN'i.... ~'TIJr..: ;;;:;;'".::1;: Li i;;:; ~n,.j:n
( /1#' - till' -II#.W or ...~ Ll NAO 1927 U NAIl 1m U USGS Quo<l J.1Ojl U Olllo,
SECTION B ' FLOOD INSURANCE RATE, MAP (~I~ INFORMA liON
I 81. NflP COMMUNITY HAM!; 4 (;()MMUNfTY NUMBER . I trL ~;~~"i i;;~~ .l' . I OJ.5TI\'1:
lo."p(\/l..."+...U",;Tt..",,,< 4155",} 1 , La\(/,COLh[4 ,I"JI<..
I B'.lMPANCPANEL I 8S.:.lUfflX IIlU.FIRIlIINDelI I ~7.t_t'.-.. IllIl'''LUOU IIl!l....:aeFLOOC~LEV, ATION(S)
NUMBeR DATE EFi'ECTIIIE/REVOATE ZONE(S) (ZoncAO. .....d.i>Ch.ltIooolng)
!.t(D:R0..1I44 "F '~"r-'l\.\1'1'l;:r/~..,-Z.I<jq"Y ~F l/Ij"it./,'
B 1 O. Indicatelha source of !he 6;$. Flood Elevation (BFEj dalD or base 1Iood depth lRenl<Iln Blil, ,
, LJ flS. Proftle ~ FIIW 'LJ ce...mnly Ddemli.-ied U Other (Descril>e).
Bl 1. Indicate the e!evaaen dallJm uae<l lor the BFE in B9: U NGVD 1929 U NAVO 111118 U Other (Oc:scriCe):
B 12. 16 111. building located in . Coastal Barrier Resourcos Sysl"'" (CeRS) area or OthOl'Nise PrOlec\acl At.. (OPA)?, U Yes L;lS No
Deslgnallon Date: '
SECTION C - BUILDING ELEVATION INFOR~noN (SURVEY REQUIREDI
c I, BuRding elevallon. aro baud on, UCons!rUdioo Drawings' L.JBUllding Under CooitIuctlon' OOFinished Constructien
"A new ElevaUon Ceniftc:ale "!JI be reqLired when cxmstruction 01 the building is oompIele.
C2. Building Diagram Number ..Z1- (Scloct tho buiJdjng ciagrwn mo~t 'imilar '" 1110 llUI!ltng Iflr wllich tl'tic certmcolo is bdng eo"",lele. . .ee
pagez e and 7. If i'iO diagr.im ilo;;l.lrately represanGi the blJl~. provide a sketch or ph~raph.)
C3. Elevation. - Zones Al'A30. AE, Mi. ,A (with BFE), VE. V1-\r.l0, V (with BFE). AR. ARIA, APJI'.E. ARiA1.A..,'O, ARJAH. AFJAO
Complell! Item. C3...i ~elow a=rding to the building diagram specffie<j in Item C2. Stile the datum useo, if the t.,IJrn is different ire,"
the datum u!lied for the BFE in Section B. conven the dab.m UI tI'lat used tor the eF:::. Show1leld ltIe211.lrements ilnC ca[um c:.::nversicn
'calOJiation~ Use ~he space provided or the Col1\ments area of Sc;.di~n 0 Q~ Seqi?" G. es appn:lI:niate. to c::JC:Jm'Z: :.he1:l::iwm"c:=nverslcr:
Datum j;.1C, V 0 '2?l Coover>ionIComment> /(\, \-" /A t <y,,,, >-')..6:.1/ 1;l..~ d, ,u",.. /r ("... '" /? e< /e.rpLo I
Elj\lation reference mark us~-j j:. odes the elevation reterenea marX LBeO apPear on tI"le F1F\M'? ~ Ye~ Li:! ".;=
lZf a) Top of bonomftoo, 0ndudingbMomOlll ortndosure) ._If s:.,O ,.fl ft.(,;,) ;] - "',
a b) Top of nel<1 higner noor .it ::> 3 , y.. f.(,) ~ " REGISTERED 1
~...,2...._:,,~:;....._....,;_lj~.~1al.t.mi~J!7'--;......{)I"'l"'flA~"":., al~r"] "-, .-..~,) i~ PROFI!SSlONAL;
'" dl Al'.:acnod g.rage (lOP OT ,100) '..." "" '_ i1,( ) "" LAt:lD SURVEYOR
.~ e) LO....~:s.1 elevation 01 mad1inery andlor eaUlpment I' '53 j- :..:.J ii
/ ,ervtc:ng the buildog I ' ~.! =_H l~.r-/. c3.(7?
