HomeMy WebLinkAboutFEMA Application 1999-6-2
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FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAl. FL.OOD INSURAHCE PROGRAM
ELEVATION CERTIFICATE
o M B No 3f;67-oon
Expirei July 31, 2002
Important: Read the Initruebons on pa,SeJO 1 . 7
seCTION A. _ PROPERTY OWHeR IHFOJUi&A. TlON
BUlLOlNl; ~ S NAME
'B~ \.d lF~ CU~i1)M ~~
BUILOI~ l:> I rtl:l: J....... ~SS (IndudatlQ ~ Und. &la, and/Qr 8ldg No) OR P 0 ROUTE AND iJQX NO
~~( ,,~ ~
CITY STATE
?PC2.-<~f-l~ OIL.- c:t14"'\b'
l11f~~oes~t~~~~T~N~tD5'.';U~~ 1\'5"2-1155 llO-Lt:. CD ~~
BUILDING USE 18 g , Ke$IlIonUl, Hcrw~ AQdlIlon, ~ au:. U30 /I C, . ms arM. II ~ )
~1~7(M-
LAT1~~ (OPTIONAl-) HORIZONTAL DATUM ;"'iJRCE. Ll COPS (T)Pe)
( W. tJtf ." till' or ...,."., L-J NAO 1927 1..-1 NAO 1983 L-l uSGS C&Iad IoIoJp l-J Of.r
SECnoH B _ FLOOQ.IHSURAHCE iUTE MAP C,!"iRJII) INFORMATION
-81 -NfIP COMMUNfTY NAME & COMMUNITY NUMBER [ 82. couNTY NJUAE ~FSTATE
-6P~Io-LOFt~ 6k~"2.. ~~ O~
54 MAP ANU p~' ~B5. SUfFIX 6l$. ARM lNOEX " 67 FIRM PN13- ~ M FlooO IW ~OOO a!VATlON(S)
NUMBCR DATE EFFE~ DATE ZDNE{S) (Zoo.1J:J 1M ~ gf fIog(Sng)
4-l0~v(\tq1 . 1= ~-'Z-~'1. ro..2-4~ .~ >' '5\"2.-0
810. IndlQJte the 50~ or the Basa Flood Elevation (aFE) claIM or base 1Iood depth 8I1lMed In 8a .
1-1 FIS Profile L-I FIRM I2ft.communrty DeUtrmmed L-l Other (o-cnbe)
811 lndll:aw the elevatlOndalwn used forth;SFE In 89 I_I NGVO 1929 l-I NAVe 1983 ~0Ihet(De.iQl~) ~
- ~ 812 Is the bLJIldlng IocBt8d III a Coutiill Barner RMo~ Sy$tOm (CaRS) IIroll or OthelWl&ct Protea8d NN (CPA)' L-J Yea ~
D6aJgnaUon Date: r .
SSCTlOH C" BUILDING ~AnON INFORMATION (SURVeY REQUlRa))
C1 Building elevabOoa are baSed on LICanall'1JCllOO Orawlng:i" L-lBulldlng Under ConaiNCtJOtl" L#lIll4t'ood ~
"'A new Elevation CartlrlC8te 'Mil be r.qutred wnan cona\1uCtlOO of ll'lO bUlld.ng 15 complete
';2 BUildIng Dlllgnlm Number -z.. (SeIe<:1 the bUlId'.ng diagram moil sundar tD VlG ~ldIng fat wf\ICtI U\Ii ~ IS Oell\Q completed. 'w
pagea 6 and 7 If no d1i19f11m ~alaly represents the building, prOVlOlt a i~atch or photograph )
C3 E1evallons _ Zones A1.A30, AE. AH. A (WIth 8FE), VE, V1-V30, V (WIItI BFE), AA ARJA. ARJAE. AAlAl...ul, ARJAH. APJAO
Complete llama C3.a-l belowac;cordulg 10 !he buiIdlng diagram apaalied In /tam C2 Slate !he dOl!Um ~ If ll'II cloillum .. ddteronl from
the clatum used tor the 8FE In SectJOn a. convert the datum Ia Ulal ~od fo{ the SFE. snow field ~.1IlClIlI:i .nd datum ~ersIOI\
calculation Use the space provided or the Comments arBa of Section 0 0( SQQWi\ G as apptOpNla, tD d~ tne d~ CQlWIf1,lO(I.
