HomeMy WebLinkAboutFEMA Application 1999-6-2
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
Important Read the Instructions on pages 1 - 7
SECTION A - PROPERTY OWNER INFORMATION
BUILDING OWNER S NAME
S\2.l,"Ck... \.C..L t ~~tz.;:\ CU~ -ro n.\ ~ Il.le. L';:,
_ BUILDING STREET ADDRESS (Including Apt, Unit, SUite, and/or 81dg No) OR P 0 ROUTE AND BOX NO
C{,,?q 0lTIt- PLk:k-
CITY STAlE
-?f>a-t \.l4 F1 ~ O'C'-
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Descnptlon, etc)
lOT '0'"") LR..J..l \ U\-I-i~ lUG m~ Mh rlLC."1S"7;.Li ~~ l~S2.-ll SC;
BUILDING USE (e g, Residential, Non-resIdential, Addrbon, Accessory, etc Use a Comments area, If necessary)
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LA TfTUDEIlONGITUDE (OPTJONAL)
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o M 8 No 3067-0077
Expires July 31,2002
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ZIP CODE
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cA-uiZ.. CO Vl..A=l !2-E-'(~'~
HORIZONTAL DATUM
LI NAD 1927 LI NAD 1983
SOURCE. LI GPS (fype)
Ll USGS Quad Map LI Other
SECTION B - FLOOD INSURANCE RATE MAP (fiRM) INFORMATION
81 NFIP COMMUNITY NAME & COMMUNITY NUMBER I B2. COUNTY NAME 83- STAlE
? P i2-i ~4 Fl ~ 4t 5542----1 - u\r..(.L Ct2-
B4 MAP AND PA,'lJEL 85 SUFFlX B6 FIRM INDEX 87 FIRM D<\NEL B8 FLOOD B9 BASE FLOOD ELEVATION(S)
NUMBER DAlE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth offloodl'1g)
4\C:R c. it tol .:p - 0- z.Ltq 0<- 2-.qc.., 5 rz.. . \
B 10 Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered If'l 89
_ I_I FIS Profile LI FIRM ~Communrty Determmed I-I Other (Descnbe)
B 11 Indicate the elevation datum used for th;SFE In B9 I_I NGVD 1929 I_I NA VD 1988 IF! Other (Descnbe)
~2 Is the bUilding located m a Coastal Barner Resources- System (CBRS) area or Otherwise Protected Area {OPAl?
DeSignatIon Date
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1 Building elevations are based on 1_IConstructlon Drawlngs* [_IBUlldmg Under Construction> I2:lFmlshed Construction
>A new Elevation Certificate wlII be required when construction of the bUIlding IS complete
C2 BUilding DIagram Number 'Z.- (Select the bUlldmg dIagram most sl~IIar to the buIlding for which thiS certIficate IS bemg completed - see
pages 6 and 7 If no diagram accurately represents the bUilding, prOVide a sketch or photograph)
C3 Elevatlons _ Zones A1-A30, AE, AH, A (With BFE), \IE, V1-V30, V (wrtf1 BFE), AR, ARiA, ARfAE, ARlA1-A30, ARlAh, ARlAO
Complete Items C3 a-I 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 D or Section G, as appropnate, to document the datum COiiverS,Oii
Datum LOCk..... Converslon/Comments./-!\)\) D '?' 'l'O ~ ~At\'(,JW\. 'IV r:?~ t_t::..IA-.A". b,A-t-vw--
E1evatlon reference ~ark used ~ cc."'-M-~? Does the elevation reference mark used apper~~""'E..~~~t.;l~)f~
o a) Top of bottom floor (lncludmg basement or enclosure) 0\'2... L ft ~ Iii I jj-!11",,~&~' "',,..~~... >',,- ~A=-
~ & Q,} 'o:l lit- h.1!:J QAt> :troi''''' ...\.kt......~~ C~"l"w~
o b) Top of next higher floor - J\ '";::) ...=L ft~) ~ ~"'-~"'< . - "-' i' pi< r~ . <~~.~....
o c) Bottom of lowest honzontal structural member (V zones only) ~ I p..". _ ft em) ~.; .-
""' 00
o d) Attached garage (top of slab) -.::> \4' ~ ft ~ E -g
o e) Lowest elevation of machinery and/or eqUIpment ~..;
servlcmg the bUilding (DeSCribe In a Comments area) Sf-=::>:L. ft ~ ~ ~
o f) Lowest adjacent (finished) grade (LAG) S ['? l ft.(~ ~ E>
~ oW
o g) Highest adjacent (finished) grade (HAG) -=l"? Q ft~) [!!
