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Home My WebLink AboutFEMA Application 1999-6-2 FEDERAL EMERGENCY MANAGEMENT AGENCY NA TIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important Read the InstructIOns on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION -BUILDING OWNER S NAME C> I LL.:-( T ~ c ""'<'1 ~ BUILDING STREET ADDRESS (Including Apt, Unrt SUIte and/or Bldg No) OR P 0 ROUTE AND BOX NO Co, 0 8 A A.a...oN L-~N c CITY STATE S~IN~E=16...o O{2.. PROPERTY DESCRIPTION (Lot and 810ck Numbers Tax Parcel Numberl~gal Description, etc) LO, \04-- LEVI l.-I"\t--lDI\J t::;: "2.-"=- F\o~rT\b~ BUILDING IlSE (e 9 . Residential, Non-residential. Addition Accessory etc Use Comments section ,f necessary ) Kl:: S'O~t->,I~,- LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM SOURCE U GPS (Type) ( ##0. ## - ## #It- or #It #####j t1S-NAD 1927 U NAD 1983 U USGS Quad Map SECTION B. FLOOD INSURANCE RATE MAP (FIRM) INFORMATION ~:a<:.'9 1-:> o M B No 3067-0077 Expires July 31 2002 I-For Insurance Company Use Policy Number [~nipanY N~IC Number ZIP CODE 4',4-1& UOther B1 NFIP COMMUNITY NAME & COMMUNITY NUMBER "S.PRIN.<:::;f'1I5...,t:) 4-1"$ S., 1. B2 COUNTY NAME L-.NJ.i:: ~~ S1"A'rE O~ . B4 MAP AND PANEL 85 suFFIX B6 FIRM INDEX B7 FIRM PANEL 88 FLOOU NUMBER _ DATE EFFECTIVE/REVISED DATE ZONE(S) +Ic~" C \\<.:.1 r J...-..Je:- ?",I,..,., Jv.....c 2., \9"Y" Ac B10 IndIcate the source of the Base Flood ElevatIon (BFE) data or base flood depth entered In 89 LJ Frs Profile U FIRM ~Communrty Determined U Other (Descnbe) B11 Indicate the elevation datum used for the BFE In 89 ~GVD 1929 U NAVD 1988 U Other (Descnbe) B12 Is the bUilding located In a Coastal Barner Resources System (CBRS) area or Otherwise Protected Area (OPA)? DeSignatIon Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) ilolng elevations are based on LIConstructlon DraWings. LIBUlldlng Under Construction. LIFlnlshed Construction . A new Elevation Certificate Will be requrred when construction of the building IS complete C2 BUilding Diagram Number 8 (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, prOVide a sketch or photograph) C3 Elevations - Zones A1-A30, AE, AH, A (With 8FE), VE, V1-V30, V (With BFE), AR. ARIA. ARlAE, ARlA1-A30, ARlAH, ARlAO Complete Items C3a-1 below according to the building diagram speCified In Item C2 State the datum used If the datum IS different from the datum used for the BFE In Section 8, 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 0 or Section G, as appropnate, to document the datum conversion Datum Conversion/Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? U Yes ~ No o a) Top of bottom floor (including basement or enclosure) 51'2.. l ft (m) ro o b) TOp of next higher floor ,,::>, S ll.. ft (m) ~ -e ,,) OUllU,,1 vi IU\'Yt;;;;,,11Ul ,zontal st, UlAUI dllllt::IIIUt::1 (v" LVlle" v.-,::,") . _ft (m) ~ ~ o d) Attached garage (top of slab) 51"';:. .f:L ft (m) ~-g o e) Lowest elevation of machinery and/or equipment ~ : servicing the bUilding N fA. _ ft (m) ~ ~ o f) Lowest adjacent grade (LAG) S l""".::l .:I.- ft (m) ~ ~ ~ ",U) o g) Highest adjacent grade (HAG) S(~ --L ft (m) ~ o h) No of permanent opemngs (flood vents) within 1 ft above adjacent grade 4 :3 o I) Total area of all permanent openings (flood vents) In C3h 10 \ \ sq In (sq em) C 1j9 BASE FLOOD ELEVATION(S) (Zone AO, use depth of flooding) "S \.\ 7- LIYes ~No '" " REGISTERED PROFESSIONAL '" "lJ:.:~l[) ?ur):,~ ~~~ ."