0a1Um ~ Convef5lonlCommentl ID l):~' 11) ~ ~~ ~ -ro
8evabon reference marl( ~~ the elevatIOn ~.ence maI1C ~ *-.~~O~
o a) Top of botloo1 ncor (IncludIng basement or enclosure) f5 ,'- .? tl.~ i '. L.k~. ~",,'~'.f!:. \ :;<<
a b) Top 0( nolC% highat noar ~\S- .2.. tt.p.t .. .
a c} Bonom or 1oweet~~1 strueturaJ member (II zonai only) 'j.jJ1J. - ft.(m) j j ~Qt' . -
Q d) AtlaQled garage (lop 01 slab) S l~ .!Q tl.{., ~ ., I - I Q
Q 8) ~ elevatlon of madlIo.ry and/or eqUIpment - .. -.J ~
sarvlclngthebUlldlllg(~sc:t1bainiCommeotulll&.) '51~. :Lttt-t J ~" .' c:~y"",,'e .~. ,I
Q f) Lowest adjaWnt (r.nlShed) grade (LAG) ~,~ JQ.. n.. j .. f' ! 1.1. ,'~
a g) HlQhest adjacent (fiOlshed) grade (HAG) ~,~ ~ rt(m) ~. \. JONA I t\r'~~I"" ..:f~ ~
'1 h} No of pennanent O~i (flood 11(015) 'Wl1Jlln 1 n. abolle ~acant grade 1"'5! I . - il
o I) Total area oraD pennanemopenlng. (nooa vcntll) In C3 h \ '0, 5Q ,n: .".' ) ~~ ~( ~
seCTION D _ SURVEYOR,: ENGINEER, OR ARCHiTECT CERTlFICA noN
This certlficabon ,s to be $lgned and sealed by a land 5urwyor, 8nglOoor or arcl'IltaCt authorIZed by ~ 10 ccr1Ify alevallon lllIonnat.Qn.
I certify that 1M lIl/Dlmstlon III S~ A. B, N1d C on tiu$ ~J. '.p1l1$ent~ my bHJ ./forl~ ID II'I~ rn. Q.atJt .~
J understand tJl81snv false $taJflment msY be OlJll/iflablfl tlV finlj nr smC1rlsonmel11 undor 18 U S ~ &:cbon 1001
CERllFIER'S NAME - . . . . ,. LJCfNSf ~
Tm.i ~~~ -A, ~..r~ . oa- (.....7 - 'Z.-\OS ,
P~>'A'C1o-1.tIc\- ~~\)~f..'"(0tL COMP~\.. ~d~~~- J:. ~I-eu~..:rl~ I~.
AOORfSS 01'( SIAlt.' bo~
P.D bl:>'1'-~" A r;o6~f- C1f2- .q'''-o-Z.
lIGNATURE........:.~~ ~~ ~CA~ ~? ~~e~~~s"
FEMA Fonn 81..31, JUL 00 SEE REVERSE SlOE FOR CON'IINUA'j ION REPlACES AL.L PREVIOUS EDlnONS
/
..;i
IMPORTANT. In these :ipacelt, copy the COIT1tspondlng Information from Sedion A. tf~~~~~ :~,~
aUILDINGjiTREE'T AOQRSSS (lndudlng AIX LJn-. &.clo. ~ BJdg No) OR P 0 ROVTEMO &OX NO ).~.~ : J\F;t:C-i\...bt~
q~l ",--m- PI.A\"t.L !~,,~
~Dtu1014 'F-&,vO . ~ '\ '1L.\?O ~,~cooe.-- "', - '~.'
SeCTION 0 - SURVEYOR. ENGINEER. ORARCHlTECT CERTlFlCAnON (COHnHUfD)
Copy both sIdeS 01 ttua elevation Can/fic:ile fot (1) commuOlly o1rlClal, (2) Insurance lIgellllcomlWlY. and (3) bu~dIng owner
CX)MMI;;NTS .
