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Home My WebLink AboutFEMA Application 1999-6-2 i' - 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 paaes 1 - 7 >, SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use Policy Number BUILDING OWNER'S NAME OtzJJG~ \LJ.1e:L-~Q:::\ C-U71OW'-. L+O~'iA~? BUILDING STR,EET ADDRESS (Including Apt, Unit SUite, and/or Bldg No) OR P 0 ROUTE AND BOX NO 0<614 ? \ M EQ.....\ D t2...t ~ E-- CITY STATE ?~ 12-\ 1-!6,:t=-1 E.Lb cr<2- PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number Legal Descnpbon, elc) lbT fO'Q L.€:>Jl t..-A1J.(;}i IJ.6 ~ Jtl)l). F-((J:, '?, -?U [)e."? i \ S'Z..- \l~5 lA'b-LE... CD. PLA=1 t2.-€.LOi"2..-DS BUILDING USE (e g , Resldenbal. Non-resldenbal, Addlbon, Accessory, elc Use a Comments area, If necessary ) lZ-'E- ~ l D el'4 TI ""'- LATITUDE/LONGITUDE (OPTIONAL) ( ##0 _ '##' _ ## ##" or ## ####If) Company NAJC Number ZIP CODE ~1412:> HORIZONTAL DATUM 1-1 NAD 1927 1-1 NAD 1983 SOURCE 1-1 GPS (Type) U USGS Quad Map 1-1 Other SECTION B _ FLOOD INSURANCE RATE MAP {FIRM) INFORMATION I B1 NFIP COMMUNITY NAME & COMMUNITY NUMBER I B2 COUNTY NAME B3 STATE ?Pi2-i~~\f:.Lt:I 4l?~'"Z-. L~e.- C<2- B4 MAP AND PANa I B5 SUFFIX B6 FIRM INDEX B7 FIRM PANa B8 FLOOD B9 BASE FLDOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO use depth of flooding) 4to'?,\c.., \lto'1 F b- 2--'t~ (0. Z-~q Ae.- 5 \2 G1 B10 Indicate the source of the Base Flood ElevatIOn (BFE) data or base flood depth entered 10 B9 I_I FIS Profile I_I FIRM ~ommunrty Determmed I-I Other (DeSCribe) B11 Indicate the elevation datum used for,{le BFE In B9 I_I NGVD 1929 I_I NAVD 1988 DQ..Other (DeSCribe) L-O("~ B1? Is the bUilding located In a Coastal Barner Resources System (CBRS) area or Otherwise Pr~tected Area (OPA)? 1-1 Yes ~ No leslgnatlon Date SECTION C _ BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1 BUlldmg elevations are based on I-I Construction Drawlngs* 1_IBUlldmg Under Construcllon* I~lnlshed 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 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. ARiAE, ARiA1-A30, ARiAH, ARJAO Complete Items C3 a-I below accordmg 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 ~\) 0.-:;;' 'TO (~ ()fi1\J M. \0 ~ ~ r...J'\ A: DA1V1A Elevation reference ~ark used ?E...E..- l.0~C4J,.1'? Does the elevation reference mark used appea'€~.ih.ii=::..~?C!~~Ni~~ o a) Top of bottom floor (including basement or enclosure) 5 \4-- ? ft E~ a; ~f""""~' ~i.:4-.....""..:'.......AL. : - " L c\,.-' t~. CiJ \",,,;;, rr-.r- f'!I o b) Top of next hIgher floor ~ \'"l 0 ft (~ ~ t ,;n...., ~..... ..",it. r < ............ " o c) Bottom of lowest hOrizontal structural member (V zones only) N fA,. ft ~ ~ ~ ~~-L'" .... ... . '''n .."", X"'''. r o d) Attached garage (top of slab) '3 \'5 ~ ft ~ ~ ~ 1,..,' De) Lowest elevation of machinery and/or eqUipment ~ ~ -fl ) \~ W servicing the bUlldmg (Descnbe 10 a Comments area) S\""5 "0 ft ~ ~ ~ l'''' ,. . ".. .. '':If;;:{~~5~ ~"~..JL.' o f) Lowest adjacent (finished) grade (LAG) 'Sl4- l ft (:j;j.). :i ~ JU!..... 1iis;.4 o g) Highest adjacent (finished) grade (HAG) 5\ '5 'Z... ft (at). ~ en JONA TH:'t:J~ Of..KES i ~ ~~ o h) No of permanent openings (flood vents) wlthm 1 ft. above adjacent grade 0 :3......,..,- ..... ...,.. " o I) Total area of all permanent openings (flood vents) In C3 h . \ --z..q I sq In ~- ~J&:("..9\ lo:>d SECTION