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Home My WebLink AboutFEMA Application 1999-6-2 ~'86""\.IO .. - FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM o M B No 3067-0077 Expires July 31, 2002 ELEVATION CERTIFICATE Important Read the instructIOns on pages 1 - 7 SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use . . - ......... . t-'Ullcy JIIumoer BUILDING OWNER'S NAME e'" K^,\' ~ L.\ ~~ Dup,- \ BUILDING STREET ADDRESS (Including Apt, Unit. SUite, and/or Bldg No) OR P 0 ROUTE AND BOX NO Go1o ~ 1\f\C40"-J ~~e: CITY STATE SpiZ.,INaflleV:;l Cf.l. PROPERTY DESCRIPTION (Lot and ~Iock Numbers. Tax Parcel Number\.~gal Descnptlon, etc) loC'" 41 l..CV\ '-"c-..1[:)1 \0.,\ ~ 1.,IloI:. "'Qo~\1'\~~ . - BUILDING U.SE (e g , Residential, Non-residential, Addition, Accessory, etc Use Comments section It necessary ) R.~SlcE","'I~ LATITUDE/LONGITUDE (OPTIONAL) ')G HORIZONTAL DATUM SOURCE I_I GPS (Type) ( ##0 _ ##' _ ## ##" or ## #####0) ~NAD 1927 U NAD 1983 U USGS Quad Map Company NAIC Number ZIP CODE ." 4-12. LI Other SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1 NFIP COMMUNITY NAME & COMMUNITY NUMBER -s.pRINC::::;f'I~ 41-$~., 't. B2 COUNTY NAME L....N-1.E B3 STAll:: oi2- . B4 MAP AND PANEL B5 SUFFIX B6 FIRM INDEX 87 FIRM PANEL B8 fU)UC> NUMBER _ DATE EFFECTIVE/REVISED DATE ZONE(S) f\o~~ C \\<..1 r J..Ne: t.lI~",\""I JuNC 2., \9"'" Ac B10 Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered In B9 I_I FIS Profile I_I FIRM IRCommunlty Determined U Other (DeSCribe) B11 Indicate the elevation datum used for the BFE In B9 !B-NGVD 1929 LI NAVD 1988 LI Other (DeSCribe) B12 Is the bUilding located In a Coastal Barner Resources System (CBRS) area or Otherwise Protected Area (OPA)? DeSignation Date B9 BASE FLOOD ELEVATION(S) (Zone AO, use depth of flooding) ':Ill +- I_I Yes I~No SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) G ..Julldlng elevations are based on LiCo lStruC!lon c,rawmgs. L1Bullolng Under Constructlon* LlF.'"1,shed Construction . A new Elevation Certificate Will be reqUired when construction of the bUilding IS complete C2 BUilding Diagram Number g (Select the bUilding diagram most Similar to the bUilding for which thiS certificate IS being completed - see pages 6 and 7 If no diagram accurately represents the bUlldrng, prOVide a sketch or photograph) C3 Elevations - Zones A1-A30, AE, AH, A (With BFE), VE, V1-V30, V (With BFE), AR, ARIA, ARlAE, ARlA1-A30, ARlAH, ARlAO Complete Items C3a-1 below according to the bUilding diagram speCified rn Item C2 State the datum used If the datum IS different from the datum used for the BFE rn Section B, convert the datum to that used for the BFE Show field measurements and datum conversion calculation Use the space prOVided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion Datum Conversion/Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? LI Yes I~ No o a) Top of bottom floor (including basement or enclosure) S \ ~ 2.. ft (m) m '" o b) Top of next higher floor S ICe. -.L ft (m) ~ I REGISTERED ' -c Jj ~J~lv", vf l.Jvvt::~t ho~lzomal struv~;.;;~1 ",,,,,,.Le.,--(\' Z6r:18& MI~,) _ ft (m) j ~. PROFESSIONAL o d) Attached garage (top of slab) "5 \4- ~ ft (m) JJ ~ i LAND SUR\.a:vOR o e) Lowest elevatIon of machinery and/or eqUlpmentE ~:;; ~~ '~...... ... t'-'.' -_/.':ti':.} ... servicing the building N. / f\ _ ft (m) -.u . . . ~ '--"\ \...X- o f) Lowest adjacent grade (LAG) 5 \ 4- ~ ft (m) ~ ~ 'l' ( -.-\.. DREGOr,; . o g) Highest adjacent grade (HAG) "'5 14- ~ ft (m) ~ '-..J FEB 19, 1999 . ~ o h) No of permanent openrngs (flood vents) Within 1 ft above adjacent grade c:; 1! JAMES \-V" COLTON . ..J #58756 . o I)Totalareaofallpermanentopenlngs(f100dvents)rnC3h It::>1\ sq In (sq em) . .._.... ......_... .... + SECTION D - SURVEYOR. ENGINEER, OR ARCHITECT CERTIFICATION ~?