HomeMy WebLinkAboutFEMA Application 1999-6-2
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FEDERAL EMERGENCY MANAGEMENT AGENCY
- NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTJFICA TE
Important: Read the instructIons on pages 1 - i
SECTION A - PROPERTY OWNER INFORMATION
BUILDING OWNE"'{ S NAME ....0 . <1.1, ~"-.. A
&...\AlII"). W ~ l\.A~~
BUILDIN~S:IBE=T ADDRESS (Inc'uding Apt Unit. Suite ~~dlor Idg No) OR P 0 ROtJiEAND BOX NO
'f'::>& (e..0tk p\q Ce-
CITY S (Jy -S' ~ \ d ST~ K
Pfop~::nY D~~PTION (Lot and Block Numoer.;. Tax Parcel Numcer L~al Descnpocrr. e!e.)
\..-.D, (;;, 9 Ley \ L4~lV\~ Z,,\/J M,L;~ .
BUILDING USE (e g , Re,rldentJal, Non-resldentJal, AdtIibon, Actessory, ere. Use Commel1lSsec:ron If necessary )
1?escd~TQ~ \ _. __
LA TITUDElLONGITUDE (OPTiONAL) HORIZONTAL UA luM SOURCE U G?~ (Iype)
( ##0 - ##' - ## ##" or ## ####!r) U NAO 1927 U NAD 1983 U USGS Quad Map
OM 8 No 3067-0077
EXDlres July 31, 2002
l!or Insurance Company Use
POhC'J Numcer
I Company NAIC Numcer
ZIP COO);
?j 7'177
U Other _
SECTION B - flOOD INSURANCE RA IE MAP (fiRM) INFORMA nON
B1 NFIP COM~UNJTY NAME & COMMUNITY NUMBER B2. WU~ NAM~ _ tt 83. STATE .0
\ oJ- S "'" . e\ . 415 ~1 z., La LDu"" - d f'...
84 MAP AND PANEL 85 SUFFIX 86 FIRM INDEX 87 FIRM PANS. 89 BASE flOOD ELEVATlON(S)
NUM8ER DATE En=-t:CTIVEIREVISEDDATE (Zone AO, use depth of flooding)
L\IO~qL.\\Lo(P F - :r~'Z1'i1:JL 'L' 1'1 510,~ :K.4!.UD-k-J?
810 Indicate the source of the Base Rood Bevation(BFE} data or base tJood depth...J......,;in 89 ~* F'11t.IA does. '-'\Dt QeSilS~1:e
U FIS Profile - '~""'-'>-lbl '_ ~Commumty Detemuned U Other (D.:..o...i:..e)' 0.. 13 ~ t7.lV' 7~ X
811 IndIcate the elevatIon datum used for the 8FE In 89' ~NGVD 1929 U NAW 1988 U Other (Descnbe)
B 12 Is the building located In a Coastal Bamer Resources System (CBRS) area or Othenvise Protected Area (OPA)? U Yes ~o
DeSignatIon Date
SECTION C - BUIlDING ELEVATION INFORMATION (SURVEY REQUIRED)
, BUilding elevations are based on. UConstrucllon DrawIngs* ilding Under ConstrudJon* URn/shed ConstrudJon
. A new Elevation CertIficate ~ be required When construdJon of th building IS _.~ _
C2 Building Diagram Number 5-5 (Select the buildmg diagram most Similar to the buifmng for whldl thiS certJiicate IS bemg comoleted _ see
pages 6 and 7 If no diagram accurately represents the bUlldmg, proVide a sketch or photograph)
C3 Elevations - Zones A1-A30, AE, AH, A (WIth BFE), VE, V1-V30, V (with BFE), AR, P-RJA. APJAE, APJA1-A30, APJAH, APJP-O
Complete Items C3a-1 below according to the buildmg OIagram soeCliied In Item C2. Slate the datum used If L'1e catum IS OInere'1t ITem
the datum used for the BFE In SedJon B~ convert the datum to that used for the EFE. Show fie/a measurements and datum convers.on
calculation Use the space proVIded or-the Comrnems area of SedJon D or SedD1 G, as aocroonate, to document the carum convers.or.
