HomeMy WebLinkAboutFEMA Application 1999-6-2
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FEDERAL EMERGENCY MANAGEMENT AqENCY
NATIONAL. flOOD INSURANCE PROGRIAM
ELEVATION CERTIFICAtE
o M.B No 3067-0077
ExpIres July 31. 2002
Important: Read the instructions on pa~eII1 . 7.
SECTION A - PROPERTY OWNER INFORMATlDH
,
zri CODE
~4"
SUILDING OWNER'S NAME
!>/tor" (D "^ l u....&tl--
BUILDING STREET ADDRESS (lnc:IIRIlrIg Apt.. UIIII. SUite, and/or B1dg. No.) OR P 0 ROUTE AND BOX NO
<'.o,Zo ..AIr1itO~ \""~'E:-
CITY STATE
?t=>4OZ-l "'~1='~b CE-
PROPERTY DeSCRIPTION (lat.1Id 8IDdt NL,. ~....... TIIll Pan;IlI NumIler, Legl1l 0e$crrptJcJn. ea:.)
U:rt to? tbJl l.o\1.1bll.1b ~t> Ai)'D'TJOW, ~,t.J!_ 1c; ~ 1\?t.:..I\,?C; c.)lIuE. ~cu...Tl"
eUILDINGUSE(e g.. RestMnb81 Non......... .....1. AddIIIon.A............D1Y, eIC. lJseCorrJIMIdsl. .;~."IIIy.) PLhT R.e.LDQ.:D~
~e?l ~"'t A~
LA. TITUOEILONG/1 WDt: (l.Ip'TIONAl)
( W - till - .. _ or ,. #INJtIIf)
HORIZONTAL OA TUM
LJ HAD 1921 U HAD 1983
SOURCE LJ qps (Type)
LJ USGS Quad Mlp LJ 0UIer
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) IIFORMATlON
81 NFIP COMMUNITY NMtE & COMMUNITY NUMBER 112. COUNTY NAME I B3. sTATE
~~t..l(;:J~\e.t-b 4's~.."l... ,-~1i-- oeEool.J
84 MAPANOPANEL = SUFFIX B6 FIRM INDEX 87 FIRMPANEL -BILFLOOD 1M 8ASEFlOODI:L.&~I'\'I..,jlJ(S}
NUMBER DATE c:rrcClNE/REVlSeDOATe ZONE(s) (ZgneAO. UBII dep1ft of t100dI/lg)
4' O~G (\ ", f' b "2..~G\ Co 2-"'" ~~et) )C. $\\ .4-
B 1 0 Indlcat. the source of !he Base Flood 8ev8tlon (BFE) data or base flood depth ent8l1ld .. 89.
U flS Profile LI FIRM ~ammumty Determmed U Other (Oesc:rtbe):
1. Indicate the elevation datum used for the BFE In 89" U NGVO 1929 U NAVD 1988 'U Other (OescrIbe) _
., 12. 15 thE building loealed In a Coastal Bamer Resources System (CaRS) area or Otherw"B P.. t,,"~:8d Area (OPA)? U V- ~ No
08Sfgnabon Cate
SECTION C - BUILDING El..CVATION INFORMATION (SURt'EY REQUIRED)
C1 BUilding elevations are ~edon: LJConstn...t-. 0,.... .:........ l,293uildmg Under ConstnJetlon- LlFmlSh8d ConstNcbon
-A new Elevation CertJfic:ate will be requared when c:onstruc:tton of the building Is compl&bl
:2 Budding DIagram Number. -z,. (Select !he buildrng dla.I... mOSl sImilar to the building for which thIS c:ertdicate Is being completed -588
pag88 S and 7 If nO dlClgflllll aa:umtely represents the building. provide a sbllch or p... '1.,~1aph_) -
:3 Elevallons _ Zones A1-A30. AE. AH. A (wfth BFE). VE. V1-V30. V (WIth BFE). AR. ARIA. MJAE. ARlA1-A30. AffJAH. M1AO
Complete nems C~ be/oW according to the buIlding oLagram spec1fieQ m Itent C2. SI8te<the datum used. If the d;ltum/S different from
the dalum used for the BFE in SecUon B. conv.rt the da1um to that used for the BFE. ShoW field measurements and datum cc .. "., Ian
QJlculatJon. Use the space" "'Jsd Of the Comments area of Section 0 or Section G. as...............i.Je.lo doc;ument Ihe datum conversion.
