HomeMy WebLinkAboutFEMA Application 1999-6-2
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FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
Important Read the instructions on papes 1 . 7
SECTION A - PROPERTY OWNER INFORMATION
BUILDING OWNER S NAME
5i2.ULe.. Y.J, l E.c.~ C-l),?"""iU.i"- ~~ Eb
BUILDING ST,REET ADDRESS (Including Apt, Unit, Suite, and/or Bldg No) OR P 0 ROUTE AND BOX NO
(0 l4~ VIAP'?E:0 PA-'?";:;>
CIlY STATE
"? P {2-< t--l6 F l e0h D<2-
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Descnptlon, ete)
Lol" COS c.kA!{ lJqJbiUG <?E:c. ^Db F(LR_"15 l -?L.d~E:."? IIS'Z.- \\5'5
BUILDING USE (e g, Residential, Non-residential, Addlbon, Accessory ete Use a Comments area, If necessary)
g.~,,?\ t>~llAL
LA TITUDElLONGITU'DE (OPTIONAL)
( #If' - ##' - ## ##" or ## #####")
OM B No 3067-0077
ExpIres July 31,2002
For Insurance Company Use
Policy Number
~,
Company NAlC Number
ZIP CODE
q141b
L~E.. CD f"LM" fZ.ELD,2h.~
HORIZONTAL DATUM
~I NAD 1927 ~I NAD 1983
SOURCE
1-1 GPS (Type)
U USGS Quad Map 1-1 Other
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81 NFIP COMMUNIlY NAME & COMMUNIlY NUMBER I B2 COUN1Y NAME 83 STATE
-S>''P i2.\ t-.l.6 t:: I EL'I) -+l SSq L... ~ E... OQ....
B4 MAP AND PANEL B5 SUFFIX B6 FIRM INDEX B7 FIRM PANEL
NUMBER DATE EFFECTIVEJREVISED DATE
4l0~011Cr.,-' F 0~z.-Ct~ to- z.-qct
B 1 0 Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered In B9
I_I FIS Profile I_I FIRM ~ommunrty Determined LI Other (Descnbe)
B11 Indicate the elevation datum used for the BFE In B9 I_I NGVD 1929 I_I NAVD 1988 ~Other (Descnbe) ~
p." Is the bUilding located In a Coastal Barner Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1-1 Yes ~o
DeSignation Date
B8 FLOOD
lONErS)
~
B9 BASE FLOOD ELEVATION(S)
(Zone AO, use depth of noodlng)
Sit '9
SECTION C _ BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1 BUilding elevations are based on 1_IConstructlon Drawmgs. 1_IBulldmg Under Constructlon* j29Flnlshed Construction
*A new Elevation Certificate Will be reqUired when construction of the bUlldmg IS complete
C2 BUilding Diagram Number ~ (Select the bUilding dIagram most Similar to the bUilding for whIch this certificate IS bemg completed - 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, ARiA, ARiAE, AR/A1-A30, AR/AH, AR/AO
Complete Items C3 a-I below accordmg to the bUilding diagram specified m Item C2 State the datum used If the datum IS different from
the datum used for the BFE m 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 ~ Converslon/Comments..kD D 0.-:;;' 11' LOC;4Acl.. t>A1 (oJ.. TV ~~ e...~^ oA,-U-M
Elevation reference mark used~ c.cu1.lM.~-S Does the elevation reference mark used appear n the fJ@:td,1-d~~~dlS~
o a) Top of bottom floor (lncludmg basement or enclosure) '5 \ '? ..l- ft (sJ ...' '; rl-I,,\..;:" ~"J~, $Q'I"-' Pol. I
_\ a> I r,;>. r'" "d..--,.-M r..-.....
o b) Top of next higher floor -:J <.0 L ft ~ ~ ; _r.......d.J wi.... y~" [,". i: .:...r.~
o c) Bottom of lowest hOrizontal structural member (V zones only) 'l4-L.A.c - ft (m) * ~ ,~--... ...-.-.... ......... ........,, ,... . . ....
o d) Attached garage (top of slab) "5 \4- ~ ft ~ ~ -g ,I !?I n
o e) Lowest elevation of machinery and/or equipment ~ ;~ J~'liu.- 4- / ~
servicing the bUlldmg (DeSCribe In a Comments area) 'Slt.\--:L. ft ~ n ~ ';....... .... .... ... ..~. ..; ... .... .r<"LL~
_ --L Eel 01 ;:"Ot~ .. I
o f) Lowest adjacent (finished) grade (LAG) "::) \..,- Q ft ~ ~ E', JU'. Y ~3, j~v.;
o g) Highest adjacent (finished) grade (HAG) S l ~ --z... ft (aI:J ~ (f) \ JGN.~ j-I'V,;,; P. OAKES
o h) No of permanent openings (flood vents) wlthm 1 ft. above adjacent grade \ I ~ \..'--' .- ...~ '...s)
o I) Total area of all permanent openmgs (flood vents) m C3 h V'lS- sq In I:.?'l ..* ~::.-;.. f',p" ?-'\ ?::.~,
SECTION D _ SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICA nON
ThiS certification IS to be Signed and sealed by a land surveyor, engmeer, or architect authOrized by law to certify elevation informatIOn
/ certIfy that the mformatlOn m SectIons A, 8, and C on thIS certificate represents my best efforts to mterpret the data avaIlable
I' 'orstand that an false statement ma be pUnishable b fine or Impnsonment under 18 U S Code, Section 1001
