HomeMy WebLinkAboutFEMA Application 1999-6-2
FEDERAL EMERGENCY MANAGEMENT AGENCY
NA TIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTJFICATE
o M B No 3067-0077
Expires July 31, 2002
Important: Read the mstructJons on pages 1 - 7
SECTION A - PROPERTY OWNER INFORMATION
BUilDING OWNE",- S NAME ~ ''iM.. _ "'
- J\~ ' . I'> u...1.1.1. lIt\I\
BUJl-.Ql,~ HRE:=T ADDRESS \InclUding Apl Uml Swteandfor 81cg No) OR P 0 ROUTe: AND SOX NO
(" (J ~.' ....JC-LL ob La V\C-
CITYSoy~f <::\4 __ STOK
p~Op~qlY D~CRlPTION (Lot and Block Numcers Tax Parcel Num-.:er legal DesClDtJon, erc.)
\-.D;- 5q ~e'\l.l L4v4(~~ '2"'4 MA~~ .
BUilDING USE (e 9 Re,TlldentJal, Non-resloenoal, ~mon, Accessory, e!c. Use Comments sec:Jcn /I ~ry)
<?e'5 Cdl~ TQ G<. \
LATITUDE/LONGITUDE (OPTIONAl) HORIZON j At DATUM
( #:,:0 - ##' - ## ##" or ## ::::;":!,'f') U NAn 1927 U NAD 1983
~urance C~any Use
POhC'J Numcer
Company NAJC Numcer
ZIP CO~ 7
?-J ? tt7
SOURCE U G?S (Type)
U USGS Quad MaD U Other _
SECTION B - flOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1 NFIP COM~UNITY NAME & COMMUNITY NUM8ER 18i Cu~rlTY NAM71_ t I B3 STA~ .0
Cl.~ od- SfY'~1Ad4' 415:;;12.-. L4'Y1P LL)U"", '1 ...L LJ1"...
84 MAP AND PANEL - 85 SUFFIX 86. FIRM INOEX I 87 ARM PANEL 88 flOOD
NUM8ER DATEl::'"rcCTlVElREVlSEDDATE ZONE(S} /
~I03qG\\~(P F J~'Z,,11q r~t\ t,qq ~x.
810 Indicate the source of the Base Rood BevatJon (BFE) data or base flood depth en~ 10 B9
- U FIS Profile ~IRM _ -U Community DetermIned U Other (Desc:Jbe).
811 Indicate the elevatJon datum used for the 8FE In 89 Q(NGVD 1929 U NAVO 1988 U Other (Descnoe)
812 Is the bUilding located In a Coastal8amer Resources System (C8RS) area or Othe!WJSePmtected Area (OPA)? U Yes
Des/gnatJon Date
89. BASE FlOOO ELEvATlON(S}
(Zone AO, use depth of flooding)
513.7
1::::.- 1( 1L S ee.p ~V e rse.
SECTION C - BUILDING ELEVATION INFORMATION {SURVEY REQUIRED}
1 8ulldmg elevatIons are based on' UConstrucbon DraWIngs. UBuilding Under ConstructJOn* ~FinJshed Construdlon
* A new Elevation Certificate w..ill-ge required when construclJon at the buIldIng IS complet.e.
C2. BUIlding Diagram Number ~ (Select the buddmg diagram most slrmlar to the buuCtng for whIch thIS cemficate IS bemg completeo _ see
pages 6 and 7 If no dlagramaCCUrately reoresents the buddmg~ preVIae a sketch or photograch )
C3 ElevatIons - Zones A1-A30, AE,-AH, A (With 8FE), VE V1-V30, V (WIth 8FE), AR, ARIA., ARlAE, ARIA 1-~30, J.RlAr, APJAO
Complete Items C3a-f below according to the buuamg C1agram soecriied rn Item C2. Sta:e the catum Usee Ir the calum IS amere"'r ITer
the datum used for the 8FE In SectIon 8, convert the datum to that used forttJe BFE.. Stur.v tie'o measure'TIe'1ts ana aarur.J c::::nvers.cr
calculation Use the space prOVided or the Commenrs area or Secnon 0 or Sealon G, as aooroonate, to ccc:.:me"t tPe aarum c::::nvers.cr
Datum Lv? V () '2 C; ConversIon/Comments
Elevatlo'n reference man<; used-7f ~ ,!2PI/t? v::e... Does me e'evanon re'Ere'1ce ma~ useo aooezr en the ~,~M? LJ 't es !A NC .