, ,Ii f) Lowe.\ adj.cen, gl'llde (LAG) 4 "_0 . _ :1.( - _ OFU!GtlN
:rt;Q) HigMst .djacBn' grade (HAGj , U <i()., ~ c.i ~" JULY 20, 1993
'il>~) No. cf pcrmar.er:: openIngs (nOOO vems) wf{;,in 1 It. ,Dave edj8cenl greCe '::I 0 d: REX~ETZ-"
if i) Total .rea of.U permanent o~nings (flood vents) in C3h ':1. C;; 20 Co. n. ~I ......,.
I-,'~?~. "" I~/ 310.3.-
SECTION D. SURV1:YOR. ENGINE::il. OR ARCHITECT CERllFlcAT:ON
T:-:is C~r:i:1::;1tior: i'll :0 be slgni':! and sealed by a ianci surveyot, engIneer, or architeC': avthcnzed by law 10 =erjty elevaton intorma:icn.
:' ce,r;ifl L":at!he inlorm:J!ion:n Sections A. 6. and C en this csrtific~te represent:s my !:Jest eifort3 to inier~~t the data B'I3//able.
i u....ders~and thot any ;also statement mav be c(;rlishable by nne or imotisonment under 18 U. S, Ccdl1. S~;,I'iOl1 lCD1.
C~~ilF!~:;'S NA'\\E~ ^' ~ + !..X..;;.NS!; ;"4UM[;E~n .. I'.
le""i'" v ,.... t-S'.. "2-- ",-S '7L., () ,.,
7',L= . , I I . - ,- COM?"'" """"'" ' '-'-:::;:';
SI...A......\I~r'-f !V\.c.c....~Cl('..~ ~Y'L~Vlt'k, .F"'l:.c /'~P~L';".Z" ..:I_'.~"
ADDREOS3\n =GJ-~ S.~1 )S:~.......:.....h-etzr __ sr1t~ Z!i'~}I./T}
JIGNATURE ~c7 An, ~'o.~L'bl{)()? TELE~r~LlI,\ 71f(;-O{n37
=;:".'A Form Bl.31, AUG GG ........ SeE R5VERSE SIDE FOR CONTn~UATlON REPLAC2SALL ?REVIOUS EDITIONS
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AU(;-26-2003 TUE 09:3'{ AM BRANCH ENGINEERING 5417460389
.. IMPORTANT: In these .pICCO, co. correspondlnQ information from Socdon A. .
BUII.OI~ STREET AO~SS (I_ding' ~I.~. Suil~. _'" Bldg, o'lo.) OR P,O. ROJTE AND BOX '
,0 I U. <r .r~ Dr .I y",V G ,~, .. '"., .. .-- ----
CITY r' r I STATt.o q ... '-VU.
::-nv.w-,:,-tl'e- d; 0.,"", 1'T77
SECTION D. SURVEYOR, ENGINEER, OR ARCHITECT CEK'ji~lCAllDN (CONTINUED)
Copy both .id.. of ,hi. Elevation Ce,utic>lo for (11 COIrrnunity official, (2) Ir101nanco agent/company, and (3) buiding owner,
CO~MI:,NI. ~ .
L!il-'1 /1, <\1JV"f'n'jheld 1?e",rJ... ).ju~,J.::-. h<!:J""..7 ". (:,^~r",t-f s-;.J.'"""'<"' l~ 11..r inp
VJAd.:.. J ("'_'''''1,;. ...~,r",,: {;+ ~ <:~~~w~t ("Oy~y d ~ 1~,1 Wu,," ""'"Y'J_
..(VeWl""'+ ~. l".".v~~ 0"" p/d"-i,,,,,,, o..f 4W1J"n (l:~ of 5.ov~h~ldf0<;ilJ""
./NhJ/.ldJIA.~+er!~: UU'7 q() LJ&',vn'Z"T IAIt:< Ll<:tt(,l ac 11.-0 ~"',..: "'-L.e:.I..V'JC~
o;;kl)uJY\ ~ """e Il\o. U Check here ihltachments
SECTION E. BUII~IlINGELEVATION INFORMAllON (SURVEY NOT R1!Q\JIRfDI FOR ZONE AO .nd ZONE A (WITHOUT BFEI
For Zone AO ond Zone A (without BFEj, ......:c.. hems El lIuQUgh =3. fIN EJlMtton CSrfflt:atel.,nlencfetffcruse as supporting
IIltormot1orl 101,_ LOMA orLOMR~. s..dJan C rr1IJ3t be eanp/lIGlI.
