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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 3067-0077 Expires July 31, 2002 Important. Read the instructions on paQes 1 - 7. SECTION A - PROPERTY OWNER INFORMATION BUILDINGf\YNJ:R'~~E r;- /'-- j'v A-~Lk:s '- .- A .- J BUILDING STREET ADDRESS ~dlng Apt, Unit, Suite, and/or Bldg No) OR P 0 ROUTE AND BOX NO (cr14 6...) A GO ~~ L ;..,:) 1 CITY . ~A~ -s, F' (2, j0 Co t::"\ a 0 ()~t;betJ PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal DesalptJon, ete.) \"/ D2- '=bLt l\ l-o-r 13L?DO BUILDING USE (e g~eSldentJa..I, Non-reSJd. entJal, AddltJon, Accessory, ete Use a Comments area, If necessary) ~6S\Oe~IA{...: LATITUDElLONGITUDE (OPTIONAL) HORIZONTAL DATUM SOURCE LI GPS (Type) ( ##" - ##' - ## ##" or ## ###/#f) LI NAD 1927 LI NAD 1983 LI USGS Quad Map ,For!nSu~ce Company b1se'~c " :1:'oIIcy' .N ,,~-.j}Jr! tf:t ~ ~ ~P CODE , '-i-1Lf 7 t) LI Other SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1 NFIP ~OMMUNITY NAME & COMMUNITY NUMBER B2 COUN1Y NAME 83 STAre Ci{. at '^. -' /SS92. L-AU f? Of::;! . B4 MAP AND PANEL B5 SUFFIX B6 FIRM INDEX B7 FIRM PANEL B8 FLOOD B9 BASE FLOOD ELEVATION(S) NUMBER DA~ EFFECTlVElREVISED DATE ZONE(S} (Zone A~ use depth of flooding) 4103 c; C.1I(.6 F F 6- z - 9'1 5'll,. {{ lItf6 B 1 0 Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered In B9 I_I FIS Profile ~ FIRM I_I Community Determined I_I Other (Descnbe) B11 Indicate the elevation datum used for the BFE In B9 ~NGVD 1929 I_I NAVD 1988 I_I Other (Descnbe) B12 Is the building located In a Coastal Barner Resources System (CBRS) area or OthelWlse Protected Area (OPA)? LI Yes I_I No DeSignation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) 'C1 Buildmg elevabons are based on 1_IConstructlon Drawmgs. 1_IBulldlng Under Construction. IPlflnlshed Construction · A new Elevation Certificate Will be required when construction of the bUilding IS complete C2 BUilding Diagram Number B. (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 Elevabons - Zones A 1-A30, AE, AH, A (With BFE), VE, V1-V30, V (with BFE), AR, ARIA, ARlAE, ARIA 1-A30, ARIAH. ARJAO Complete Items C3 a-I below according to the bUlldmg diagram speCified In Item C2 State the datum used If the datum IS different from the datum used for the BFE 10 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 Conversion/Comments ... ... Elevation reference mark used 61 z... Cl> Does the elevation reference mark used a?pear on~'A~~1 No lJ a) Top of bottom floor (including basement or enclosure) ~ ~~ ~ ft (m) 1 ~~' G\ N~~' ~~ lJ b) Top of next higher floor _ft.(m) ~ ~ ~ ,,~~ lJ c) Bottom of lowest honzontal structural5!ember (V zones only) ft (m) = ~ ~ <t; 54 22~-1> ~ lJ d) Attached garage (top of slab) - &:3 t ~ ~ (m) ~ -g' /. ~ lJ e) Lowest elevation of machinery and/or equipment ~ : ' v ~ - servicing the building (Descnbe In a Comments area) L";; I ~ !L.~ (m) ~ ~ ~11; OR EGO~r3' lJ f) Lowest adjacent (finished) grade (LAG) t:;, I. ~ ft (m) ~ M -:% ~11. t.0 ~ lJ g) Highest adjacent (finished) grade (HAG) 1;;lIL'tf. ~ ft.(m) ~ ~ :.<tRY \ S, ..~ tJ:l lJ h) No of permanent openings (flood vents) Within 1 ft above adjacent grade l~ ~ 'l;f S M~\.\.~' rz.% lJ I) Total area of all permanent openings (flood vents) In C3 h I Y ~ 0 sq In (sq cm) . U. . SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICA T~jRATi6N DATE 6/30/0 -3 r ThiS certification IS to be Signed and sealed by a land surveyor, engineer, or architect authonzed by law to certify elevation information I certtfy that the information 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 CERTIFfJ'~~LA- ~ bt l u....~T(l.vtll\ p. 'f:.. LICENSE NUMBER? Ll e z, z, P& f1TLE tSN~lt-.::J et3f2. ~oe:rF~~~tr1G"etR-l ~b ADDRESSl J:-.J Pe; lSU~e ~E ~~~I SIGNATURE ATE C-J ~ELEPt-!o,NE I j t"JJ Gh~""'\ 2J Z, -,..,..,\ - -r6-. - -,OVLI ~I=I= RI=\lI=R~1= ~Inl= I=OR rm"TINIIATION RI=PI Arl=~ All PRI=VIOII~ I=nITlON~ " I=I=MA I=nrm A'i. ~i 1111 nn IMPORTANT. In these spaces, copy the correspondmg Information from Section A. BUILDING STREET ADDRESS (including Apt , Unit, Suite, and/or Bldg No) OR P 0 ROUTE AND BOX NO 'For !~lfl'1ce",Cflrrpany Use' :;L ' ~r ,p~n~~~r w ~~ t ~ ~'"l~; {j; CITY STATE Z1PCODE ream a 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 '-_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 Intended for use as supporting Information for a LOMA Or LOMR-F, Section C must be completed E 1 BUlldmg Diagram Number (Select the bUlldmg 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_lln (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 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 In accordance With the community's f100dplam manaQement ordinance? 1._...' Yes I_I No I_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 knowledf1.e PROPERTY OWNER'S OR OWNER'S AUTHORlZcu r=r-r=~e;.~ I ATIVE'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 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, engmeer, or architect who IS authonzed by state or local law to certify elevation mformatlon (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 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; r-c;t\Jv11T ISSUED I G6 DA. c; \"c;t\T1FICATE OF COMPLIANCE/OCCUPANCY ISSUED G7 ThiS permit has been Issued for I_I New Construction I_I SubstantJallmprovement 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 OFFICIAL'S NAME _ ft (m)Datum _ ft (m)Datum TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS '-_I Check here If attachments FFMA Fnrm R1_~1 1111 nn RI=PI A("I=~ All PRl=Vlnll~ I=nITlnN~