o a) Too OT bottom Tlcor (InCuQIngoasemernore'lcosure) 513 CJfl(~'):3 I / _... -;...
o b) Tco of next hlOner ileer c:::; 1 '5 ..3 fU ~ I Rcu!STERED I
:: c) Bottom aT low;st nonzcmal Sm.c:ural me'TIOer (V zones OnlVI 2. ft (~) ~ ~ LAPRN~~~~~~;~~;
!..J 0) Attacnea garage (too or Slao) 5" I L/. ..L it ( 1 ~ -g f~ ".-1 I
O /! '-I / // rff--/I
e) lowest e'evatlOn aT macmnery anaior eculOmerr ",I', ,/"... I '3 _ _ -= ~ I ///? ~ / ,,/ / !
Ii' { ...... / /..l. - - - I ." ~ / /v~-::r r I / /
servlc ng the bUilDing ./ (- ~ _;;. ~ 7i~') ~ ~ I ORE ""'OM---'
C) f) Lowest aClacent grace (LA.G) 7 'J ? ~ ( .) ~:? I JULy'28. 1993
:J g) hlgnest aaJacent graae (hAG) .5 I, ~ 11 (.) ~ REX A SE: J "
o h) No OT perman em ooemngs (flooa ve"'rs) wlrmn 1 ft aoove aOlacent grcce / c') . ~ \.. tt2606 ,/
o I) T alai area OT all permanent ooenrngs (flooa vems) In C::h f f q /) sa U1 ("1OI::Zn) L l(: , E lC f7 f 2-/1/ /0.3 I
SECl"JON D - SURVEYOR, ENGiNE=R. OR ARCHITECT CE=tTlFICAT10N -
T nJS certlficanon IS to be Signed and sealed bv a land survevor, engIneer, or arCtJlteCl: authanzed oy law to cerury e1e"auon InTOrmatlcn
I certIfy that the Inrormanon In SectJons,4, B, and C on thIS certJiicate represents my best eifons to Interpret the data available
I unaerstand that any false statement may be pumsnable by fine or ImDnsonment under 1 BUS Cace SectIOn 1001
~cqTIFIEq S NAME.-r-:> f\ r;) J.... LICE'-iSE NUMSE"'( P
~e)C /...,~ tJe--\"2-- UP LS '2.{r;Q G
IITLE S U. y-~ ev( u;. VI Q Co ey ~.UMI-'."NY NAM~y UII\0~1._~ I v-, ~c:.y Y"-", Kc'
ADDRESS 3\() 1'\.ft~ 'Str~K u,~~ SO,,'''"> ;:; d"I'~A~iZ ZhODE q 7'f7' .
SIGNATURE / ~ // // DA~ L \ / /7 2 T.:rLEPHONE,- _ "\ . -')
L..:!:::.'l(1 ~ /4// - Uc \ Ol?c';- I UO;2 {~YI 1. 7'f&-{)(P::J 7
/ /
FEvlA Form 81-31, AUG 99 L/ SEE REVERSE SIDE FOR CONTINUATION REPLACES-.AlL PRFVlnll<:; r=nlTlmlC: .
~o
lo t- s;:-vL LevI Lte/1l\('L~r: 'Z'Vl.~( ~J
IMPORTANT In these spaces, copy the correspondlOg'infonnanon from Secnon A.
BUILDING STREET ADDRESS (Inc'uding ApI Unit Sude and/or Bldg. No) OR P 0 ROUTE AND BOX NO
,\~LDb Lc.v>P .
CITY STATE Z'P CODE
-S P (" )- Y\ c:-J\''(J, t.f () fZ a ( If II
I For Insurance Company Use
PohCf Numcer
Ccmcany NAIC Numce'
SECTION D . SURVEYOR, ENGINEE.~ OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides or thiS Elevation Certificate for (1) commumty offic:al, (2) Insurance age'1Ucomoany, and (3) bUlIOlng owner
~ COMMENTS (' .
>f=. C'; +'1 U:r c; P' '''' 'J ~'e It t :B e" <:. J" JJav L "",,-,"'A <\ C\,,,, el eA <;.<".<4 v e. ^ LL + ,'^ -1''''''-
..,1 ( r.d. r' i'
Y(1 hJe.. 'fi C",..", ?1 + -\'t", "" ~po)"t ,.~ (~".I" ,<0, L<,,-'" ( T iL..t S ')" tI,,><Jed Co ill ev o:r .