Datum kl(ov 0 'eCj Conversion/Comments
Ele.J?~on rererence mark used*" ,<)e.e Qeve VS" ~Does tne elevanon rere.rern:e mark used aOOear on the FIRM? U Yes t::tr-No
13"" A lOp or bottom floor Oncluolng basement or enClosure) 5 \ 0 l) ft.(~ ~ .. . ,
t{ b) Top of next hlgner floor t:J 1"3 '3, ,ft.(~ ~ / ~EGI:> I e:REO '"
T u..J.......c...".,c..~ -::::.... fl ) ~ 7J PROFESSIONAL
o jif) Attached garage (top of slab) .5 I 2. 2- ft.( ~ ~ L.AW> SURVEYOR
ri{ e) Lowest elevation of mac11lnery anolor equlOme'1t ' ~ : ~ /ft / /' -d-- 1
/ servIcing the bUIlding ,5/5 ~ it ( ~ ~ . (-./I /::2...X7..
ti Ji Lowest adjacent grade (LA.G) 5/1 2.. ft.( ; ~ JU~:~g~N ~
8"~) Highest aOJacent grade (HAG) 5 J Z 0 it. ( ) ~ REX A Be: ~
~ No or permanent ooenlngs (flooo vents) WIthin 1 jt aoove aOJacent grace -, -"! \., ~ ../
I) Total area of all oermanent openings (flood ve'1ts) In C3h ,J:;" S9 so. Ill. (s"'t'"'Cor.) 1.-1 C ti2:;P' / c/~ I / () 3
-
SECTION D. SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
Tms certlficanon IS to be SIgned and sealed by a land surveyor, engineer, or archdedauthonzed by law to certrfy elevatIon informatIon
I certify that the infOrmatIOn In Sections A, B, and C on thIS ceroficate represents my best efforts to Interpret the data available
I understand that any false statement may be pUnishable by fine or rmpnsonment unti!!.r 1l!3L S. ._C:oc!~,_ Section 1001
~RTIFIERSNAM~e>c A- Bd--z- Lj~t:N~CNUMI:lI=RPLS ~6 ((7
TITLE COMPANY NAM~ c
S LcrVe'-1 LA a. "" c: tj!!.-v _ 15)'" UV\dA . _~ l "'"' (' Gy ~"" - J--kL'
ADDRESS 3 \ 0 11 Ct~ <' \y j. \';ITY S .,.. Y'A h c l~S IAJ ~ v? Z'o CODE J I -,-
;). Cl --. P 7 ~ ---- ''---- q 7'f7
SIGNATURE a ~ UAI- I I:: Ll::f'HON
/f;?~' 0 ~ DecewJJe-.---I&,ZL702. r.$L(/)7tf~-Q(P37
FCJlv!A Form 81-31, AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES All PREVIOUS EDITIONS
IMPORTANT In these spaces, cooythe corresponding mformaooo from Secoon A-
BUILDING ,gREET ADDRESS (InC'udlO-~ -Apt UnIt SUite, and/or Bldg No) OR P (j i<uu~ ANjj'~U
CITV '-1 S & (Q & ,\..-. P\9~1" -e'"
, I S{)TA~ Z'P CODE
"S P (" ," Y\ ') -h--c~ c-f r-- q -; If 7 /
, For Insurance Company Use .
POhC'f Numcer
C.:::moany NAIC Numce'
SECTION D . SURVEYOR, ENGINEER. OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both Sides of this ElevatIon Certificate for (1) communIty offical. (2) Insurance age'lUcompany, and (3) building owner
COMMENTS f (") r I I
"*' C' ,1-'1 u --;p-r'v'v.,l..,j}\'c.\d MfV\6h)v\avL \--.el'-\~ c.. c,^\'je.l~~ "')CJl.A.4VE:. ('A..-L+ \'^ tlu2-
"". r' r [-' -
~~1 r!~.(<::- eN CUY'b ~t f~ \N\lJpiil~t (~,... ('c_H'b lGfl.L~h. (I' -t~ <-;/1LLtLtl.0ed Cu{vre'y of
&-7 f~ Cl/VI.d, ~lA: Y'-:'+()Y"\ ~ @ \"", ~ C7V1 e leva. tLOV'< ~t 5 1'2.-. g \ C \' \~ <\. -R.INI. OVId t::< d J <.t <., f::t..(
~ e(.~'vu.ntv'\ '5 !3. ~ \ D&VD'2~ WitS u.<)~.J a<) ~ Q,uSllS d e-levt<.hOVl") ~(eyec\l1
U 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 Bevatron CerlIficate IS mtended for use as supportIng
mformation for a LOMA or LOMR-F, SectIon C must be compJeIed.