D _ SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION ThiS certification IS to be Signed and sealed by a land surveyor, engineer, or architect authOrized by law to certify elevation information / certify that the mformatlOn m SectIOns A, B, and C on thIS certJficate represents my best efforls to Interpret the data available ...!..!!p'^'stand that anl false statement ma ' be r;:;:'e by fine onmpnsonmen' unded 8 U S Code, Sect,on 1001 CE :=R'S NAME I D ^ ~J..IL I 1-' LICENSE NUMBER ~ ~f"(1I\1"t}...l."- 0 Dl2-L? ~ -z.IDS' TITLE ' COMPANY NAME . .p~rt.0?lt>J,..l-A\- LA-uh Sv~f..""(Oe- ;?O~E.. 'eA--ir, (1o-Le.EA.-t1..1./\.d. ~\V..LE,""(tl-i(\ l}..{.(.... ADDRESS 7'> 0 1:::l....,... CITY STATE I. ZIP CODE ,.-_ ~.,... "Z.SI tz:DD~L ~ C{/40"2- SIGNATURE \ At' t l DATE , TELEPHONE ---....1 I~.I.. (':.M'~ . ?....l-C,,? S>4-l- 4-<6S'4SDS <:;FF RF\lFR<:;F <:;lnF FnR rnl\lTJl\l1 JA Tlnl\l RFPI ArF<:; AI ,I PRF\llnllt: FnlTlnl\lt: FFMAFnrmR1-~1 1111 nn ORTANT In these spaces, copy the corresponding information from Section A. lJ.....ILDING STREET ADDRESS (Including Apt, Unit, SUite, and/or Bldg No) OR P 0 ROUTE AND BOX NO Co9.::>"14 ~ eM. ~ 'f.l. D 12...l \...( t- - CliY STATE ZIP CODE I Company NAIC Number 0Pi2-t U6 ~l Evb oe...- q741.r~ 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) bUlldmg owner COMMENTS c...rT Of tjP\2..\ F-l~ ~~ I ,4;;; -A.? A c~~ lU ~ 11>P en:: mtLt)QR; k=r T*f,..IW-DPDI7J.T 01= ~ Ct)i2A? ~ kll1\-€:. 00u1r\~&?' ~ea.. OF- ~ ~1._l"tf"fl?'e:LTLo1J, DF 01~ '* ~'?~ u Q.C~ ~lkJ.t - '5\7. - ~ \ I 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 mformatlon for a LOMA or LOMR-F, Section C must be completed E1 BUlldmg 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) E2 The top of the bottom floor (lncludmg 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 BUlldmg Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the bUilding IS I-1_lft (m) I_Llm (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 floodplain management ordinance? I I Yes I I No I I Unknown The local offiCial must certlfv thIS informatIon m ?p:cbon 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 10Ut a FEMA-Issued or community-Issued BFE) or Zone AD must Sign here The statements In Sections A, 8, C, and E are correct to Jest of m knowled e PROPERTY OWNER S OR OWNER S AUTHORIZED REPRESENTATIVE S NAME For Insurance Company Use Policy Number ADDRESS CITY STATE ZIP CODE SIGNATL.i;<~ COMMENTh DATE TELEPHONE I_I Check here If att~chments The local offiCIal who IS authonzed 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 1-1 A community offiCIal completed Section E for a bUIlding located rn Zone A (without a FEMA-Issued or community-Issued BFE) or Zone AO G3 I_I The follov:,lng mformatlon (Items G4-G9) IS prOVided for community floodplain management purposes G4 PERMIT NUMBER I GS DATE PERMIT ISSUED I G6 DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY J ISSUED G7 ThiS permIt has been Issued for I_I New Construction I_I Substantial Improvement G8 Elevation of as-bUilt low~st floor (rncludlng basement) of the bUilding IS G9 BFE or (In Zone AO) depth of f100drng at the bUilding site IS LOCAL OFFICIAL'S NAME SECTION G _ COMMUNITY INFORMATION (OPTIONAL) _ ft (m) Datum _ ft (m)Datum TITLE COMMUNi"j,," NAME TELEPHONE DATE \TURE COMMENTS I_I Check here If attachments RFPI ArF~ AI I PRF\!I()ll~ FnlTl()N~ FFMA Fnrm R1. ~1 II II nn