The URL can be used to link to this page

Home My WebLink AboutFEMA Application 1999-6-2 :. FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE o M B No 3067-0077 Expires July 31. 2002 Important Read the instructions on pages 1 - 7 SECTION A - PROPERTY OWNER INFORMATION For Il)Surance Company Use P~lIcy Number BUILDING OWNER'S NAME :e:.Q..uGa. '-U~U-{ E.a;r c..e~~ CVAA ~.\k.c~ l f.J..c.., BUILDING STREET ADDRESS (Including Apt , Unit, SUite, and/or Bldg No) OR P 0 ROUTE AND BOX NO ce~ 0e=>~ ~T~ CllY STATE ? P C2-1 t-J.. ~ f:.l ~ 0f2- Pkut"'c/'\I T DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Descnptlon. ete) UJTb:> ~( ~~Il-LG ~b ~t:J FlL&- 75 ~L.l ~f:'S 1\S2-\lS5 L1\iJ.E. (l) R..A1~b? BUILDING USE (e 9 , Residential, Non-resldentlal, Addition, Accessory, ete Use a Comments area, If necessary ) ~?I ~~ I" (A\...- LA TITUDElLONGITUDE (OPTIONAL) ( ##" - ##' - ## #If' or ## #####") ,,-' Company NAtC Number ZIP CODE ~( 4- '"1'2:. HORIZONTAL DATUM LI NAD 1927 LI NAD 1983 SOURCE I_I GPS (Type) LI USGS Quad Map LI Other SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION I B1 NFIP COMMUNllY NAME & COMMUNllY NUMBER I B2 COUNlY NAME I B3 STATE -sPl2-t I-i6R \UJ\ 4-t "S'J(c.... U\1.l C- D IL B4 MAP AND PANEL B5 SUFFIX B6 FIRM INDEX B7 FIRM PANEL B8 FLOOD B9 BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding) 410?q,c..l\Col t= ~.'Z-qq C,.'"Z4Q >~~i- S\ZrO 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 L~ommunlty Determined I_lather (Descnbe) B11 Indicate the elevation datum used for the BFE In B9 I_I NGVD 1929 I_I NAVD 1988 I~Other(Descnbe) \..O~ B12 Is the bUilding located In a Coastal Barner Resources System (CBRS) area or Otherwise Protected Area (OPA)? I_I Yes ~o DeSignation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) .. BUilding elevations are based on I_-'Constructlon Drawlngs* I-I BUilding Under Constructlon* I.~nlshed Construction *A new Elevation Certificate Will be required when construction of the bUilding IS complete C2 BUilding Diagram Number 'Z. (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 BFE), VE. V1-V30, V (With BFE), AR, ARIA, ARlAE, 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 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 appropnate, to document the datum conversion Datum ~_ Conversion/Comments ~b 0 '?' TO ~ D..An-cl,IA TO ~ Fe}AA bA-t-U;tA Elevation reference mark used~ ~f:.I..L""-? Does the elevation reference mark used appearflthe fttfi~~-;i:;+Y~rW'~ o a) Top of bottom floor (including basement or enclosure) '5\'? ~ft~ iii -, t"!s't._....t.'t-.")"".,...... <t'.L. J CD l. IJ. W":~ rr""., ,m lor. - ~1- .. vlI. o b) Top of next higher floor ~\(o _~ft~ ~ ;:;... l.......... t"I.,',:', ,'..,'.rt o c) Bottom of lowest hOrizontal structural member (V zones only) t4/ J>.. __ ft (m) ~ ~ \.. c. .......,... . . , . ..,. .,. .."..."' . o d) Attached garage (top of slab) '5 \~ ~ ft (m.) ~ -g L, I J A I!\ ~ o e) Lowest elevation of machinery and/or eqUipment ~-;. ~ ~ ~ servicing the bUilding (Descnbe In a Comments area) S\+::L ft W1) ~ ~ ;' ,. r,. '.'0;' ;.;~~~..,., , .......,.""' o f) Lowest adjacent (finished) grade (LAG) S \ d.- 3- ft ~ ~ ~ j Jl.!~ ,) ~ ~ i:.~~ o g) Highest adjacent (finished) grade (HAG) <:=;\ 4- l ft (-+-- ~ ~ JONA'i}{"v; A. OAKES o h) No of permanent openings (flood vents) Within 1 ft above adjacent grade \ 0 ~ '-- ~ t""i!) o I) Total area of all permanent openings (flood vents) In C3 h \:2,'2..2 sq In (~ ~' ,.,_~ -=?I ~ ~ SECTION 0 - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION ThiS certification IS to be Signed and sealed by a land surveyor. engineer, or architect authonzed by law to certify elevation information I certtfy that the informatIOn In Sections A. B, and C on thiS cerllficate represents my best efforls to Interpret the data aval/able I understand that any false statement may be pUnishable by fine or Impnsonment under 18 U S Code, Section 1001 l.,~/,\ I IFIER'S NAME \ 7>"1 ^ .... J A ., A <T\ I ~ LICENSE NUMBER.! )v,...,......,~ ~ ~-s. en.... \",_":;0> ~z..