0fk CW\d ",<<vsto", l,av"",~':>VI elevat,"", oX 511-.g1 c.,\~ 0"-*"-",, ".."vI",dJ~,h.(
:to e(cvl<.ntv\. t] 13. ~ I, )j(/?Vl)'Z'1 \.,VltS u<;e.J ti<) ~ Q,tts~s cJ ~Iev?<.how') ~leyeol1
*"* ~",-hYe re.;.,,fe,,f,,, t S-lvULtuVe. I,e,> '''' 2o~e.. X eT F t< U Ched< here IT attachments .
SECTION E _ BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIR D) FOR ZONE AO and ZONE A (WITHOUT BFE)
For Zone AO and Zone A (WIthout BFE), complete ItemS E1 JhroU!lO E3. If the Bevabon CertJiicate IS mtended for use as supportIng
mformabon for a LaMA or LOMR-F. Section C must be compieled.
E1 BUlldmg DIagram Number ^ - - -(Select the builoln9 otagtaID most ~Imilar to the bUilding fcrwhK:h this certriicate IS beIng completed-
see pages 6 and 7 Jf no diagram accUrately ...y,....ents the building, p~de a sketch or pl..l....~.dph.)
E2. The top of the bottom floor (lnduding- baSement or enClosure) of the budding is - I I \ ft.(m) , I - fin. (an) U above or U below
_ (check one) the highest adjacent grade' - - -
E3 For Zone AO only' If no flood depth number IS avaIlable, ~!he top- C?fthe bottom floor elevated In a........Jc.ncewrth the commumty's
floodplalO management o:-J-::.cnce? ,-, Yes- -, _J No - U unknoWn- The klcaloffical must cer1Jfyttus i..f"'"lC1t:on In Section G.
SECTION F _ PROPERTY OWNER {OR OWNER'S REPRESENTATIVE} CERTIACAnoN
The property owner or owner's authonzed representatIVe who COO1pletes Secbons A. B, and E fur Zone A (WIthout a FEMA-lssued or
commumty-Issued BFE) or Zone AO must slgo here.
PROPERTY OWNER'S OR OWNER S AUTHORIZED REPRfS~IAll~ NAMt:
[II '('
STATE
ZIP CODE
SIGNATURE
DATE
TELEPHONE
ADDRESS -
COMM~N I ::.
1-1 Check here If Cittachme'1ts
SECTION WOMMUNIlY INFORMATlON (OPTlONAL)
Tne local offiCIal who IS authonzed by law or oromance to adlTUntster the communltv's nooaDIalIl management orarnance can C::Jrntlle!e
SectIOns A, 8. C (or E), and G of thIS Elevaton Cerniicate Comtllete the aooncable rtemls) ana Sign belOW
GiLl Tne InTormatlon m Secnon C was taken lTOm other oocumemanon mat has-been slgneu ana e'l1Cossetl DV a uce.<1Setl survevor,
engmeer, or architect wno IS autnonzeo by state or local law to ceruiv e'evancn lrnC,...Quun (InuI...."e toe source ana aate OT tne
elevation aata 10 the CommentS area below)
G2 U A communlrv offiCIal ccmDle!erl Secnen E fer a bUIIOIng leczte':l In Lore A (wnnout a ~"IlA-1SSUeu cr c::;mmunlIV-lssuec Ef:. or
Zone AO
G3 U Tne TolloWIng IntOrmanon (Items G4-G9) IS provlOea rer ~mmumN i1ccCOIaln manage'I'e'1t curnases
I, G4 F:=RMIT NUMBE=i. \ G5 DA~ ;:t:~I,IIT 155..!!:.J I Gc C.l j:: ==.= ,r,C""'1 C 0;: C:JMPLW4CSGC~wFANC /
11C:C: 1:::-
I ~~-
G7 Tms permit has DeeD Issueo Tcr U New ConstruC'Jcn U Suostannai Imcrove'T'e'it
G8 Elevation OT as-bUIlt lowest floor (InClUOIng basement) Of the bUIIClng 15
G9 8FE or (10 Zone AO) deoth OT floodmg at the building sIte IS ;
LOCAL OFFiCIAL S NAME
_ ft.(m) Datum _ _ fL(m) Datum
Ti11.E
COMMUNrii N;':M~
I :LEl:HONE
SIGNATURE
DATE
....
COMM~N I S
LJ CheCK here If attachments
REPLACES ALL PREVIOUS EDITIONS
Ft=MA Form 81-31, AUG 99