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 Important Read the instructions on pages 1 - 7 SECTION A - PROPERTY OWNER INFORMATION OM B No 3067-0077 Expires July 31,2002 For Insurance Company Use Polley Number BUILDING OWNER S NAME e,Q..UL.E- \c...J. \ \Z.Cl+~\ c...u s \O~ ~~ BUILDING STREET ADDRESS (Including Apt , Unit, SUite, and/or Bldg No) OR P 0 ROUTE AND BOX NO Cci..D S<o UlA-o I';]~ p/' ,,-':f' - CITY STATE ZIP CODE ~ P (2..l t-lC:tF \ ~U) De- ?t-z 41 €> . PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal DeSCription, etc) \ loT 4'7.. L€.-\..{( L-fOJ.~,l% ~J-J.~ At> D rr \Q).j FIL,E- ,G. -:::X-1l)E:- \ S'l- \\'SS LAut. COOf-ir( BUILDING USE (e g Resldenlial Non.reslcenllal, Addlllon, Accessory, etc Use a Comments area, If necessary) PlM \Z...€.(D12...i)S ~-?( D~ T{A\..- LATITUDElLONGITUDE (OPTIONAL) HORIZONTAL DATUM SOURCE 1-1 GPS (Type) ( ##0 _ ##' _ ## ##' or ## #####") 1-1 NAD 1927 1-1 NAD 1983 1-1 USGS Quad Map 1-1 Other Company NAIC Number SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION .. _ -. '.'-' ....-- B1 NFIP COMMUNITY NAME & COMMUNITY NUMBER I B2 CUUN I '( NAMt: o P IZ-l i--1.6 F \ E-t- 1:) 4t '315 q 2. .. (.....~ E- B4 MAP AND PANEL ' B5 SUFFIX B6 FIRM INDEX B7 FIRM PANEL B8 FLOOD .1 NUMBER DATE EFFECTIVElREVISED DATE ZONE(S) '-\"1039.G\l\oto F 0 Z-'1q <&>..Z.qct I' B 1 0 Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered In B9 I_I FIS Profile L-I FIRM l~ Community Determined I_I Other (DeSCribe) B 11 Indicate the elevation datum used for t~e BFE In B9 1--1 NGVD 1929 L-I NA VD 1988 l;BDther (De~crlbe) LOGA-L- B12 Is the bUilding located In a Coastal Barner Resources System (CBRS) area or Otherwise Protected Area (OPA)? I_I Yes ~No DeSignation Date B3 STATE DeL B9 BASE FLOOD ELEVATION(S) (Zone AO, use depth of flooding) 5\0 ~ SECTION C.. BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1 BUlldmg elevations are based on I-I Construction DraWings. 1_IBUlldlng Under Construction. ~mlshed ConstructIOn · A new Elevation Certificate Will be reqUired when construction of the bUilding IS complete (' C2 BUilding Diagram Number Z. (Select the bUlldmg 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 A 1-A30, AE, AH, A (With BFE), VE, V1-V30, V (With BFE), AR, ARiA, ARiAE, ARIA 1-A30, ARiAH, 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 appropriate, to document the datum conversion Datum ~ Conversion/Comments Ai) b O.? FT 10 LOC.A-L. i!:)A=i U M. "TO ~ F e .1,11\ A ~\}M. ElevatIon reference mark used ~--F_CDfV\M. ~ Does the elevatlon...:.eference mark used appea n the~ '. _I>, f--i , ]~~~ o a) Top of bottom floor (including basement or enclosure) "::> l \ ..2 ft _ ~ ~'l'h.; ;;K'~;.'/~'1:';t,"\.:lA~' o b) Top of next higher floor '3 ~-:a., ~ ft (mf ~ l./I"J"..\ U t~l.::-~.;"i?:: ~:'JlR o c) Bottom of lowest hOrizontal structural member (V zones only) ~I A. - ft (m) m ~ ,.-.~ 1 o d) Attached garage (top of slab) '5 \ "2- .2 ft ~ ~ -g lAi- . In a e) Lowest elevation of machmery and/or eqUipment ~ i--.J~ servicing the building (Descnbe In a Comments area) CS l'Z- L ft ~ E ~ r.---"G-~~""'" ~\\ c: , 0il".r!J o f) Lowest adjacent (finished) grade (LAG) ~ :? ft (m) ~.E' 1 .su[ .. ';:1 ;'i,~4i o g) Highest adjacent (finished) grade (HAG) S 1'L-. _L ft ~ ~ (f) - JOi'M: H,',,'! A Oi\J<ES o h) No of permanent openmgs (flood vents) Within 1 ft above a<;l)~cent grade \4 ~ ~1:'~ o I) Total area of all permanent openrngs (flood vents) In C3 h t~t1 sq m...(.,~ .,:.'