HomeMy WebLinkAboutFEMA Application 1996-12-4
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ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does not provide a waiver of the flood Insurance purchase requirement. This form Is used only to
provide elevation Information necessary to ensure compliance wllh applicable community floodplain management ordinances, to
determine the proper Insurance premium rale, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR).
Instructions for completing this form can be found on the followIng pages.
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O.M.B. NO. 3067;0077
E><piro. May 31, 1996
SECTION A PROPERTY INFORMATION
J FOR INSURANCE COMPANY USE
POLlCY NUMBER
BUILDING OWNER'S NAME _____ \ _ ~ .
'--' OV\ y-., \' I t7) e Oh
J
STREET ADDRESS (Including ApI.. Unll, Sullo ond/or aldg. Numbor~ OR P.O. ROUTE,AND BOX.tiU~BER,
193:5 r", \ 01.-\ d. W CL'1 , <;'0'''__ .1.< L: 0 J'Z-
OTHER ~ESCRIPTION (Lot and Block Numbers. etc.) ^.J ~ +
LoT 32. } "Fi be...-\- (OYDV-e. <:;e c ti'vvJ Jidb\.l ioY\
CITY ('. . r. \ d STATE 0
~ flY IV'>' -rle- 0 "-_
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
COMPANY NAIC NUMBER
ZIP CODE
Q7'1i7
Provide the following from the proper FIRM (See Instructions):
1. COMMUNITY NUMBER
2. PANEL NUMBER
3. SUFFIX
.t. DATE OF FlAM INDEX
5. FIRM lONE
l\ \ '5 S':) \
'370
c
De.e... 1\:3\ \Q95'
A9
8. BAse FLOOD ELEVATION
(In AD lonGS, U~f1 doplhl
l\46.9
7. Indicate the elevation datum system used on Ihe FIRM for Base Flood Elevations (BFE): 0 NGVD '29 0 Other (describe on back)
B. For Zones A or V, where no BFE Is provided on the FIRM, and the communlly has eslablished a BFE for this building slle, Indicate
the communlly's BFE: I I I I I I.U leel NGVD (or other FIRM datum-see Section B, lIem 7).
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certlflcale Inslructlons, Indlca~he diagram number Irom the diagrams found on Pages 5 and 6 thai besl
describes the subject building's reference level .
2(a). FIRM Zones A l-A30, AE, AH, and A (wilh BFE). The top 01 the relerence level floor from Ihe selected diagram Is at an elevalion
, 011 I IlIJ~ ,~ feel NGVD (or olher FIRM dalum-see Secllon B, lIem 7).
(b). FIRM Zones Vl-V30, VE, and V (wilh BFE). The bollom of Ihe lowest horlzonlal slruclural member of Ihe reference level from
the selected diagram, Is at an elevallon 011 I I I I I.U feet NGVD (or olher FIRM dalum-see Secllon B, flem 7).
(c). FIRM Zone A (wllhoul BFE). The floor used as the reference level from the selecled diagram Is LlJ.U feel above 0 or
below 0 (check one) the highest grade adjacent 10 the building,
(d). FIRM Zone AO. The floor used as the reference levellrom Ihe selecled diagram Is LlJ ,U leel above 0 or below 0 (check
one) the highest grade adjacent 10 the building. II no flood deplh number Is available, Is Ihe bulldlng's lowest floor (reference
level) elevated In accordance wilh the communily's floodplain management ordinance? 0 Yes 0 No 0 Unknown
3. Indlcale the elevallon dalum syslem used In delermlnlng the above reference level elevallons:El NGVD '29 0 Olher (describe
under Comments on Page 2). (NOTE: IIlhe elevation datum used /n messurlng ",e elevations Is different Ihen /het used on
the FtRM (see Section B, lIem 7/, Ihen converl the etevations 10 the de/urn system used on Ihe FtRM snd show tile conversion
equation under Comments on Page 2.)
4. Elevallon relerence mark used appears on FIRM: 0 Yes ~ No (See Inslrucllons on Page 4)
5. The reference level elevallon Is based on: ~ctual construction 0 conslrucllon drawings
(NOTE: Use of construction drawIngs Is only valid il ",e building does nol yet have ",e relerence level noor In place, in which
case this cerll/icate will only be vslld for Ihe building during the course of construction. A post.construction Elevation Cerli/icate
will be required once construction Is complele.)
6. The elevallon of the lowest grade Immediately adjacenllo the building Is: I I 1L\i4181.G feet NGVD (or other FIRM dalum.see
... Secllon B, lIem 7).
