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Home My WebLink AboutFEMA Application 1999-6-2 BUILDING OWNER S NAME .t>K~.)(-E \J. \ E-<-rtEfc'T CAJ S \0 rV\ rtD 1\A.t: S BUILDING STREET ADDRESS (Including Apt , Unit, SUite, and/or Bldg No) OR P 0 ROUTE AND BOX NO Cv/41 AAa..ol--1 ~5L CITY STATE '? P l2-11-J.Lt F \ e.~ ot2- PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc) LOT 10D LC-'-tl L-~D\w,q~' 1\1...L~ MDi\10\J F,le 75. Sl1des 1l5~155. BUILDING USE (e g, ReslOentJal, Non-reslcennal, Addition, Accessory etc Use a Comments area If necessary) J2.~? \ D t.lo-.l "\ I A-L.. LA TITUDElLONGITUDE (OPTIONAL) ( ##" - ##' - ## #II" or ## #####') 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 -Policy NlJmb-er Company NAIC Number ZIP CODE Qi4.., b I i'l.np r.Q.llnty Pl'it Records HORIZONTAL DATUM L-I NAD 1927 LI NAD 1983 SOURCE LI GPS (Type) LI USGS Quad Map I_I Other SECTION B . FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B3 STATE C:>l2.E.~ Ot-l B1 NFIP COMMUNITY NAME & COMMUNITY NUMBER B2 COUNTY NAME "'.::>Pi2-IM.14 ~l c..LA) 4\~4,-- Gi'\i.lE... B4 MAP AND PANEL B5 SUFFIX B6 FIRM INDEX B7 FIRM PANEL B8 FLOOD NUMBER DATE EFFECTIVElREVISED DATE ZONE(S) 4-\G~c..ll<O~ F C, 2.-q~ ~.Z-q~ ~ B10 Indicate the source ofthe Base Flood Elevation (BFE) data or base flood depth entered In B9 I_I FIS Profile I_I FIRM I~Communlty Determined I_I Other (DeSCribe) B11 Indicate the elevation datum used for the BFE In B9 ~ NGVD 1929 I_I NAVD 1988 I_I Other (DeSCribe) B12 Is the building located In a Coastal Barner Resources System (CBRS) area or Otherwise Protected Area (OPA)? DeSIgnation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1 BUilding elevations are based on 1_IConstructlon DraWings" I.:6IBUlldmg Under Construction" 1_IFmlshed Construction "A new Elevation Certificate WIll be required when construction of the bUlldmg IS complete C2 BUilding Diagram Number 7_ . (Select the bUlldmg diagram most Similar to the bUlldmg 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, ARlAE, ARIA 1-A30, ARlAH, ARlAO 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 L.oL-A-L- Conversion/Comments A:iJ [) 0 l ~ \0 LOc..-A-\....- DrrN M. TO ~~~ F l2: > M .A. ~ 1\1 i)A.. Elevation reference ';'ark used "X.-E... CDrAM.rJ..JT-7 Does the elevation reference mark used appea~ the FIRM? I_I Y:.s ,kC'"f-hJ~, o a) Top of bottom floor (including basement or enclosure) S \'2.. ~ ft e-) ~ ~ ,... ,e' o b) Top of next higher floor ~ \ S _'2..- ft (11'1) ~i ' . - o c) Bottom of lowest hOrizontal structural member (V zones only) 1--4 II><- _ ft (m) * ~ '-'- - - -, - - o d) Attached garage (top of slab) I}.....I e.o M Pt.,.e.Te..- __ ft (m) ~ -g I /Ill o e) Lowest elevation of machmery and/or equipment .- ~ ~ ~ A ~ servicing the building (DeSCribe 10 a Comments area) -:::> \:, ..L ft (m) ~ ~; -=--:: - - - ----. o f) Lowest adjacent (finished) grade (LAG) 5 \""";> _~ ft ~ ~.2> j o g) Highest adjacent (finished) grade (HAG) '5.4 _L ft (m) ~ en l J~', o h) No of permanent openmgs (flood vents) wlthm 1 ft above adjacent grade 1 ~ ~ "== .. o I) Total area of all permanent openings (flood vents) 10 C3 h \11 CO sq In ~ B9 BASE FLOOD ELEVATION(S) I (Zone AO, use depth of flooding) SL\.q LIYes I~No _J .....