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FEDERAL EMERGENCY MANAGEMENT AGENCY
NAnONALFLOOOINSURANCEPROGRAM
ELEVATION CERTIFICATE
OM B No 3067-0077
Expires Decem ber 31, 2005
Important: Read the Instructions on pages 1 - 7
SECTION A - PROPERiY OWNER INFORMATION I For Insurance Company Use
BUILDING OWNER S NAME I Policy Number
BUILDING STR5ET AD_DRESS (Including Apt, Unit, Surte...a.!:!.d1or Bldg No) OR P 0 ROUTE AND BOX NO I Company NAJC Number
(,? t3 fj() S t vVl e r)\r"\ l)Y"" \\.1 e.. '" '.
CITY S rlv '^" "i ~ e l cf o~ 47 ~9.J7
PROPERTY pEsc~ipTION (Lot1lrid Block Numbers Tax Parcel Numcer Leg~1 ~75Cflptlon, et:l.. II t
I-t'?t 50 L(.?\/I LChvf,,,,,,, ZVlt-( A-ldITlc.\.A. IA><'M?<C? 17-01-3\f-lllt\.\CLo 8300
BUILDING USE (e g~eSldentJal, Non-resldentJal, AddrtJdn, Accessory, etc Use a Comments area, If necessl!lry)
, f":S..\ 1 ~ -t. ~- \ ATUM
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL D
( ##0 _ #II! - ## #if' or ## ####if) U NAD 1927 U NAD 1983
SOURCE U GPS (Type)
U USGS Quad Map U Other
SECTION B - FlOOD INSURANCE RATE MAP (ARM) INFORMATION
~. NFIP CO~~ITY NAME ~ COMMUNITY NUMBER B2 COUNTY NAME B3 STA~ 0
~l~ tV '::>PY\"'~ hdtX ttls~q2- LaV/e... LJf'.-
B4 MAP AND PANEL 85 SUFFIX B6 FIRM INDEX B7 FIRM PANEL Ba FLOOD
NUMBER DATE EFFECTNElREVISED DATE ZONE(S)
41()3qc..II~& F ~!APZ,Jqq'1 J:tll1e 2-"Q1'1 X
B10 Indicate the source of~e Base Flood Elevation ~Drt:J data or base flood depth entered In B9
LI FIS Profile ~FIRM U Community Detennmed LI Other (Descnbe)
811 Indicate the elevation datum used forthe BFE III B9 U NGVD 1929 U NAVD 1988 U Other (Descnbe)
B12. Is the building located In a Coastal Barner Resources System (CBRS) area or OthefW1se Protected Area (OPA)? U Yes I;ttNO
DeSignatIon Date
89 BASE FLOOD ELEVATION(S)
(Zone AO, use depth of flooding)
j)oJ,.r e -r; ~ X
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1 BUlldmg elevations are based on UConstrucIJon DrawIngs. UBuddmg Under ConstructIOn. It:::tRnlshed ConstrucIJon
*A new Elevation Certificate will be reqUired when construcIJon of the building IS complete
C2 BUilding Diagram Number fj (Select the bUlldlllg diagram most slmdarto the buddmg for which thIS certrticate IS bemg completed - see
pages 6 and 7 If no diagram accurately represents the bUilding, proVIde a sketch or photograph)
C3 BevatJons - Zones A1-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 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 m Section B, convert the datum to that used for the EFE Show field measurements and datum conversion
calculatIon Use the space prOVIded orthe Comments area of Section D or SectIon G as aopropnate to document the oatum conversion
Datum kJGV 0 ''2C! ConvelSlonlComme,p;ts -
Elevation reference mark. us~ ve (:lev e &f< e... Does the elevation reTerence marx useo aopear on the FiRM? I I Yes t-/-J. N;
::J a) Top of bottom floor (Including basement or enClOSUre) 51""3 7... ft (,) ~ I r REGISTERED - .\
:! b) Top of next tllgher floor 5" J (p .2. ft~) ~" PROFESSIONAL 1
~ .:.} :J~H~...., .,H, ~.:.~'-L....w..","; "",,~""w,.:..1 ::r.::::r.esr (V Z9R8& gr~:'J _ A (\Zlj ~ ~ I LANI'\ SURVEYOR
::J d) Attached garage (top of slab) t!) I c; !:t.. ft (rw ; ~ I . . ,~. .