Datum \...f!)(.A1.... C.. ,,""~Co"'m4mts ACt:;) e> 2,' 'rD UlGItrt.. 0"",",,--011\ 'n) ~" 9..e.,.,_"",- bIIr-rvf\ .
Elevatron reference mart used <f,1I:E.. (.o"'''~ Does the e1evabon referen<:e mark used appear~!'!.f.~if~b:J~)~O.
[] a)TopofbodomflOGf(rndudingb85ementorendosuFe)- , ~"-\- _J.e:.fb~ i A~~""'~' :~}--;:...~."~~;-~- ~
[] b) To of next htgtf8l' flOor ~,4 :2... ft.,,.) II) t.. . ~...) .-..h - . ..... , vel' ':If j
p - ~! - ---.....~-~--~-.....;
[] c) Bott.~... ,;"lIowest horrzontaf-struc.1utal m ~ ~"., (V zones only) """ (Ar . --t ft.(In) J! rT\ ()
[] d) Attached garage (lop of $lab) t-lOT a>>\.~. ---: ft.(m) It ~~
o e) lowest elevatIOn of Mac . ~ ~.} andIar eqUIPment . j t
servicing lt1e building Wl:1\CDM.PtAt.11!- . ~ ft.(m) ~ 1i' . . J
Q f) lowest -.scent ...,.".~~ (LAG) c;,('2.. ~ft.(.) z Ii. ~-J:~~_:\:'~ :~~.~~~:
Q g) H'9he&t"';,-..cerigrade(HAG) Sl-? -k ft.~ jaJ ~~"':_"'Z'_~'~'::::;:'.--ij
a h) No. of permanent openmgs (flOod vents) wl(hin 1 ft. above adjacent grade 'ZJ:> ..
C I) Total area of aU pennanent oper'lan9s (ftood vents) in C3h "Z-I"l,.., _ sq. an -(~ em) --- ~. ~l -ZCOL.-
SeCTION 0 - SURVEYOR, ENGINEER, OR ARCHITeCT dERTIFICATION
ThiS certification is 10 be signed and sealed by a land surveYor. {engineer. or architect authonz.m by law to certify elevation Informabon.
csttify that the IfJfonnallOn " Sections A. B. and C on this c~rt1Iicate IfIpresents my best o/frttt$ to IntetpI8t IhfI dal. BVaJabJa.
1 understand thot any ftl/$e .tI1JtemenI may be jUl1lShabIB by.tte or unpnsonmenl und'!!..!!. U.S. CoM. SeCIIGn 1001.
CERTIFIER'S NAME --J()JIo.-~ A.. OA:YX.r? . UU:l~~~~. '%.\01$
- TlE I COMPANY NAME
TI VI2O~t";~~ Urt4b "=OL"E,'('Or2- fP~ ~'N~~'''~O~',~ f~r';,
... . . CITY S'TA1E. ZIP CODE
ADDRESS .p.O .&0'(-- .l.!6.2:1_. . e.v<:c~e..., ~il-' ~n40~
<;IGNATURE \-:-_I~ _ 1 v' .l.t1. D~~ (~.lq '~~ ~
m d 1s'a TO. 61 Ja(I I7l9S-SSI7-117S'xe.:l ~I~33NI9N3 39ljOd
.. <
..
~rj ~i
'PORT ANT: In tttese spaCttS. copy the comspondlng jnfunnabon from Section A.
AlIlDIIIIG sTREET ADDftESS (lndudlng Apt. Unit. Slide. !IlldIor BIdg. ~j vR P 0 ROUTE AND BOXINO
'-1 -z..o ,...,. ~fo-) ~
:ITY STATE ZJPCODE t
?PP-' t.l~1=(~ 0 &.- 1\14'-1 ~
SB;TION D. 5URVEYOk. ~INEI:R. OR ARCHITECT ceATI~TJON (CONTINUeD)
;opy both sides of this Bevabon CertJfic:atefol (1) cammumly ofIic:lal, ro 111St.,........:. agemlco~pany. and (3) building owner
;OMMENTS _ ~
c..o-f Dr -:a.pp..IU(..tr~(~ t5eu(~IW.~ DebC'..,Ajt.t6E.&. ~ I>. G.t+,?~~ ~~
I,.s. ~ -ro~ of: I ,.~ ~ AT ~ M iD Po.....,.. CIF Cf~~ ~T\JIU.! ~ T\t1i ~ "-' .