\(tE~ 1"l./~11 o} ThiS certification IS to be Signed and sealed by a land surveyor, engineer, or architect authOrized by law to certify elevation information I certIfy that the mformatlOn m SectIOns A, 8, and C on thIS certificate represents my best efforts to mterpret the data avaIlable I ""derstand that any false statement may be pUnishable by fine or Impnsonment under 18 U S Code, SectIon 1001 -IFIER'S NAME C 'T' LICENSE NUMBER ..JAt'\e~ W . C\.;.ON o~ . L~ *' '5~1~~ TITLE L~o :s.\llZ-~ e-"(o1Z, COMPANY NA~\tP - N E "S.~ - 'F~ ~ s &""OelL ADDRESS. ru. 1.'2"l~ '5 CITY - - - STArt ZIP CODE... .A _ '- V.~, u-->)C ....... ~__ l:.uG~c C . Y, -, 'T') SIGNATURE~ ~. ~ DATE 1/2.~/c"'L. TELEPHONES4-\ . ~++ \~St. FEMA Form aW AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS' ~ .", . IMPORTANT In these spaces, copy the correspondmg mfonnatlon from Section A . . - - - - -. .-- ... BUILDING STREET ADDRESS (Including Apt Unit SUite, and/or Bldg No) OK fJ U KUU I t: ANU BOX NO Go"1~~ ~O~ Lc..~e CITY E..UGe-. E For Insurance Company -;Jse. Policy Number STATE Cl2.. ZIP CODE ,14 '1~ Company NArc Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) Insurance agenVcompany, and (3) bUilding owner COMMENTS I_I Check here If attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO and ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1 through E3 If lIle Elevation Certificate IS mtended for use as Supportmg mformatton for a LOMA or LOMR-F, Section C must be completed E1 BUilding Diagram Number (Select the bUilding diagram most Similar to the bUilding for which this certificate IS being completed _ see pages 6 and 7 If no diagram accurately represents the bUilding, prov~de a sketch or photograph) E2 The top of the bottom floor (including basement or enclosure) of the bUilding IS 'I 1ft (m)1 I 'In (em) LI above or U below (check one) the highest adjacent grade E3 For Zone AO only If no flood depth number IS available, IS the top of the bottom floor elevated In accordance With the community's floodplain management ordinance? I_I Yes I_I No I_I Unknown The local offiCIal must certify this information In Section G SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authOrized representative who completes Sections A, B, and E for Zone A (Without a FEMA-Issued or communitY-Issued BFE) or Zone AO must sign here PROPERTY OWNER'S OR OWNER'::; AUT'H6RrZ~D REPRESENTA:T1VE'S NAME ADDRESS Co.." , , 51ATt:: ZIP CODE SIGNATURE DATE TE:LEPHONE COMMENTS I_I Check here If attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) fhe local &fficlal who IS authonzed by lay or ordinance to administer the community's floodplain management o"~lnance can complete Sections A, B, C (or E), and G of this Elevation Certificate Complete the applicable Item(s) and sign below G1 U The Information In Section C was taken from other documentation that has been Signed and embossed by a licensed surveyor, engineer, or architect who IS authOrized by state or local law to certify elevation information (Indicate the source and date of the elevation data In the Comments area below) 32 U A community offiCial completed Section E for a bUilding located In Zone A (Without a FEMA-Issued or community-Issued BFE) or Zone AO 33 U The follOWing information (Items G4-G9) IS prOVided for community floodplain management purposes G4 PERMIT NUMBER G5 DATE PERMIT ISSUED G6 DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED 37 ThiS permit has been Issued for U New Construction U Substantial Improvement 38 Elevation of as-bUilt lowest floor (including basement) of the bUilding IS 39 BFE or (In Zone AO) depth of flooding at the bUilding site IS LOCAL OFFICIAL'S NAME TITlE _ ft (m) Datum _ ft (m) Datum COMMUNITY NAME SIGNATURE COMMENTS TELEPHONE DATE EMA Form 81-31, AUG 99 ~ I_I Check here If attachments REPLACES ALL PREVIOUS EDITIONS