E1 Building Diagram Number (Seled the bulldang aaagram most sunilar to the building fer whidl thIS certriicate IS being completed-
see pages 6 and 7 If no diagram accLrately represents the buikfing, provide a sketch or photograph)
E2. The top of the bottom floor Ondudlng basement or endosure) of the building is I I \ fl(m) I I lin.(cm) U above or U below
(check one) the hIghest adjacent grade
E3. For Zone AO only. .If no flood depth number IS available. IS the tap of the 00iIDm floor elevated tn accordance WIth the community's
floodplain management ordinance? I~I Yes UNo U Unknown. The Iocaloffioal must certIfyttus l..fu....Cl;.on In Sed10n G
SECTION F _ PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTlACATION
The property owner or owner's authonzed representatIve who .....,,,.,Ietes SedIonsA. B, and E for Zone A (without a FEMA-Issued or
commumty-Issued BFE) or Zone AO must sign here
PROPERrf OWNER'S OR OWNER'S AliTHbRIZED REPRESENTATlVE'S NAM~
ADDRESS
(;ri'V
DAT~
S,ATE
ZlP CODE
SIGNATURE
'TELEPHONE
COMMENTS
LJ Check here If at"..achme'1ts
SECTION G _ COMMUNITY INFORMAllON (OPTIONAL)
The local offiCial who IS authonzed by law or ordmance to admmJSterthe commuruty's 1Ioooolam manage'11ent orOlnance can comOlete
SectIOns A. B, C (or E), and G of thiS Elevation Certriieate Complete the aooncaolertem\s) and sign below
G 1 U The Information In Section C was taken from other docume..laLunthat has been signal ane emcossed by a licensee surveyor,
-engIneer, or-architect wno IS authonzed by state or local law to certify elevation (mo. ...ClUon (lnOleate the source ana date or the
elevatIOn data In the Comments area below)
G2 U A communrty oriiclal comoleted Secuon E for a bUlldmg Iccated In Zone A (WIthout a F::MA-!ssued or communitY-Issued 5Fa cr
Zone AO -
G3 U The followmg Inrormatlon (Items G~G9) IS provloed Tor c:ommunltV ilccomam manageme'1t Durcoses
\ G4 PERMIT NUMBE:=;' G5 DATE PERMIT ISSUEJ I G6 UATE CE=TiF,CATE OF COMFLIANCE-OCCUPANCY
I I~~
G7 Tms permit has been Issued for L! New Construe' Jon U SubstantJallmoroveIT'e'i{
G8 ElevatIon of as-bUilt lowest floor (lncludmg basement) of the bUIIOlng IS
G9 BFE or (In Zone AO) depth of flooolng at the bUlldmg site IS
LOCAL OFFICIAL'S NAME
_ 11 (m) Datum
_ fl(m) Datum
TITl.E
COMMUNlrf NAME
I t:u:o.JHUNl:
SIGNATURE
UAI/::
COMMENTS
I CheCK here If attachments
REPLACES ALL PREVIOUS EDITIONS
FEMA Form 81-31, AUG 99
FROM
FAX NO
DEe 18 2002 03 27PM P5
...
-IMPORTANT. In theS~e5, eo~orre$pandJn9 Information from Section A.. _ :'E~~!leJ;r~~ny.Q~~~'
BUIL.OING SlREET ADO~SS (\ndUding. AptJ.tnrt. SUItB, anG'or BIdg No) OR P 0 ROI.I'TC AND BOX NU - .:I?ar~ ~~~
(-?~Bq U o<e'" (./0 $5 - G~.""",""~
CfTY . - .. . STAn; ZIP cooe ~-- -
Sp....,.,...."h<-W O~ Q7'C/{1 ~~
,., SECTION D ~ SURVEYOR, ENGINEER. ORAACHITECT C~lIl"'ICA.T10N (CONllNUED)
Copy both S10eS of ttus Elevauon CertIficate for (1) coromunity ofliaal, (2) msurance agent/company, and (3) buildlng owner
: ~ <;I"~' h<'.\<l &.... 11".-1.-- \,~ t:. rl..<~\<J S!f!JI'f"- ,_;1-. ~ 11.. -h,;, -'-Ju.. rb ~i
::11& 1M~~f'Q\'^t- c:J? Cu....-\-.. r'",p_-tuv'"V\-C?t t'W-S.()'^~tp~-t COVnr.:Y' J "''1~i- Th,u~j"c::i""""7
.CL,^ e.{e.V",,-1>b'-\ J 5rz.~l (.ltlf Jtih1''''''' CiL"'& G-rl:",'i.kd ~ ~A.-h.t1,.oo, 5121, \\ ~10V f)'Zq l~S
. use& ~ ~y"c;'7 ~ Gl~A.tI6t-1.~_ s1v.x.u", k.~yeO\'\. .. \.,_1 Checlc here If attachments .