~ ot:....-?Pi4~~~ ~bt~ D~€:.~ ~ A. G~~~ -:Q~~'-
fj.L 1*e-"TOP Of- ~ cu-a.e (~ ~ iJ.\DPCCUT r? t*E- CJ.J~ ~ ).n ~ ~"""~'ST
COIULeA- ~F-~ lU~~TlOU. m: ro,~ + ""'TltVYViTO~ p.olwi) ~. S\'2.-~\
. ,__, ChodC her. d anadlmenta
SECTJON E _ BUILDING EL.EVAnON INfORMATIO~ (SURVEY NOT RfQUIRfD) FOR ZOHE AO AND ZONE A (WITHOUT Ble)
For Zone AO and ZOne A (Without BFE) complete llama E 1 Waugh ~ It \he Elevabon CettltlC41te IlIlntenoed fer ~ is luppa1lrtl
InlormatlOn fDr a LOMA or LOMR-F, SectKlll C muat be completed
E1 Budding Diagram Number (Seiectthe buildIng dIagram mo&t smJarto ltIe bUIlding forWfllCh this cor1lflQl1e Ia betl'lll ,. ..~'. Jod-
sat! pag8.i 6 and 7 If no diagram 8CQ.I~ represents the bUlIdItlg. pro.,.~ a skotch 0( phoIDgrapI\ )
E2. Tt\e top of th8 bOUcm floor (If\~ulQ basement 0( .nc:iOsure) 0{ U"III bulk1ang 1$ l-l-I ft.(m) Ll-Itn (<:rn) U aoo.... Of LI belOW
(chec:k one) the hlgheal aq,acent grade (UM nawr.al grade, If ava.lablta )
E3 For Budding Otagrama 6-B wrth open.nga (Me page 7). the MXt higher floor or al8valad noor (elevatIOn b) ci the bI.llldang III
Ll-I ft.(m) , I IIn (em) above the highest adjacent grade Complete 1lil1\>> C3 h ar4 C3J go fronl of farm.
E4. FOl Zo". AO only If no flood lHIplh numL)er l& available. 15 UlG top of Ine bouom noor elevated 10 ._danCe wdtl1hc c:omlmlMy'l
ftoodplaln mSMqemant ottIlIlanee71_,/ Yes , I No I I Unknown Tile local otticieI mUll! certltot 11'115 InlormatlOn In Sec1lon G
SECTION F - PROPeRTY OWNeR (OR OWNER'S IU!PRESa4T~llVE) CERTlFICA~
The propertY owner Of owner's authonZed ,.presantatrJe who lXlt1\pleles ~ A B. C (Items C3.n ,nd C3J oNy). iiind E for z.on. A
(WIthout a FEMM&aued 0( commUllrty-ta5ued BFE) 01 Zono AO must &!gn here Tho .uuemeflU III SeclIon.s A, B. C, end E .. (;Drf.a /Q
the beBl of my know/edQfI
PROPERTY 0WNEJfS oR ~'S ALITHORIZ&C RCPRESENT ATlVE'S NAME
ADDRESS
-'GN.t.TURE
crrv
0,.. TE
STATE
1"EL.EPHOfoolC
lJP COOk
....:lMMENTS
1 r Ctwck here If attltChments
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SECTiON G - COMMUNllY IHFORMA TlON (OPTIONAL)
Tn. IDcaJ affiClal who 1$ authonud by law aT ordltwl'* ID adnunlitllt' the commurutY'i IIoodplaln ~l Ofdln4l'lCe can ~
SKllOnG A, 8, C (or E), and G of 1M .Elevation CertIficate Complete the appllc:aDle lIom(i) iIlCS &!gn bok)w
G 1 1-1 The tnfonnatlon III Socbon C was taken from other dOCl.ltnentabOn thatl\as been SIQI\8d and .mIXlAed by a llcanaod sutVeyoI'.
angtna8l', 01 arcMec:t wtlo .. authonzed by state or local law to ce/1Jfy ele....tlon II1formallOtl. (Indica.. the source and 0..18 of U\a
elevation dala.lI\ the Comm&ma area belCM' )
G2 LI A community otfiClal completed S8clIon E for a bulldmg located III Zoo. A (WIthOUt a FEMMuucd 0( !;OmITIuM~ afE) Of
Zone AO,
G3. LI The foIIowlnglllfonnabon (Iteml G4-G9) IS provided for communrty t100dplrun ININ90ment ~rpoae$
G4 PERMIT NUa.aeeR r GS. DAn; PERMI'I' lSSUED I G6 [M\TE CERTlflCA.TE OF ~NiCY 1
. ISSUEC
G7 thiS permit hill been ISSued for. I-J New ConstruCllOn LI SubstiUltlallmprOVtllJlCnt
G6 E1evabon of lIS-bulIt IoWNt floor (lI"lCK.IdInQ baiemont) at the b~Ndlng I' - h.(m)Oatum
Gel 8FE Qf (In ZOM AO) depth of I\ocxWlg at the bwldll\g site IS - rt. (m) DMWin.
LOCAL OFFlCW.'S NAME TITLE
TEL.EPHONC
DATE-
COMMUNITY NAME
SIGN.\TURE
COWM~
I . , Check here If dachmenli
REPLACES AU. PREVIOUS EDITIONS
FCMA Form 81.31, JUL 00