.J. R__, " ".:"_' "~'" '2_.' ~_ ~~ _. 2n";(~ SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION ThiS certification IS to be Signed and sealed by a land surveyor, engmeer, or architect authOrized by law to certify elevation mformatlon I certify that the mformatlon m SectIons A, B, and C on thIS certIficate represents my best efforts to mterpret the data avaIlable I understand that any false statement may be pUnishable by fine or Impnsonment under 18 U S Code, SectIOn 1001 ~ERTIFIER'S NAME \ r I ^ ({'\. .. _ . LICENSE NUMBER ,. --.lON,.~ ~ r ~ e:::t2R.... L c:;. -co. 2-1 oS f1TLE COMPANY NAME ~C~\ O~ ~i) ~ \'2.\L ~(DCL fbM::3. E- ~ ( t-.1tf;::. ~ 11/. .d. ?L) au E.. '(I.~ te.Lc.... ADDRESS -n --t:L~ C-"7,"""\ . cra 'e STATE"" ZIP COpE r ,0 r.;u'f- X'-;;Jc:'::- t { E~ ~~ 0i2- q,4<)L~ SIGNATURE \A-._ \Jl f( \.. I j . DATE TELEPHO~ J __. . ~~l.tU.- ~ I' 2.-\ ~o3 541- - ~S ~FMA ~nrm R1_~1 1111 nn ~FF RF\!FR~F ~lnF ~OR rONTINI JATION RFPI Ar~q AI I PRF\lIOllq FnlTlONq IMPORTANT In these spaces, copy the corresponding information from Section A BUILDING STREET ADDRESS (Including Apt, Umt SUite and/or Bldg No) OR P 0 ROUTE AND BOX NO (o<cs~ MC~ PA~ CIIY , STATE Ch ZJP CODE Company NAIC Number ?PfLl WUFt~ oe... -, f4'l~ SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this ElevatIOn Certificate for (1) community official, (2) Insurance agent/company, and (3) bUilding owner COMMENTS ex" OF-0P\2..I~Fl~ ~~ D~~ek-A A? A c..+h~ ~u~ (U,""tltL \DP OF l1\-€..c-UYU.J NT ~ t/lA-lbPoIJ.lT oF ~t:.utUb ~~ ~ ~ ?'L.t LOtL1-1.E.i2- ~ ~ IJ-.l.TeIf2...~TIQ)...1 tJl: loi"'1J!-4 ,t-h.N2-?1O\..J Q.O~ ~~. S lL. ~ \ :__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 E1 through E4 If the Elevation Certificate IS Intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed E 1 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, provide a sketch or photograph) E2 The top of the bottom floor (including basement or enclosure) of the bUilding IS 1--1-1 ft (m) 1_1_11n (cm) I_I above or I-I below (check one) the highest adjacent grade (Use natural grade, If available) E3 For BUilding D,agrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the bUilding IS 1-1-1 ft (m) 1_1--Iln (cm) 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 In accordance with the community's f1oodplall" managernent ordinance? I-I Yes I ! No I I Unknown The local offiCial m_ust certify thiS information In 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 m SectIons A, B, C, and E are correct to the best of my knowledpe PROPERlY OWNER'S OR OWNER S AUTHORIZED REPRESENTATIVE S NAME I For Insurance Company Use Policy Number AUUtl.t:SS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS I_I Check here If attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local offiCial who IS authorized by law or ordinance to administer the community's floodplain management ordinance 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, 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 I_I A community offiCial completed Section E for a bUilding located In 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 floodplain 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 (including basement) of the bUilding IS G9 BFE or (In Zone AO) depth of flooding at the bUilding site IS LOCAL OFFICIAL'S NAME .. __ ft (m)Datum _ ft (m)Datum TITLE COMMUNIIY NAME TELEPHONE SIGNATURE ,DATE COMMENTS L_I Check here If attachments RFPI ArF~ AI I PRF\lI()IIC:: FnITI()NC:: - FFMA Fnrm R1-':\1 1111 00