SECTION 0 COMMUNITY INFORMATION
1. If the communily official responsible for verifying building elevallons specifies Ihat lhe reference level Indicated In Seclion C, lIem 1
Is not Ihe "lowest 1I0or" as defined In the communily's fioodplaln managemenl ordinance, the elevallon 01 the building's -lowest
floor" as defined by the' ordinance Is: I I I I I I.U feel NGVD (or olher FIRM datum-see Secllon B, lIem 7).
2. Date ollhe slarl of conslrucllon or subslanlial Improvemenl
~\
FEMA Fonn 81.31, MAY 93
REF\ACES All PREVIOUS EOlnONS
SEE REVERSE SlOE FOR CON1lNUATION
.
SECTION E CERTIFICATION
.
This certification Is 10 be signed by a land surveyor, engineer, or architect who Is authorized by state or local law to certify elevation
informal Ion when the elevation Information for Zones Al-A30, AE, AH, A (with BFE),Vl-V30,VE, and V (with BFE) Is required.
Community officials who are authorized by local law or ordinance to provide floodplain menagementlnformatlon, may also sign the
certification. In the case of Zones AD and A (without a FEMA or community Issued BFE), a building official, a property owner, or an
owner's representallve may also sign the certification.
Reference level diagrams 6, 7 and 8 - Distinguishing Features-If the certifier Is unable to certify 10 breakaway/non.breakaway wall,
enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not
Included In the certification under Comments below. The diagram number, Section C, Item 1, must stili be entered.
/ certify that the in/ormation in Sections Band C on this certificate represents my best efforts to Interpret the data available.
I understand that any lalse statement may be punishable by line or imprisonment under 18 U.S. Code. Section 1001.
.'
CERTIFIER'S N~
K'E' ).('
TITLE
ADDRESS
A. ~-e.- t-~-
WOi fC,J S; L.{ Yve'-;l vY-'
'3 \ 0 _ t:; -t{", S-Iv- t' e.r
f&y r2 4:"
LICENSE NUMBER (or AUI, Seel)
PLS ~00{P l'l Mtn,vec. 12{3.)Q7
COMPANY NAME
MrCtV1c.k E'Vld'.t'\4 eeViYlc,
CITY F - Sl)fE J ZIP
Spr I ~~ Ie lef 0 r--<.. C/7477
~~~ 4. Iqqtp PHONE{541) 74-0-0037
SIGNATURE
Caples should be mede of this Certlflcete for: 1) community ofllclal, 2) Insurance agent/company, and 3) bultdlng owner.
COMMENTS'(' il''1 J S?rl"? he\c:;(, 'Be\-1d" MCd\::. 6e1"'~ a -S~l.{Me.. c.I.A.*' \\", k top
h.. c..\t. it'" -\IAL IV\lJtolle. uf -\W... C'-O'-I., re..1L<V,^ Cct -\~ ~O(Atl.e4s.h~DYVJer S
\-\~{ .- bDv- Dy~ e... a.'V\ &. :r '" \ Co" ~ I..()t{( 1 (j.)' I..., e", -\v-4 VI l e') lr,<l( v vV" Cc It\ ~ \ " If u -h OV\
cJ 4Y.S.\D (',.k J'<;f("'---;:.:h'CLA '04'h.,~ all\J ad')'-t<,h.;J --6...Jev4+i"""
L\4-5, L\'o )J{."VD'2"l lA.Me; (..\<;ed tis. -jt..e "Btt51'S of r=1-e1/4-h~VlS 6\...OW\"1
1-\ e .-of! oV\.
ON
UlAB
WITH
BASEMENT
A V
ZONES ZONES
A
~
~ ......
FLOoO
' El""1ON
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"OJAC'NT:" 'LQI:" REfERE~1
~". lEVEL
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IREFERE~E~ ~
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I ~!J"'~,\1!d)\\'ii~
eA.SE
"000
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I REfERENCE I ADJACENT
lEVEL ~
ON PilES,
PIERS, OR COLUMNS
A V
'__'I ~ i!ONES
IE'" . . ) RE~~~~CE I
? \ t
, ......
\ FlOOO
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III <
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;..3" 1\ '~'{r""{l":',~"'::\'~
r'~qj !~(:~~~),:':;i';b!< (I. .')' "11:\,(1':
,,1)," ::;'i.\ 111:~"":V'.r:~:".l UJ ',,/:,.. . '~(:'"
:?~...~i \); ;J;:...!li'.,i;r 1~1:;;\;11 J'..~~lADJACENT\
g.~~i f<1 .~!:~:~:;~:,::ii{;..~~;~; rru; :~:. GRADE i;
The diagrams ebove Illustrate the points at which the elevations should be measured In A Zones and V Zones,
Elevations for all A Zones should be measured at Ihe lop of the reference levellloor. .
Elevations for all V Zones should be measured Btthe bollom of the lowest horizontal structural member.
Psge 2
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