(.otULf!,2- OF"'T1t€. 'k~~IQt..J. tff= (Ol1!': ~ -Ai\J~1't)~ ~ GIlY t>>n'VJIIo\ ~1Z. &\
1=':e M.I- ,O,,"v'" 1&\2; . \, \ I I Check here if attachments
_ SECTION E - BUILD'N? ELEVATION INFORMATION (SURVEY N.QT REQUIRED) FOA!ZONE AO AND zONE A (WITHOUT BFE)
Jr Zone AO and Zone A (without BFE). complete Items E1 through E4. ,,1h8 &vatlOn C8~ IS ,,", "~I'. t forllH G~,.." '.'
formation for a LOMA or LOMR-F. S6cfion c must be . " , '1'1aI8d.
1 Buddtng Oia,.. ....,,, Number (SeJecr the bulking diagram most SllJIiIar to the budding fer whlch IIn certificate is b8lng...i . .,~ leted -
see pagelS B and 7 "no diagram accurately 1....,=enlS thebuilding. proYld.. sketch or ~ph.)
2 lhe lOP of the bottom floor (including basement or encIa&ute) of the bUIldIng IS f I I tl(m) f I !In (an) LJ above or U below
(check one) the hlghust ad,acent grade.
3 l=or BuildIng Diagrams 6.8 with apemngs (see page 7) the J1ed higher floor or elevated fIoqr (elevation b) of ttte budding 1$
I I I ft.(m) I I ~n.(cm) abtwe the highest adjacent grade. ,
4 For Zone AO only: If no flood depth number. llYallable, 18 the top of the bottom floor elavaled In a.._. .;ance wdh Itle commumty'1
floodplain management orcfinance? U Yes .I..,.J No U Unknown The local official myst c:2I1ify thIS Information In SedKm G
!iECTION F . PROPERTY OWNER (OR OWNER'S REPRESENT ATtvE) CeRnFlCATION
~e propertY owner gr owner'a lI""'On:ed represenlatlve who c:ompleles SedJonll-A. B and e~or ZOne A (WIthout a FEMA-lssUlld or
ommunlty-lssued BFE) or Zone AO must Slgtl herv
ROPERTY OWNEA'S OR UV7vriER'S AUTHORIZED REPRESENTATIVE'S NAMe
,DDRESS
CITY
DATE
STATE
TElEPI10NE
ZIP coDe
,IGNATURe
OMMENTS
I_I Check here if attachments
sEcTiONG'. COMMv~n..., INFORMATION (OPTI
,
e ~I offiaal who 1$ authonzed by law or ordlrnll1C8 to admlru&ter the cornmumty's f1oodpla. anagement onfinance can cgmplebt
dlOns A. B, C (or E), and G ofttus elewtJon C8l'bficate. Complete the applicableltem(.) andiaJgn below.
U The mformatlon In Secbon C was taken from other docum ,,;.. Jon that has been Signed and embossed by a keenSed 8UfWYC'I'.
engIneer. or an:hrted who ill authorized by stale or loc:allaw to ~ eIev&tIon Il1fonnaltlOll (Indicate the source and dat8 of the
elevabon data In the Comments area below )
I U A commumly offiaaJ completed Sedton E for a bulldcng located in Zone A (WIthout a F~ssued or community-Issued BFE) or
Zone AO.
I U The folloWIng informatIOn (Items ~ IS provtdBd for wmmunlty floodplain managerrient JMlIOS8S,
.. PERMIT NUMBER ~ UAIC ;;i;i(Ml'i' ISSUED I bb. UA'i"c \,oeRTlr,CATE OF (;6MPJJAM:i~i\A:WpAI\ICY
ISSUED
. lhls pennd has been Issued for. U New ConstnJdIOn U SubSlanballmpravement
Elevation of as-built lowest fIgOr [mcludJng basement) of the building IS
BFE or (in Zone AO) depth of flooding at the bullc1lng SJt8 IS:
JCALOFfIClAL'S NAME
_ fl(m) DiJIum;
_ft.(m)Oatum:
TITLE
DMMUNITY NAME
TELEPHONE
GNA TURE
DATE
:)MMENTS
.
I Check here If attachments
A~PI Ar.F~ All PRFVlOt Leo t=nITtn......q
.AA Ftvm ^1..~1 AII~ $IQ
t70'd
~s G1 10. 61 Jaa
.
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