C. =IER'S NAME ) A\ f 11.-. c.L LICENSE NUMBER ..
.... ()N.K~ ~ Ci'~. L."7.-1t. Z-lCS
TITLE - .. , COMPANY NAME
?~Fe...'7?\D}.LAL. ~~ ~t,'iOL. ~~ C-I-U\Ij.lE...E.Q.j.W. ~~S~IUG IN-G
ADDRESS CITY STATE \ ZIP CODE .
.p~O ':f1::;c')C- Z'3""2..-'l FA )L'1 l7,..UE- 01'_ C{,C-Q7!
SIGNATURE \Ai If. r (\....\ Il DATE TELEP,HONE
"-_{A..J(t1IA.(u-.1-\ :.Jy.!J~ \. -z.~ -o~ S't-l - 4CCS~ 4'36'::>
c:c:U^ t:~r", R1.':l1 /III f)f)
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For Insurance Company Use
~umber
lPORTANT In these spaces, copy the corresponding Infonnatlon from SectIon A
dUILDING STF}EET ADDRESS JlnCludln~-C; }~rt, SUIte, and/or Bldg No) OR P 0 ROUTE AND BOX NO
(01 ,+<b M..07rt.~ v, .
CITY STATE ZIP CODE Company NAIC Number
"";lPi2-l ~F \-e.~ OQ.- t:f74,<D
SECTION D _ SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of thiS Elevalton Certificate for (1) communrty offiCial, (2) Insurance agent/company, and (3) bUilding owner
COMMEN'rg (),rt'( OF ';7PIll \..I6f-lELAI ~I'~ pC.?c-"'-'~ -k? A. Cth"7~ ?Q<)"'eL,
! tJ. Il\€- \Di' or~"1U7 ~ 'Tll€..- 11\,1 D PO, !-IT OF-l1"I"€ Gl.Jl'U7 ~ m- -n\-e. "-":i,.Ynt<.L!;':>T
(DU.lt.12.- (F ~ r \J, 1'82- ?fLX tm..t or to ,1:!!" ~') '"Tt10Q..0\O W ~~
~ 5\"Z.-. b l Check here If att~chments
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
Infonnation for a LOMA or LOMR-F, Seclton C must be completed
E1 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_I'n (em) I-I above or I-I below
(check one) the highest adjacent grade (Use natural grade, If available)
E3 For BUilding Diagrams 6-8 \"Ith openrngs (see page 7), the next higher floor or elevated floor (elevation b) of the bUilding IS
I_l_f ft (m) I_LIIn (cm) above the filghest adjacent grade Complete Items C3 hand C3 I on front of fonn
E4 For Zone AO only If no flood depth number IS available, IS the top of the bottom floor elevated In accordance With the communrty's
flood lain mana ement orchnance? Yes No I Unknc::n The local offiCial must certlfv thiS Infonnatlon In Section G
SECTION F. PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authonzed representative who completes Sections A, B, C (Items C3 hand C3 I only), and E for Zone A
thout a FEMA-Issued or communrtY-lssued BFE) or Zone AO must sign here The statements In SectIons A. B, C, and E are correct to
.1 best of my know/edge
PROPEl< I r OWNER S OR OWNER S AUTHORIZED REPRESENTATIVE S NAME
ADDREsg
CITY
STATE
ZIP CODE
SIGNATt.i;:(~
DATE
TELEPHONE
COMMEN"iS
I_I Check here If attRc-hments
SECTION G _ COMMUNITY INFORMATION (OPTIONAL)
The local offiCial who IS authonzed by law or ordinance to admlnrster 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 1-1 The Infonnahon 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 ~e source and date of the
elevahon data In the Comments area below)
G2 1-1 A community offiCial completed Section E for a bUilding located In Zone A (Without a FEMA-Issued or communitY-Issued BFE) or
Zone AD
G3 I_I The fO"O~lng Infonnahon (Items G4-G9) IS prOVided for communrty floodplain management purposes
G4 PERMIT NUMBER I GS DATE PERMIT ISSUED I G6 DATE CERTIFICATE OF COMPLlANCEJOCCUPANCY
.. ISSUED
G7 ThiS pennlt 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 OFt=iCIAL;; NAME
_ ft.(m) Datum .
_ ft (m)Datum .
TITLE
COMMUNI1Y NAME
TELEPHONE
DATE
JATURE
COMMENj"g
I Check here If a!!~chments
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