E 1. Building OiagNlm Number _ (Select the bu~ding dIayt3II1 most IImillr 10 the buldng ~ which lhi. cer1ilicate is being comple1ed-
see page. G and 7. If no diagram acclntely represents the buiding. prtMde a - 01 phclIlgrapn.)
E2. The lap 01 lhe bCX10m floor (rcludlng basemen! Of end05iIre) allhe buflrJng is LLJ ft.(m) LLJIn.(an) L.J abova or L.J below
(check one) the highest adjaCe.it grade. ' ' " '
E3. For Zone AO only: If no flood depth number is ava~abk!. is !he tope/the ba80m IIoor elevateel in accordance with the community'.
, fllllldglain r'1~niIQ'm'nl Qiglfiir.ce7 J I Yas U NoI I unkniNm.Tlle local 0flidaI1ftJSl""~lt'is ~..:......_~.., In SecIIon G,
, ' SECTION F . PRDPER1Y OWNER lOti OWNER'l; IO'PPl!!llCl'lIJloIlvt:I ,"<:I<lI"I'"JIo IIUN
Tho property owner or ownef. lI\I1hori>ed reprasonlaliVe who a>mpletes :,.;:..... A. B, and E far Zllne A (Wilnoul a FcMA-i$$ued or
community.issuod BFE) or Zone At:) must sign here.
p, 03
For In5U~ Company Use:
POliCy Nutmer
Ctmwny NAte Number
tJKOPERTY CNJN~K'~ OK ~-~ AU lr:oflliEo RCPRE5~TAr~ ~ ~
STATE
ZIP CODE
ern
Cl"TE
ADORESS
TeLePHONE
SIGNATURE
COMMEN7S
LJ Check here If attachments
SECTION G. COIlMUNITY INF(lRMAllON (OPTtONAl..)
The local official wh~ is authortze~ by law or orai:rlance to adrniniSt9t tI\e COITYnUJ1ity's1lood-pJain manaQement orriinanc~ ::an cornplcre
Sec:ions A. e. C (or E). and (l oflhis Ele'I1ltion Certi6cate. Co~ete the~.iItom(.) and sign below,
Gl. U The information in Section C was taken 1rom ether cicwmentMiOTl thaJ: has b6en s.ignea and emDQS.lI:ed by ;a licensed surveyor.
.. engineer, or ercnitsc: wno is ;IU..ltnonzed by stale or loc:allaw to'centiy 4Iev3tiDn ~ .:......o:....:..n. (!ndicate the acu:rce and dale of the
elev;ltion data in :he Commems area beJow.)
G2. U A commL:r:ity official completed Sedicn E for a tluilclng ICC3Ied in Zor.e A (without a rEMA-issued. Or c:)mr.urjiy.iuuec:! E!=~: cr
Zone AO,
G3. U Tne follcw;ng lnforTn:l.tion (Items G4-(9) is provided lor comrm.Jnit'y nocdDtain man3Qemem C:J~Q~.
,:, G... PEPJ..~IT NUM5ER I G~. DA-ii r'ffiMlT ISSUE.D i ~.::. CA~ ~='i'i;:iC;"TE C:F COMPLlA.\:Cc.;"CC;CUi.:l~NC'!
i ISSUE!)
G'/. This permi~ ~s bean i~su,e fer: I I New :onstruc:icn U Sl.CstantiaJ Jm=,rovemem
Oi. ilOV1tlon or ii.built ICWlilit floor (inG1Jdino M~rm:nt) Qf tt'l8 buih:Jin9 is:
Gg. EFE or (in Zone AO) ce~th oil1oocing at the building .;,e is:
LOCAL QFF!CIAL:S NAME
. _ n.(m) Datum:
, _ il(rn) Oat",,::
lilU:
COMl\'U~lrf NA.\I:;,
1~-HUI'(e.
SIGNA T;"Irii:
l..'I'\l:
C~MMi:.N is
L ; Check here it anaCnl':1EnlS_
REPLACES ALL PREVIOUS ED:TIONS
::E~IA Fom'\81-31, AUG 99