HomeMy WebLinkAboutFEMA Application 2008-6-9
U S DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
NatIonal Flood Insurance Program
ELEVATION CERTIFICATE
l OMS No 1660-0008
EXPlfes February 28 2009
A1 Budding Owner's Name
"3'~es
Important Read the instructions on pages 1-8
SECTION A. PROPERTY INFORMATION
WccJa.rci
I For Insurance Company Use I
Policy Number i
comp_any NAIC Number j
ZIP Code
"'1~\1""
A2 BUilding Street Address (lncludmg Apt Untt, SUite and/or Bldg No) or P 0 Route and Box No
\ '\ 1 (p W l,../l.o.> 0 Vo.Hc'f
City Stat~
""VILI"''''I''It1t..>D "f'..
A3 Property DeSCription (Lot and Block Numbers, Tax Parcel Number, Legal DeSCription, etc)
A4 BUIlding Use (e 9 ,Residential Non-Resldentlal Addition Accessory, etc) _. "-c:..~ \ 0 9,..,1' \-'L,...
A5 Latitude/Longitude Lat . Long HOrizontal Datum 0 NAG 1927 0 NAD 1983 '
A6 Attach at least 2 photographs of the bUilding If the Certificate IS being used to obtain flood Insurance
A7 BUilding Diagram Number~
A8 For a building with a crawl space or enclosure(s) provide A9 For a bUlldmg with an attached garage provide
a) Square footage of crawl space or enclosure(s) ("\'?D sq ft a) Square footage of attached garage sq ft
b) No of permanent flood openings In the crawl space or 1'1 b) No of permanent flood opemngs In the attached garage
enclosure{s) walls within 1 0 foot above adjacent grade _ _ walls wlthm 1 0 foot above adjacent grade
c) Total net area of flood openings In A8 b I~~ sq In c) Total net area of flood opemngs In A9 b sq tn
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81 NFIP Commumty Name & Commumty Number I B2 County Name
<Grl1.1~(;,.n~" .' __ L-A>>fi-
84 Map/Panel Number 85 Suffix B6 FIRM Index B7 FIR'M Panel --
Date Effective/Revised Date
B3 State
o e.Bc"or-1- ,
Mo ?'tc.\14LtF"
. B8 Flood
Zone(s)
Af5
B9 Base Flood Elevatlon(s) (Zone
AO, use base flood depth)
444..0
810 Indicate the source of the 8ase Flood ElevatIon (8FE) data or base flood depth entered In Item B9
o FIS Profile !:8tIRM 0 Commumty Determined 0 Other (Describe)
811 Indicate elevation datum used for BFE In Item 89 ~ NGVD 1929 0 NAVD 1988 0 Other (Describe)
812 Is the buddmg located In a Coastal Barner Resources System (CBRS) area or OthelWlse Protected Area (OPA)?
De"gnallon Date . 0 CBRS DOPA
DYes
o No
SECTION C _ BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1 BUilding elevations are based on 0 Construction Drawmgs. 0 BUlldmg Under Construction" ~ Fmlshed Construction
." A new Elevation Certificate will be required when construction of the bUilding \S complete
C2 Elevations _ Zones Al-A30, AE AH A (w,th BFE) VE Vl-V30 V (w'th BFE) AR ARIA ARlAE, ARlAl-A30 ARlAH, ARlAO Complete Items C2 a-g
below accordmg to the bUlldmg dIagram specrfied In Item A7
Benchmark Ut,l,zerl C.o.o;, u./l llo.II.....Q f t<.fr'l1lMo"'" Vertical Datum \J"" 1) 'L,q
Conversion/Comments
a)
b)
cj
d)
e)
Top of bottom floor (mcludmg basement crawl space, or enclosure floor)
Top of the next higher floor I
Bottom of the lowest hOflzontal structural member (V Zones only)
Attached garage (top of slab)
Lowest elevatIon of machinery or eqUIpment servlcmg the bUlldmg
(Describe type of equipment In Comments)
Lowest adlacent (finished) grade (LAG)
Highest adjacent (finished) grade (HAG)
4 4-fI
4-c,'l.
Check the measurement used
8f2.@ feet 0 meters (Puerto RICO only)
JQJl!;] feet 0 meters (Puerto RICO only)
o feet 0 meters (Puerto RICO only)
_D feet 0 meters (Puerto RICO only)
~~ feet 0 meters (Puerto RICO only)
D
g)
_41:,,0
4('fl
44'\
~[!I feet
~l1SIfeet
o meters (Puerto RICO only)
o meters (Puerto RICO only)
SECTION D _ SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
ThiS certification IS to be signed and sealed by a land surveyor engineer or architect authonzed by law to certify elevation
Information I certify that the mformatlOn on thIS Certificate represents my best efforts to mterpret the data available
{ understand that any false statement may be pUnishable by fine or Imprisonment under 18 U S Code Section 1001
o Check here If comments are provided on back of form
rN-lt;i,A "" \-'c1U/:>,tz,Orvl t54 f> 22..
