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Home My WebLink AboutFEMA Application 1999-6-2 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE o M B No 3067-0017 Expires July 31, 2002 Important Read the instructions on pages 1 - 7 SECTION A - PROPERTY OWNER INFORMATION I For Insurance Company Use Policy Number l , '- BUILDING OWNER'S NAME DeRi.,\(.\( "'JE~CJe:f!- BUILDING STREET ADDRESS (Including Apt Unit Surte, and/or Bldg No) OR P 0 ROUTE AND BOX NO (.,88 ~ ~ I ~E~~ CITY STATE ~~I"'-lc::;H CLo O~ PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc) Lo-r +8 L..~\ L."''''lO\~G. 'Z.t..)C) 1=\00\1\0"1 BUILDING USEJe g , Residential, Non.resldential, Addition, Accessory, etc Use a Comments area, If necessary ) "R e:~\ D~N Tl/V-- LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM SOURCE I_I GPS (Type) ( ##0 - ##' - ## ##" or ## #####") 1-1 NAD 1927 LI NAD 1983 I_I USGS Quad Map Company NAIC Number ZIP CODE 41418 1-1 Other SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1 NFIP COMMUNITY NAME & COMMUNITY NUMBER B2 COUNTY NAME 'S~IN~FI~1..D +\ ~S '11... L.A.NE. B4 MAP AND PANEL B5 SUFFIX B6 FIRM INDEX B7 FIRM PANEL B8 FLOOD NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) +10::'9 c llto"l f ..J('j~E '"I \."., .)~NE' '-.. 19"19 AE. 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 )4 Communll.tgetermmed I_I Other (DesCribe) B11 IndIcate the elevation datum used for the BFE In B9 I.6l,NGVD 1929 I_I NAVD 1988 I_I Other (Descnbe) B12 Is the bUilding located 10 a Coastal Barner Resources System (CBRS) area or Otherwise Protected Area (OPA)? Designation Date B3 STATE C~ B9 BASE FLOOD ELEVATION(S) (Zone AO, use depth of flooding) ?I~ I I_I Yes ~ No SECTION C - BUILDING ELEVATION I~FORMATION (SURVEY REQUIRED) 1 Building elevations are based on 1_IConstructlon Drawings. I~Bulldlng Under Construction. I-I FInished Construction . A new Elevation Certificate Will be reqUIred when construction of the building IS complete C2 BUilding Diagram Number 8 (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, AR/AE, AR/A1-A30, ARlAH, AR/AO 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 Elevation reference mark used Does the elevation reference Mark used appear on the FIRM? I_I Yes L-I No o a) Top of bottom floor (Including basement or enclosure) 5 14- ~ ft (m) ro o b) Top of next higher floor '5 II ~ ft (m) ~ Jf" o c) Bottom of lowest hOrizontal structural member (V zones only) ft (m) ~ ~ REGISTERED o d) Attached garage (top of slab) '5 \ OS ~ ft (m) ~ ~ - PROFESSIONAL , o e) Lowest elevation of machinery and/or equIpment tJ../A. ~; !, LAND Sf0\o~ii..- servicing the bUilding (DeSCribe In a Comments area) _-.:.. ft (m) E ~ ~ '"^" ~ o f) Lowest adjacent (finished) grade (LAG) 'S 1 '\- _?_ ft (m) 1. Q. o g) Highest adjacent (finished) grade (HAG) 51fc _L ft (m) ~ CIl :.' FE~R~~~~rm- .; o h) No of permanent openings (flood vents) Within 1 ft above adjacent grade \4- 3 i JAMES W. ' COLTON : o I) Total area of all permanent openings (flood vents) In C3 h \C;S'1... sq In (sq cm) ~, ._... _ H#5B75~__ __ .,..4 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION e.....~~ \~i~ leI . 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 informatIOn In SectIOns A, 8, and C on thIS certifIcate represents my best efforts to Interpret the data avallab/e I understand that any false statement may be pUnishable by fine or Impf/Sonment under 18 U S Code, SectIOn 1001 CERTIFIER~:::.~AME LICENSE NUMBER"", .).-..n~ \I'J. CoC\t:l~ o~ . l- .o;.,.;J~I~ TITLE . COMPANY NAME ___. Lf\"1!:l ~~42." 6"'t~ ~O~ -~~:;.~ - fh~~~NOOl-- ADDt-(t::~.~ ~w "2.y.,l~S CITY6Jc:;.CN e- ST~r~ ZIP~~~t. SIGNATURii.... . I ~ DATE TELEPHONE ~-'- v.. ~-r. '1...(., 'LOd \ 344- . lS S 't. I=I=~AA I=nrm<;U,h1 1111 on ~i=i= RI=\/i=R~i= <::Inl= I=()R r()NTINIIATI()N Ri=PI Arl=<:: All PRi=\II()II~ I=nlTl()N~ " ~ IMPORTANT In these spaces, copy the corresponding information from Section A BUILDING STREET ADDRESS (Including Apt Unit, SUite, and/or Bldg No) OR PO ROUTE AND BOX NO <.:. ~'B 'a 'So \"-\81 N For Insurance Company Use Policy NU'!Iber < STATE ZIP CODE i Company NAIC Num~r s.~\~~~O C~ 91""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 CITY 1__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 mtended for use as supporting Information for a LOMA or LOMR-F, Section C must be completed E1 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 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 Diagrams 6-8 With openings (see page 7), the next higher floor or elevated floor (elevation b) of the budding IS 1_1_1 ft (m) 1-1_11n (cm) above the highest adjacent grade Complete Items C3 hand C3 I on 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 communtty's floodplain manaQement ordinance? I_I Yes I_I No I_I Unknown The local offiCial must certify thiS information 10 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, 8, C, and E are correct to the best of my knowledge PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS 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 communtty's floodplain management ordinance can complete SectIons A, 8, C (or E), and G of thIS Elevation Certificate Complete the applicable Item(s) and sign below G1 I_I The Informalion 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 elevalion 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 84 PERMIT NUMBER I G5 DATE PERMIT ISSUED I 86 DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7 ThiS permit has been Issued for 1_-1 New Construction I_I Substantial Improvement G8 Elevalion of as-bUilt lowest floor (mcludlng basement) of the bUilding IS G9 BFE or (m Zone AO) depth of flooding at the bUilding site IS LOCAL OFFICIAL S NAME __ ft (m)Datum _____ ___ ft (m) Datum TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS L-' Check here If attachments I=i=MAl=nrmR1.<1 1111 nn Ri=PI A('i=~ AI I PRi=\/InllC::: i=nlTlnNC:::