\j OReGON FE8 19,1S99 JAMES lY'V. COLTON 'llo ....... #58756 , SECTION 0 - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION 2.x..?lltC'<;> )'2./31 f 0) ThiS certification IS to be SIgned and sealed by a land surveyor, engineer, or archItect authonzed by law to certcfy elevation information I certify that the mformatlOn In SectIOns A, B, and C on thiS certificate represents my best efforts to mterpret the data aV8llable I understand that any false statement may be pUnishable by fine or Impnsonment under 18 US Code, Seclion 1001 C elER S NAME C LICENSE NUMBER j -->AI'''e~ \N . elL-TON O~ ,L':> · 5~1 '5~ TITLE" L~o S,,(2...-J f:-'(o1Z. COMPANY ~~ _ NE 'S.~ _ 'F~";) :S&N,DCet. ADDRESS. .,..,..,'1.'5 CITY_ ~ STALE ZIPCODE... ..1_ \-,.6 ~)( ,,~, J t:-l.)G~c CK. ~ll'-l'- ....... - SIGNATURE L-... \... U DATE I /2~/o,- TELEPHONES4-1 ~4-f- \a5L FEMA Form 81- ,AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT In these spaces, copy the corresponding InfonnatlOn from Section A BUILDING STREET ADDRESS (Including Api Un/I SUlle andior jjidg No) OR P 0 ROUTE AND BOX NO ~ 10 ~ t\^P.~N L_A,NC CITY ::iTAl E ZIP CODE ~RIN <:A flD-9 <::::) 1-. C\) 41 ~ For Insurance Company 0S& Policy Number ~ ] Company NArc Number r 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 the ElevatIOn Certificate IS mtended for use as supportmg InformatIOn for a LOMA or LOMR-F, SectJon 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) =2 The top of the bottom floor (including basement or enclosure) of the bUIlding IS I I J ft (m) I I 1m (em) U above or U below (check one) the hIghest adjacent grade =3 For Zone AO only If no flood depth number IS available, IS the top of the bottom floor. elevated 10 accordance with the community's floodplain management ordmance? '-_I Yes I 'No I I Unknown The local offiCIal must certify thiS mfonnatlon In Section G SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authonzed representative who completes Sections A, 8, and E for Zone A (without a FEMA-Issued or communIty-Issued BFE) or Zone AO must sign here PROPERTY OWNER S OR OWNfih; AU1'HORILED REPRESENTATIVE'S NAME ADDRESS CITY s'r A T~ ZIP CODE ,~ATURE DATE TELEPHONE COMMENTS SECTION G. COMMUNITY INFORMATION (OPTIONAL) le local offiCIal who IS authonzed by law or ordinance to admlnrster the community's floodplain management ordmance can complete 2ctlons A, B; C (or E), and G of thiS Ele\'atlon Certificate Complete the applicable .tem(s) and sIgn below 1 LJ The mformatlon In Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who IS authonzed by state or local law to certify elevatron information (Indicate the source and date of the elevation data In the Comments area below) 2 LJ A Community offiCIal completed Section E for a bUIlding located In Zone A (without a FEMA-lssued or community-Issued BFE) or Zone AO 3 U The follOWing informatIon (Items G4-G9) IS prOVided for communrty floodplain management purposes ;4 PERMIT NUMBER G5 DATE PERMIT ISSUED G6 DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED I ThiS permit has been Issued for U New Construction U Substantial Improvement 3 Elevation of as-bUilt lowest floor (mcludlng basement) of the bUilding IS J BFE or (In Zone AO) depth of flooding at the bUilding site IS I_I Check here If attachments _ ft (m) Datum _ ft (m) Datum lOCAL OFFICIAL'S NAME 'OMMUNITY NAME TITLE TELEPHONE IGNATURE DATE OMMENTS \ v1A Form 81-31, AUG 99 I_I Check here If attachments . REPLACES ALL PREVIOUS EDITIONS