The URL can be used to link to this page

Home My WebLink AboutFEMA Application 1985-12-18 CI11 J,'X5 ~ ?f/f67S' -.- --- . 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,B, NO, 3067.0077 Expires Moy 31, 1996 SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE POLICY NUMBER BUILDING OWNER'S NAME e;rI=_\l"C ""IL.LI:O..I'.. ~Ot-\5TR.\lC.TION !lJE,uV/S ~ h7iW.U J7:);t(,J STREET ADDRESS (Including Apt., Unit, Suite and/or Bldg. Number) OR ~.O. ROUTE AND BOX NUMB~R 3a 5~ 1-\1\'1 Q E\.l BRIQ<;,E. l',0 1\') OTHER DESCRIPTION (Lot and Block Numbers, etc.) PI\I'..c..e.C ~ 2. OF L"'H> P""'","ITIO>-t COMPANY NAIC NUMBER I'L."'''''' ,'"' q4-- 1'0 '555 STATE ZIP CODE CITY '::>1'1'-.\1'1<0 FI ELO O....E.<;:;O'" q'14-,) SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM (See Instructions): +\ss'\\ 0:',0 c.. PEe.. Ie, '''I~5' 1\-<0 6. BASE FLOOD ELEVATION (in AD Zones, use depth) ~2. ~o 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): D NGVD '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 buiiding site, indicate the community's BFE: 1 1 I 1 I I,U feet NGVD (or other FIRM datum-see Section B, Item 7), 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 describes the subject building's reference level ~ ' 2(a), FIRM Zones A 1.A30, AE, AH, and A (with BFE), The top of the reference level fioor from the seiected diagram is at an elevation of I 1 14 h I.~ feet NGVD (or other FIRM datum-see Section B, Item 7), (b). FIRM Zones Vl.V30, VE, and V (with BFE), The bottom of the lowest horizontal structural member of the reference level from the selected diagram, is at an eievation 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 fioor used as the reference level from the selected diagram is W ,U feet above D or below D (check one) the highest grade adjacent to the building, (d), FIRM Zone AO, The fioor used as the reference level from the selected diagram Is W, U feet above D or below D (check one) the highest grade adjacent to the building, If no flood depth number is avaiiable, is the building's lowest floor (reference level) elevated in accordance with the community's floodplain management ordinance? DYes D No D Unknown 3, Indicate the elevation datum system used in determining the above reference level elevations: D NGVD '29 I1SI 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, Item 7J, 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: DYes I6J No (See instructions on Page 4) 5, The reference level elevation is based on: ~ actual construction D 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 fo, the building during the cou,se of construction, A post-construction Elevation Certificate will be requi,ed once construction is complete,) 6, The elevation of the lowest grade immediately adjacent to the building is: I 1 1~("e.I,Q5,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 floor" as defined in the community's floodplain management ordinance, the elevation of the buiiding's "lowest floor" as defined by the ordinance is: I 1 I I 1 I,U feet NGVD (or other FIRM datum-see Section B, Item 7), 2, Date of the start of construction or substantial improvement 00..,-, \"Iq~ FEMA Fonn 81.31 , MAY 93 REPlACES All PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION I. . . 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 wh'en the elevation information for Zones A1-A30, AE, AH, A (with BFE),V1-V30,VE, and V (with BFE) is required, 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 unfinished area Feature(s), then list the Feature(s) not included in the certification under Comments below, The diagram number, Section C"ltem 1, must still be entered, I certify that the information in Sections Band C on this certificate represents my best efforts to interp,et the data available, I understand that any false statement may be punishable by fine 0' imprisonment unde, 18 U.S, Code, Section tOOt, CERTIFIER'S NAME LE-'i> I'-<:)BE-~::' TITLE 1'1'-'<:.5\1:><:.......,. ADDRESS LICENSE NUMBER (or Affix Seal) II Or I'.L.~. 10~" COMPANY NAME \Z..DBa~s S()I'-\)I;'~'lIp,Jc;, CITY INQ., '2Q was, ~9'T1:!. S,<<'E.E..., I:.Ll<oE.N.E. Olt..E.c.ol-.l cn....os' SIGNATU~_ ~ Ii -t- DATE PHONE .:::7'Y'- J ~~ O....-I,<:;-q,5'" ~o:;- 3'\-5'- II '"2.- Copies should be made of this Certificate for: 1) community official, 2) Insurance agent/company, and 3) building owner. STATE ZIP COMMENTS: ~..N\. ~ \ _A.'N. E.. eou..."" ~ RASS c.""p (.Ij, t'o..... ,,,<..) IN c.o w.c..RE-""t'"F- mot-..\l'ME_.......'T"" ",..c. .....e.....QIl<Jc" 10fl f\ BO\! e. (;~UN.O ~o ", ~'" ",-, ....\"- :; \-\OVLOe.g, Or I-\A"~F"" e~\ 'V<:'E. Rnc>c> p,-r- "100 I\Jf!:.."" \.N 1'-01'+0. ~- "". E..LE.'-l . +<. 'Ir- I'i. LI'l....'" c.o_ nATum ON SLAB WITH BASEMENT A ZONES V ZONES A l{tr ZONES d5~ ~ ~#!i .:~:;.\\~ GRADE . ":,m -~;i !!I'm., " :$'i'f'~ .'1 .,~, """ "000 ElEVATION ON PILES, PIERS, OR COLUMNS A V ZONES ~ ~ IREFEFlENCe~ CEV" .~ I r:~~~("1 ~~ '\ ~/~ II , I...... \ ~ , " I ELEVATION 18,';: :,.', :",,' :,' '~\:~k"'"'''''''''' '., f I t/~.<~ :;, !i' ';,"-";,' ;..~,;.,: ',);,:'.hi11.',;!",:~,:,:! /.::i:....,;...;./..,Jjffi:../. GRADE I"''''~'h l lEVEL, \ , " ' ~~^;;M'~,~"'~~ ..., "000 ELEV"TION REFERENCE I lEVEL The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones, Elevations for all A Zones shouid be measured at the top of the reference level floor, Elevations for all V Zones shouid be measured at the bottom of the lowest horizontal structural member, Page 2