(as TITLE COMPANY NAME PDOrli"~./AD~ ~b .sv~t-\OYL ~ ~'~r-.LG ~ ~Vlt-.LG l~ ADDRESS .p 0 t::l.~ CllY STATE ZIP COPE . . ~y.... . Z 5"2,.., tz-U(i C+.LE.. 0\"...- Q"14-D'2..- SIGNATURE \..I-.~ U . I r\.. I r. DATE TEU;PHONE J ~~r- ~7\--~ 3-?-1-~ Es4t-~::;-~ FEMA Form 81-31, JUL 00 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT In these spaces, copy the corresponding Information from Section A BUILDING STREET ~ESS (Including Apt , Umt, Surte, and/or Bldg No) OR PO ROUTE AND BOX NO C{Sb tCFo ~TQ.E&T CITY STATE Z1f CODE ,Company~NAIC f:olumber""y" ~Q...l y.J.(fr-t~ D12- C{14-"1~ '.',:' ,~"' ,. I ;~-~,;-' . SECTiON D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both Sides of thiS Elevation Certificate for (1) community official, (2) msurance agent/company, and (3) bulldmg owner COMMENTS U\'--{ Of= ?p(2;H..1(?Ft&~€..- ~~~~ ~ A c...~L'S~L~ 2Q~ tu. '*Y -m~ ~ ~~ ~n ~ M-l~PD(\..L..r ()i:. I'rt-€ ~~ ;\-r'~ ";;OVT\t k-'~~ T C~ 01= ~ (}.j.Ti:~\ t~ ~ lQi c:L- ~ \ttVY2.-,"::>T1) j..,( JlJ) ~ Sl Z. _ CD \ '-_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 E4 If the Elevation Certificate IS mtended for use as supporting Information for a LOMA or LOMR-F, Section C must be completed E 1 BUlldmg Diagram Number (Select the bUlldmg diagram most Similar to the bulldmg for which this certificate IS being completed - see pages 6 and 7 If no diagram accurately represents the bUlldmg, prOVide a sketch or photograph) E2 The top of the bottom floor (Includmg basement or enclosure) of the bUilding IS 1_1_1 ft (m) 1_1_lm (cm) I_I above or I_I below (check one) the highest adjacent grade (Use natural grade, If available) E3 For BUlldmg Diagrams 6-8 With openings (see page 7), the next higher floor or elevated floor (elevation b) of the bUlldmg IS 1_1_1 ft (m) I_i_1m (em) above the highest adjacent grade Complete Items C3 hand C3 Ion front of form E4 For Zone AO only If no flood depth number IS available, IS the top of the bottom floor elevated m accordance With the community's f100dplam manaqement ordmance? I_I Yes I_I No '-_I Unknown The local official must certify this mformatlon m Section G SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authOrized representative who completes Sections A, B, C (Items C3 hand C3 I only), and E for Zone A (Without a FEMA-Issued or community-Issued BFE) or Zone AO must sign here The statements In SectIons A. B, C, and E are correct to the best of my knowledge PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME t For rnsurance Con'ipiiny Use ,Policy Nuiilber < -, , , J -.....<A." .... ,.. I ....I~.. , ;.f/t. SIGNATURE CITY DATE STATE TELEPHONE ZIP CODE .. ADDRESS COMMENTS I_I Check here If attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local offiCial who IS authOrized by law or ordmance to administer the community's floodplam management ordmance can complete Sections A, B, C (or E), and G of thiS Elevation Certificate Complete the applicable Item(s) and sign below G1 I_I The Information In Section C was taken from other documentation that has been Signed and embossed by a licensed surveyor, engmeer, 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 I_I A community offiCial completed Section E for a bUlldmg located m Zone A (Without a FEMA-Issued or community-Issued BFE) or Zone AO G3 I_I The follOWing Information (Items G4-G9) IS prOVided for community f100dplam management purposes G4 PERMIT NUMBER I G5 DATE PERMIT ISSUED I G6 DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7 ThiS permit has been Issued for I_I New Construction I_I Substantial Improvement G8 Elevation of as-bUilt lowest floor (mcludlng basement) of the bulldmg IS G9 BFE or (m Zone AO) depth of floodmg at the bulldmg site IS LOCAL OFFICIAL'S NAME _ ft (m)Datum __ ft (m) Datum TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS '-_I Check here If attachments FEMA Form 81-31, JUL 00 REPLACES ALL PREVIOUS EDITIONS