o h) No of permanent opemngs (flood vents) Within 1 ft. above adjacent grade t 0 ~
o I) Total area of all permanent openings (flood vents) In C3 h \~Z2- sq In (~)
~
1-1 Yes ~o
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SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
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 rn SectIOns A, B, and C on thiS certificate represents my best efforts to mterpret the data available
mderstand that any false statement may be punrshable by fine or Imprisonment under 18 U S Code, Section 1001
.=RTIFIER'S NAME I A n. _ LICENSE NUMBER
"'----" ~ ~? c:;:rn_ L..--.S -sl:'2...lo':';
TITLE COMPANY NAME r
.p~"'S>SfO~ ~~ ~""[)~~........-((::nL. .\?Dkc.t.S- e.w..( [u."GE:.t>--tLLf'. 4r ?0'2.>-.LE.-{/J..J.(" l'k!:.(
ADDRESS . CITY - STATE \ 'ZIP CODE
_ -V-D ~\L. Z;::-'OQ.:G..1 \?..-UG.E:-wE- Cl;2- q(40~
SIGNATURE . t" ~ ,".PI _' ^ .... - DATE _ _ TELEPHONE
........ ~~ &..~ 3-Z-'l.1....'? 9-\-4-'DS-4~5
~~hAI\ ~"nT\ R1_':i1 1111 no SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
IMPORTANT In these spaces, copy the correspondmg mfonnatlon from Section A '~t..o~rlJ.~g::~9~~rnffiifi~~~~~~fr3'
BUILDING STREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg No) OR P 0 ROUTE AND BOX NO
Q"'?9 ~'"1~ p~
Cm' STATE ZIP CODE
?PIUJ..i.4~\ E.t.....v~' Dt2- "'f1~(~ 1-
SECTION D _ SURVEYOR, ENGINEER, OR ARCHITECT CERTIACA TION (CONTINUED)
Copy both Sides of this Elevation Certificate for (1) community official, (2) Insurance agent/company, and (3) buddIng owner
COMMENTS
c.,c,-r ~ ~C24l-4'-~\"c(A', 'BE?.-AVM M.>~<- be<'":::>~eC--/\ ~ ~ c..-tA-\'"'::>~ ~-
. ". -. - .
l\-.L ~--' 11)P CJ1:- nK:.. ~ ~ ~_ JMtt:> PDI ~ T <n= ~ CLfe-6 (2..€:W ~ k=r ~
~V~\'('Le.':), Cut2.-N..t..Q... ~ ~ l4\8!2.-~lUW. ()F.- 0~~ -nhJ12...7\1)~ \2.0_ 'EL srz. SO\
1_1 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 E 1 through E4 If the Elevation Certificate IS Intended for use as supportIng
Information for a LOMA or LOMR-F, Section C must be completed
E1 Buddmg Diagram Number (Select the bUilding diagram most Similar to the budding for which this certrficate IS beIng completed-
see pages 6 and 7 If no diagram accurately represents the bUildIng, provide a sketch or photograph)
E2 The top of the bottom floor Ctncludmg basement or enclosure) of the buildmg IS 1-1_1 ft(m) I_I_1m (cm) 1-1 above or 1-1 below
(cheCK one) the hIghest adjacent grade (Use natural grade, If.~vallable )
E3 For BUlldlrg DlagraJTls 6-8 with openings (see page 7), the next higher floor or elevated floor (elevatton b) of the bUildIng IS
1-1-1 ft (m) 1_1_IIn (cm) above the highest aOJacent grade Complete Items C3 hand C3 Ion front of fOf1Tl
E4 For Zone AO only tf no flood depth number IS avaIlable, IS the top of t'1e 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 REPRESENTATNE) CERTIFICATION
The property owner or owner's authOrized representative who completes Sections A, 8, C (Items C3 hand C3 I only), and E for Zone A
(Without a FEMA-Issued or community-Issued 8FE) or Zone AO must sign here The statements m SectIOns A, 8, C, and E are correct to
the best of my know/edf)e
PROPERTY OWNER'S OR OWNER S AUTHORIZED REPRESENTATIVE'S NAME
SIGNATURE
COMMENTS
CITY
DATE
STATE
ZIP CODE
ADDRESS
TELEPHONE
I_I Check here If attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local offiCial who IS authonzed by law or ordinance to administer the community's floodplain management oralnance can complete
Sections A, B, C (or E), and G OfthlS Elevation Certificate Complete the applicable ltem(s) and sign beloW
G1 I-rThe information 111 Section C was taken from other documentation that has been slgn,ed 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) ..
-G2 1-1 A community offiCial completed Section E for a bUilding located In Zone A (WIthout a FEMA-Issued or community-Issued 8FE) or
Zone AO ~
G3 I_I The following Information (Items G4-G9) IS prOVided for community floodplain management purposes
G4 PERMIT NUMBER t G5 DATE PERMIT ISSUED I G6 DATE CERTIFICATE OF COMPUANCElOCCUPANCY
. ISSUED
G7 ThIS permit has b~en Issued for I-I New Constructton l-l Substantial Improvement
G8 Elevation of as-bUilt lowest floor (including basement) of the buIlding IS
G9 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
TELEPHONE
SIGNATURE
DATE
COMMENTS
.:
I_I Check here If attachments
REPLACES ALL PREVIOUS EDITIONS
FEMA Form 81-31, JUL 00