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Home My WebLink AboutFEMA Application 1985-12-18 , u ~~ .;. ''" . . ELEVATION CERTIFICATE 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. O,M,8, NO, 3067.0077 Expi..... May 31, 1996 SECTION A PROPERTY INFORMATION BUILDING OWNER'S NAME / A 11 /)"'(/;" Hurthrhl' STREET ADDRESS (Including Apt.. Unit, Suite andlor Bldg, Number) OR P,O, ROUTE AND BOX NUMBEJj .7~rt Ifard~ /j~M~""_ /,~ OTHER OESCRIPTION (Lot and Block Numbers, ete,) J!arr..,/ J ~Ah.l ~A...7iy..,O__ ,ilk-/- if. ?'I-PO..s:rr) j.4~ CCU.....fy CITY ' - I ~ ST~E ZIP CODE / --.k~ .J::j,..Jn {/~4"1f/ f.7~77 , SECnON B FLOOD INSURANCE RATE MAP (FIRM) INFORMATIoN FOR INSURANCE COMPANY USE POUCYNUMBER COMPANY NAIC NUMBER Provide the following from the proper FIRM (See Instructions): 4\5'5'\ \ o~..,o .. , C tlEll. 18, 1'\8S' 1\-'<> 6. BASE FLOOD ELEVATION (in AD Zones, use depth) 6,C,~sg... 1. COMMUNITY NUMBER 2. PANEL NUMBER 3. SUFFIX 4. DATE OF FIRM INDEX 5. FIRM ZONE 7, Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): 0 NGVD '29 J&1 Other (describe on back) 8, For Zones A or V, where no BFE is provided on the FIRM, and the community has estabiished a BFE for this building site, indicate the community's BFE: I I I I I I,U feet NGVD (or other FIRM datum-see Section B, Item 7l. SECTION C BUILDING ELEVATION INFORMATION 1, Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best de~cribes the subject building's reference level-8- ' 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 I I ""GoI!>I.W feet NGVD (or other FIRM datum-see Section B,ltem 7), (b), FIRM Zones V1-V30, VE, and V (with BFE), The bottom of the lowest horizontal structural member of the reference level from the selected diagram, is at ~n elevation of I I I I I I,U 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 0 or below 0 (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 0 or below 0 (check one) the highest grade adjacent to the building, II no fiood depth number is available, Is the building's lowest floor (reference level) elevated in accordance with fhe community's floodplain management ordinance? 0 Yes 0 No 0 Unknown 3, Indicate the elevation datum system used in determining the above reference level elevations: 0 NGVD '29 [lg Other (describe under Comments on Page 2), (NOTE: If the elevation datum used In measuring the elevations is different than that used on the FIRM (see Section 8, /tem 7], then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) 4, E,Ievation reference mark used appears on FIRM: 0 Yes ~ No (See Instructions on Page 4) 5, The reference level elevation is based on: I2SI actual construction 0 construction drawings (NOTE: Use of construction drawings is o,fly 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: I I 14!4>I~I.~ .feet NGVD (or other FIRM datum-see Section B, Item 7), SECTION D COMMUNITY INFORMATION 1, If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1 is not the "lowest f1oor- 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 I,U feet NGVD (or other FIRM datum-see Section B, Item 7), 2, Date of fhe start of construction or substantial improvement FEMA Fann 81,31, MAY 93 REPlACES All PREVIOUS EOmONS SEE REVERSE SIDE FOR CONTlNUATlON . . . " SECTION E CERTIFICATION This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation information when the elevation information for Zones A1-A30, AE, AH, A (with BFE),V1-V30,VE, and V (with BFE) is required, Cocc;nunity 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 Ii 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-II 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, I certify that the information in Sections Band 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, T A " II a STATE ZIP T F \ fI L il ir L IE LICENSE NUMBER (or AffIX Seal) . . ~. L. 'So l03Q COMPANY NAME PRe=SIOtSf.JT '\>.O~E.~ StJR\\e'lIN<" INC.. ADDRESS CITY 1'.0, e.OX 1'~S5 .. EVC,E.I..LE., OR.Ec;,O/oJ. Q,401 SIGNATUR~., ~) DATE PHONE C'f'~ '>1' O\-2~~; 54-1-'?,4s-I/I"W Copies should be made of this Certlflcafe for: 1) community official, 2) Insurance agenllcompany, and 3) building owner. CERTIFIER'S NAME LIS.::' 1<..0 ~E..~",'::' TITLE T II d i~ GROOtJ.D . BRASS c.A-P LO C.A"\E..O f\"" N, E., SHOuLDER. r Dr.'r.:l~"'i;::qF:n " PRo CFr7._SS;0."'I.r-'Jt. ",1.. ~.l\.::~ C~~._'';.7''<.f)R , ,,-"_niZ~l ~- ~!~:.~- COMMENTS: l;',EloJN4 ""At:!'. OSE.O f=DfZ... Tf+lS C.E.R\\Fl c.A-,\OI-! :. lA....E ('nUN"r'f i'>RA~S C.A P (t! f'...T. ,"Ie., \ <:.,~ IN C.OI-lc.RF.;.\E. f1'\ OM 0 ME.N"\ E~\1:.N<;)It.l(;, 10" AeO\JE '\f+E. OF \-I A '1 DE.N e,RI DC,E. RO A 0 B, to<\. Ec l.E..\J = 1-'-4-1j, (LA'" E AT "100 ,\VRI-l. 'lo WEST. c.()oJ~ QA'lLI/l'\ ') UI~l...t..:JUI'<ol AUGU::;T 2:'>. '~l~ T e " c p ~ . ,.., "I"'r"~'-n-r'(", -. -, 1036--' , 1 s ON SLAB WITH BASEMENT ON PilES. PIERS, OR COLUMNS A V IFlmFlE,,,,,~ZONES ~ LEVEe ~I":~:-CEI ~r \1 t ~' \ ,,~~ :;)" ~~ "~I ' '''1-11: k,,,,,,,,,,' "'~"; I(~ '., '''!,'''''' ,;,<,.., U '!/iiiiii ~!f~k.~ :;~1~~};;j;f1;i0i;i:}~;t ~.;jl;~:;;r:i; a A ZONes V ZONES A 1l1r ZONES I r- ..., FlOOO ELEV"TlON ,', ~ ,,' ...........,... . ,. ,,: .': ~, : '''''':',~!i1i . ADJACENT':::; \ ' REFERENCe I ~...~ lEVEL ,'Ii ~j,t,\,.~'~},r" E I """NCEh_ ~ LEVEL \ J ~liill;i~(;tw!j BASE ",000 ELEVATION 1 1 c .--.! !;W.1'!l\\l!li;f""'~'{~""" , ,11" ,"Y',,'" . '~.\/!r:;: I REFERENCE I ADJACENT lEVEL ~ I' r r f, I' L The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones. Elevations for all A Zones should be measured at the top of the reference level floor, Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member, II s fl Page 2