:l e) Lowest etevallon OT machmery and/or eOUloment - 4- L ~; I ~.~ /.&7' '
sef'VJcmg the building (Descnbe 111 a Comments area ) ~::;;, _;1 (rf) ~ ~ Il.' /:.~.. ~EGOO
::J f) Lowest aOlacent (finished) grade (LAG) ~ / ~ ~ ft (fjl) : ~ I JULY 20, 1993
:l g) Hlgnest aOlacent (finlsneo) grade (hAG) '::;> /4 2- -t 'IT!) ~ REX A 1:'1:: I L
:1 h) No of permanem opemngs (tlood vents) wrtOln 1 it aoove aOlacent grace I I i #?-OO6 /
...J I) Total area of aU permanem opemngs (tlooa vems) In C3 h Cf2 4- sa In (,,0.-...) .: I (';-: t:::YfO (zJ '2;, /02, f
SECTION 0 - SURVEYOR. ENGINEER OR ARCHITECT CERTIFICATION
thIS certificatIOn IS to be sJgned ana sealed by a land surveyor engineer or arcnnect authonzed bv law to cenrfy eleVatIOn ImormallC''l
I certify that the mrormatJon In SectIons A. 8 and C on thIS cemficare represents my Dest efforts to Interpret the data available
I understand that any false statement may be punIShable by fine or Imonsonmenr under 18 U S Code SectJon 1001
CERTIFIER S NAME--;"), 1 ~ t LlCE\JSE '\IUMEE=<'.J S; /7 0{) (0
1"(' ~ '>c ^ r-5-f", 2-- _" __ rL. 'C-
TITLE S.. CUMPANY NAME-;') ---.
~ L-{YVc<-/ ,AA UII\ C1C;eV_ 1)Y<<I1CL, Bt'::;/v1('''erlh''1. -h1C
'" - 1"\ ~ CI)-+. r STAr' /"} ZIP CeDE
'3 t U _-r I :-T~ S' 'TV E G t ~1'J1'~Y] '1 -; c Ie) GK. q 7 if- 77
,/ /J / d-- .---.pAl!: I " TEU::::lHCNE/ )
/'1'/';V t/ ~~ L,e ceWll?c'y 10. ltJ[)"3 - (S41 1J-{o -C~ '37
ADDRESS
SIGNATURE
FEMA Form 81-31, Januarj 2003
See reverse Side for contrnuatlon
Replaces all preVIous editions
IMPORTANT. In these spaces, copy the correspondmg mformatlon from Section A
BUILDINg STREET AOORES~ncludJng Apt, Unrt, Suite, and/or Bldg No) OR P 0 ROUTE AND BOX NO
o BPJ() 0 11M ~ UV\ Dy-\v~
CITY c-' r (-^ - STATE -;J q ,zIP CODE Company NAIC Number
--,p y "'^ ~ j\ e d C ~ -....... 7 If 77
, ./ SECTlON Ii - SURVEYOR, ENGINEER, OR ARCHITECT CERTlRCA110N (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) Insurance agent/company, and (3) budding owner
CJ;JMMENTSr C"' r I , + r r .
~ (1 \ h1 aT '.9Yh---S ,\'Cld RC\(I(.lr. ,(,{Cu"~, he-lYle, ~ cJ'llsded S~l.U:( y~ PI.A lh tke.. Tho iZiu' ~.-:- (<-, v~
+ [' r I ,.."