SECnON E _ lilUlLD/NG E1.EVAnON lNFORMAnON (SURVEY NOr REQU!RED) FOR ZONE AO AND zoNE A (WITHOUT BFE)
. .
For Zone AO and Zone A (WIthout BFE), complete Item5 5,1. thrOUgh =4 If the E18'18tion certificate IS intended for use as supporting
Information for a LaMA or L.OMR-F. SedJQn C must be completed.
E1. Budding C.ag~ Number ($elect the building diagl3m me&t sunilar to the tluildlng for which thts ...... ;..r._~ is being completed -
see pages 6 and 7. If no diagram accurately. "1'.<.Jents the building, prowie a $.i....l..:. or I)ho;..... <-to:..)
E2..The1Cp ofY,e bottom ftcorfmduamg basementorenQosul'e) gfthebuUdIDg Is 'I lft.(m) , I ,pn (em) t-I above or W below
(check one) the highest adjacent grade. (Use natural grade, If available )
53. For Building Olagrams 6-8 with epenings (see page 7), tile I)~ higher floor or eltMJted t100r (elevation b) of the bUlldmg IS
_I ,- 1 ft.(m) I I 11n.(cM} ;ibavettle hlghllStad"J8cent:r"''':''' Complete Items C3.h and C3.1on rrontofform.
E4. For Zone AO only. If no flood depth number IS available. is 1M top of1he bottom floor elevated in a_':ance WIth the c::ommundY'$
flood!)lain maml~ern~w...iI-:_-:lb1 Yes . L\ No ~I Unlcnawn. The Ioc:al...fr...:..l must cettifvtht5lnfonnation In SectIon~
SEC110N r _ PROPER'N OWNER (OR [)V{NER'S REPRESENTATlVE) (.;Ct(lIrICATION
The property owner or owner's authotlZed rep~nta\Ne who c:ompJetes SectiOns A. e, C (Items C3.h and C3 ) only), and E for Zone A
(without a FEMA-issullld or eommunlty-issue BFE) or Zone AO must Sign here. The statements in Sed1on$ A, S. C, and E are correct to
the ~ ~~'!!l knowledCle.
PROPe<! y l.IW"'~S OR OWNeR'S AUTHORIZED REP~AtlVE'S NAME
CITY
STArE
"at' c:ot>t:
AUURl;;;Sl:i
DArE
TeLePHONE
.sIGNATURE
COMMI:NTS
1..-1 Check. here if attachments
_ SEC110h ~. COMMUNJ'lY ..i.FORMATlON (OP1lONAL)
The local offiCIal who IS authonzed b)'1aw or ordinance tD adrnlnisterttle communIty's fIoodplarn mar\agemen1. ~1I'lance can _.""Iete
Sedlons A. B, C (or E). and G oUhis.Elevabon C~ Complete the ~pllC:able rtfJm(S) and l;:igr. below.
G1. W The Information In Sl..~..... C was taken from other cloaIm....~;;on that hcIs been :ngned '1nd emboSSed by a ficensee surveyor,
engmeer, or B.": .i.....l who IS authonzed by state or loCal law 10 cettJfy 81evaton infonnatie.n: (Indicate the source and date of the
elevation deta In the Commen1s area below.)
G2.1-1 A. communrty offic;zal completed $ectIon E fot a bUilding \oQated In Zone A (without a FEMA-isSusd or cornmuntty-lssued BFE) or
. Zone AO.
G3.I_1 The folloWlng :. .f.. ...atlon (Items G4-G9) IS proVIded for ccmmunrty floodplaIn .......cog....' .~,.: purposes.
... ........ N_ .-J ... "'''' -......, ~. C"".,.;[AT;! UF 00Mf'UANCEJ0CCUN'CY
G7. nus permit has been_ISSUed for- 1-1 New ConstrUCtIOn L-I Sub~ntlallmprovement
Ga. ElevatIOn of 8$-'bUl1t lowest fioor {mcluding baSement) of1he builcf&n9 is:
G9. BFE or (in ZOne AO) depth of flooding at the !:lUl1dirtg site is:
L.OCAL QfOJolt;IALS NAME.
_ ft.{m) Catum
_ ft(m) Datum
TlTI.E
COMMUNITY NAME
I~HONE
DATE
SIGN.-., urv:::
COMMENTS
Ll ~hflr~ h".f'll\ If BttElclUDents
Rl=PI 4rft~ 411 PR;:vtOI L~ ~nlnnN~
ce:UA. e:^"" R1_~1 1111 M