~-- - """.. / ~'";::: ::_. M,:. 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 mformatlon I certIfy that the mformatlon In SectIons A, B, and C on thIS certIficate represents my best efforts to Interpret the data avaIlable , understand that any false statement may be pUnishable by fine or Impnsonment under 18 U S Code, SectIon 1001 ERTIFIER'S NAME 1""11 ~_ A 1"\ LICENSE NUMBER ----..I VN-T\~ ik;->- Uk €:. C..;> OO-t. l- "7 *- 2-1 0 S TITLE COMPANY NAME .pgoFE:..<-h \ O!-lAc- t t\}.ll) ?U l2.-\.l E.- '( OiL .Pt:}"~uf.. rnG l}J.f EJ2l MU {. ~\E.. '( I 'I-~ I \.lc ADDRESS" ""' 0-,..., '7 CITY STATE ZIP CODE t"" '-' 1..A)'f-- '- S?;A _ _ '\ E:..(,_X:-\ E j....i E.- 012- <=n ,,+"'0'2.. SIGNATURE \...+.-_ U , (\ L I~. DATE TELEPHONe I ----...-t-~(.I.(Ll...,.. ~ 1 G:l 0"2., 54-~ - ~S-qsns I=FMA Fnrm R1_ q1 1111 ()() e::FF RFVFRe::F e::lnF FOR rONTINI JA TION RFPI ArFe:: AI I PRF\lIOI Ie:: FnITlONe:: IMPORTANT In these spaces, copy the corresponding information from Section A BUILDING ST~EET ADDRESS (Including Apt , Unit, SUite, and/or Bldg No) OR P 0 ROUTE AND BOX NO ~l~l A;fra.u~ L~L CITY STATE ZIP CODE Company NAIC Number 7P12-1 t-..lq \=l etAJ lfl2- c::n4~5 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) COQY boQ1. ~Ides of thl~ E~ev_at~on _Certlfic.a~e f~r (1) comm~nlty official, (2) Insurance agent/company, and (3) bUilding owner COMMENTS ' Gl II ~ '00 Q" 'IJ. ~ 1=1 ~ L /) ~H: M ki2-IL- ~.?au e,~ Ac7 A c. ~~Lt.-{) ~V1\-I2k- l ~ ll\.~ It> P Ot=- ~ GtJ'l2.AP:, A:=f ~ 1'\\\ D(>D (~(T m:- me LVQA?;J 1U2:--l'\JiU-i t? ~ -s \JJ, ( o<U--L E.I~ a:::- ~, u..n€;f2..~I\O~ ~ (o,l1\- -4-1mJ"<2.-'-?TWJ ~ Ct.\( ()ffN1V\ 5\7.- ~l F.E- loA.';'" !'::Yn-u-M '::Jl~ \ -E-LBJATIO/-l'7 7rtv\L..f,1-! l+A.! ~ ~ C{);l.l.\(~ I'D ~,t:: -M A (JA-1~-,v'\ ~__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 information for a LOMA or LOMR-F, Section C must be completed I E 1 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 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 51vallable ) _ E3- For BUilding Diagrams 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_11n (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 10 accordance With the community's floodplain manaQement ordinance? I_I Yes I_I No '-_I Unknown The local offiCial must 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 In SectIons A, 8, C, and E are correct to the best of my knowledqe PROPERTY OWNERS OR OWNERS AUTHORIZED REPRESENTATIVES NAME For Insurance Company Use Policy Number 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 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 mformatlon 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 (mcludlng basement) of the bUilding IS G9 BFE or (10 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 I Check here If attachments RFPI ArFC:: AI I PRF\llnllC:: FnlTlnl\lC:: FFMA Fnrm A1-"l1 1111 00