Q -rklMti'pO\",-ti-\JCur--6 re+ul'V"- CO tke.. "')f)LLtkl-\Je.:;..t CurVlev c.;: ~7~ ~/)n'.I',,<t-oV"\
hav~&) t{V\ eleva.ft~ of 5,2,01 CI.\'" Th.tl{\IV'\ (1;vtd aL(')~Lsk<-~ -fa 5/3 1\ AJGvO'Z<=f
UJu s u. s.-ed. .::<.", t"'.e.. 15"~, ':' of e(ev.?t t-~ OV\ <.. ~~ouJ'v\ ~e'n:" OV\ J U Check here lfattachments
SECTION E - BUILDING ELEVATlON INFORMATlON (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zone AO and Zone A (without BFE). complete Items E1 through E5 1f1f1e ElevatIOn Cert1ficate IS Intended for use as supporting
InfonnatJon for a LOMA or LOMR-F, Section C must be completed
E1 8ulldlOg Diagram Number (Select the bulldsng dIagram most Similar to the building for which thiS certificate IS being completed _
see pages 6 and 7 If no daagram accurately represents the bUlldmg, proVIde a sketch or photograph)
E2 The top ofthe bottom floor (mcIudlOg basement or enclosure) of the building IS I I I fl (m) I I I m (em) U above or U below
(check one) the highest adjacent grade (Use natural grade. If available )
E3 For BUilding DIagrams ~ WIth openmgs (see page 7), the next higher Boor or elevated Boor (elevation b) of the buddmg IS
I I' I fl (m) I I hn. (em) above the highest adjacent grade Complete Items C3 h and C3J on front of form
E4 The top of the p1atfontl of machmery and/or eqwpment seMcmg the bWldmg IS LU fl (m) , I'm (em) U above or U below
(check one) the highest adJ8cent grade. (Use natural grade, If avaIlable )
E5 For Zone AO only If no flood depth number IS avaJlable, IS the top at the bottom Boor elevated In accordance with the community's
flOOdplain manaQement ordmance? W Yes I I No I I Unknown The local offiCIal must certify thIS II1furmatlon In Section G
SECllON F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFlCATlON
The property owner or owner's authonzed representabve who completes SectIons A, 8, C (Items C3 hand C31 only). and E for Zone A
(without a FEMA-Issued or community-ISSued BFE) or Zone AO must slQn here The statements In SectIons A, S, C, and E are correct to
the best of my knowledae
PROPERTY OWNER'S oR ONNER'S AUTHORIZED REPRESENTATIVE S NAME
I For Insurance Company Use
parJCY Number
ADDRESS
CITY
STATE
ZIP CODE
SIGNATURE
COMMENTS
DATE
TELEPHONE
LJ Check here If attachmerns
SEC110N G - COMMUNITY INFORMATlON (OPTIONAL)
The local offiCIal who IS autbonzed by law or ordInance to ~"ulI...u,.rthe community's floOOplalO managemem ommance can comolete
SectIOns A, B, C (or E). and G oHms BevatJon Certificate Complete the appbcable item(s) ana sign below
G 1 U The rnformatJon In SectJon C was taken from other documentation that has been signed and emDossed by a I1censea surveyor
engineer, or architect who IS authonzed by state or local law to certify elevation mrormanon (InolCate tile source ana oate or the
elevation data In the Comments area below)
G2 LI A community offiCIal completed SectIOn E for a budding located In Zone A (without a FEMA-lssuea ort:ommunItY-lssued BFa or
Zone AO
G3 U The follOWing I. ,iu... .atJon (Items G4-(9) IS proVIded for commumty f1ooaolam management purposes
I G4 PERMIT NUMBEq I G5 DATE PERMIT ISSUED I Go DATE CEi'mFlCATE OF COMPUANCEfOCCUPANCY
I ISSuE
G7 This permit has been ISSUed for Ll New ConstnJcuon LI SuoS1amlallmoroveme'il
G8 Elevation of as-bUilt lowest floor (mcluolng basement) at the bUlldmg IS
G9 8FE or (10 Zone AO) depth of floodmg at the bUlldmg site IS
_ ft (m) Datum
_ tl (m) D31um
LOCAL OFFICIAL'S NAME
COMMUNITY NAME
TITLE:
TELEPHONE
SIGNATURE
DATE
COMMENTS
FEMA Form 81-31, January 2003
I I Check here If attachments
Replaces al/ prevIous editions