Certifier s Name \ license Number
l;;:~c"I",I;C:;12. 1-\\11.. 'i nt..u.; E.I>&.' 0:> !;igQ.l"'~ l..U.
Title Company Name
1!l~O O.l.1C '!>"t 5\:>= c- \"!.u&S""c;
Address CIty
{>{;
Slgnaturp~ ,.J. ,
~
~\'\ IDt>
Date
I!>la
State
r":>4-I- ~.. .
Telephone
<::\1AcI
ZIP Code
" f2......,
See reverse Side for contInuation
FEMA Form 81-31, February 2006
IMPORTANT In these spaces, copy the corresponding information from SectIOn A
BUIlding Street Address (Includmg Apt Unit SUite and/or Bldg No) or P 0 Route and Box No
For Insurance Company Use
Polley Number
C,ty
State
ZIP Code
Company NAte Number
SECTION D _ SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sIdes of this Elevation Certificate for (1) community official (2) Insurance agenUcompany and (3) bUilding owner
Comments
Signature
o Check here If attachments
SECTION E. BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
Date
For Zones AD and A (wIthout BFE) complete Items E1-E5 If the Certificate 1$ Intended to support a LOMA or LOMR F request, complete Sections A B
and C For Items E1-E4 use natural grade If available Check the measurement used In Puerto RICO only enter meters
E1 Provide elevation Information for the followmg and check the appropriate boxes to show whether the elevatlon IS above or below the hIghest adjacent
grade (HAG) and the lowest adjacent grade (LAG)
a) Top of bottom floor (including basement crawl space or enclosure) IS _ ~ 0 feet 0 meters 0 above or 0 below the HAG
b) Top of bottom floor (including basement, crawl space or enclosure) IS _ _ 0 feet 0 meters 0 above or 0 below the LAG
E2 For BUilding Diagrams 6-8 With permanent flood openings provIded In Section A Items 8 and/or 9 (see ~e 8 of Instructions), the next higher floor
(elevation C2 b In the dIagrams) of the bUildIng IS _ 0 feet 0 meters 0 above or U below the HAG
E3 Attached garage (top of slab) IS _ 0 feet 0 meters 0 abov~ or 0 below the HAG
E4 Top of platform of machinery and/or equipment servicing the bUilding IS _ 0 feet 0 meters 0 above or 0 below th,e HAG
E5 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? 0 Yes 0 No 0 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 Band E for Zone A (without a FEMA Issued or communitY-Issued BFE)
or Zone AO must sIgn here The statements In Sections A Band E are correct to the best of my knowledge
Property Owner s or Owner's AuthOrized RepresentatIve s Name
Address
C,ty
State
ZIP Code
Signature
Date
Telephone
Comments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local offiCial who IS authOrized by law or ordinance to administer the commumty s floodplain management ordinance can complete Sections A 8 C (or E)
and G of thiS Elevatlon Certificate Complete the applicable ltecn(s) and sl~n below Check the measurement used In Items G8 and G9
G1 0 The information In Sectlon C was taken from other documentation that has been signed and sealed by a licensed surveyor engineer or architect who
IS authOrized by law to certify elevation information (IndIcate the source and date of the elevation data In the Comments area below)
G2 0 A commumty offiCIal completed Section E for a bUIlding located 10 Zone A (without a FEMA-Issued Dr communItY-Issued BFE) or Zone AO
G3 0 The followrng rnformatlon (Items G4 -G9 ) IS provIded for com~munlty f100dplarn management purposes
o Check here If att~
I G4 Perm,t Number I G5 Date Permit Issued I G6 Date Certificate Of Compliance/Occupancy Issued
G7 ThiS permit has been Issued for [] New ConstructIon 0 Substantial Improvement
G8 Elevation of as-bUilt lowest floor (rncludlng basement) of the bUilding
G9 BFE or (10 Zone AO) depth of floodrng at the bUlldrng Site
o feel
o feet
o meters (PR)
o meters (PR)
Datum
Datum
Local OffICial s Name
Title
Community Name
Telephone
Signature
Date
Comments
o Check here If attachment::!.
FFMA Form 81-31 Februarv 2006
Replaces all prevIous editions