HomeMy WebLinkAboutPermit Miscellaneous 1996-04-11- - ELEVATION CERTIFICATE
SECNON A PNOPENTY INF.ONMATTON
O.M.A. No 1067 O<.\.
Erqi.et Mry J l. , o'l
T ,ERAL EITERGENCY MANAGEMENT NG...
NATlof,tAL FLooO tNsunANcE dhocnnu
ATIENIION: Uso of tlris cartilicale doos nol provirlo a waiver of ths llood insurance purclrase rcquiremont. This lorm is used only toprovidc elevaliorr inlormalion necossary lo onstrre oomplianc-e wiih;ppll;bt" --*J"lry n"oOpir;" management ordinancos. to
delernrine llre proper instrrance premiurn rato. and/or 16 suppori a requesl lor a Leller of Map Amendmenl-or Revision (LOMA or LOMII)lnslrucllons lor c-omplellng thls lorm cen be lound on the lollowlng pages-
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OIllEn I)FSCnlPltOtl (Lot an<J Btm-t< Ntrmbrrs. etc.f
r(XI INSt,,NANCE COMPAT{Y ('SE
CCIIJFANY NAIC NI'MOEN
t'otrcY NUM0€n
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sEcnoN B FLOOD |NSUnANCE RATE MAp (HnM) |NFOnMATTON
Provirlc lltc followinq lrorn lhe proper FIRM (See lnslruclions):
7. lrrrlicale lhe elevalion daturn syslem used on the FIRM tor Base Flood Elevalions (BFE): EruCvO'zsl [- lOttrer (describe on back)
B. For Zones A or V where no BFE is provlded on the FIRM. and lhe community has established a BFE for ttris building site, indicate
lhe corrtrntrnily's BFE: l- l- I -l-lJ .LJ leet NGVD (or other FIRM datrm-see Sec{ion B. ltem 7).
sEcnoN c
1. Using lhe
rJescritres
Elevaiion Cerlilicatb lnstructions, lndicale lhe
lhe subject building's relerencr level I numlel.lro{T (re diagrams lound on Pagcs 5 and 6 lhal besl
2(a). FIRM Zones A1-A30, AE. Al,l, and A (wilh BFE)- The lop ol the relerehcb bvel lloor lrom lhe selecled diagram is al an elevaliond I -M-A.[1)teetNGVD (or olher FIRM daturn--so6 geglioiiB.ltem 7r-(tr) l-lt-lM Zones Vl -V30, VE, and V (wilh BFE). Ttre t ofiodi of lhe lowest horizonlal structural member ot lhe relerence level from
lhe selecled diagram, is"al ari elevaton ol I I I l-lj.Ll teet NGVD (or oiher FIRM datum-see Section B. ltem 7).
(c), FlflM Zone A (without BFE). Ttre floor used as the reference level lrom the selectert diagram is L-l-J.l-l teet aUore [-,1 ot
' trelow I J lct,ect one) the highesl grade adiacent to the building.
((,) flnMZoneAo. Thefloorusedaslhereferencelwel frorntheselecleddiagramh [-]-J.Ll teet atrcre[-|orbelow[ 11cr,ecr,
one) lhe hiqhest grade adiacent lo ltre building, ll no flood depth number is avaiiable, is the building's lowest lloor (reference
level) elevated in accordance with the community's lloodplain management ordinance? [ ves [-] ruo [] Unkno*n
3. hdichte lhe elevalion dalum system used in dotermining lhe above referenco level elevatio.,., EI NGvo '29 E Other (describe
under Comments on Page 21. (NOTE: ll the elevalion daktm usd in measuring the elevalions is dillerent then thet used on
llrc FIRM [see Section B, llem 7], then dntred lhe elevations to llle datum system usd on lhe FIRM ard show the mnversion
equalion under Comments on Page 2.)
4. Elevation relerence mark used appears on FIRM: E y"r Xl ruo (S* lnslruclions on Page 4)
5. The reference level elevalion ls based on' XI adual constnrclion f] cofistruction drawings
(NOTE: l|se ol conslruction dra&ings ls only valid it lt:re futUirg &* ml fi haie lhe relerence level tloor in plae, in which
case lhis cediliale wilt only be valid lq the btildrq durirg tle cous€ ol qktruclion- A postanslruclion Elevation Cedilicale
will be required once conslrucliort ls amplete.l
6. The elevalion ol lhe lowest grado lmmedialely adjaeent to the building ls: U W44 A reaNGVD (or olher FIRM dalum-see
Section B.llem 7).
SECNON D COIIITUNTTY INFOBMANON
I. ll lhe community olficlal rosponslble lot veriflng builAkrg elevallons spedfim that ttre reference levelindicaled ln Sec-tion C, llem 1
ls not lhe 'lowosl floor'as deflned ln the cotnmunlys floodplaln ilhdagpmord ordinance, lhe elevation ol lhe building's'lo$rest
lloor'as delined by the ordlnanco ls: LIJ I I l.Ll tnet NGVD (ororher F|RM datum-see Section B. ttem 7).
2- Dale of lhe start of conslruclion or sr-rbstanlial lmprovoment
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f CMA form 0i-rl, MAY 90 REPTAC€S AI.T PREVIOUS IDIIIONS SEE NEVENSE SIOE ToR CONTINUATION
SECTIONE CERTIFICATION
LICENSE NUME€R (ot
Trris certilication is to be signed by a lantl survoyor. engine€( or arcNtoct who is aulltorized by state or local law to cerlily elovation
irrtor.alion wlren rho ",",l"1iln"i,i[ffiil*
f,;;il;;;Ai-A30, AE. AH, A-1"i{r BFE),Vl-V30,VE. and V (wittr BFE}is required'
co.rrnuniry orficiars *d;;;;;ih*i1uJ t y tocalaw or ordinanco lo provitio lloodpliin managem€nt inlormalion' may also sign tlte
cerliticarion. ln the caso;i z;;;AO in,i n ln ittiort a FEMA or corirmuniry issudd BFE), a building ollicial. a property owtrer' o( arr
o*i,"i'u tuprusentative may also sigrt tlte certilication'
Rclerence lovel diagrams 6, 7 and B - Distinguislring Featuros-lf the cortilior is unable 1o certily lo b(oakaway/notl-breakaway wall'
crrcrosur. sizo, rocarion or servicing equiprnent, ;;;; L,u, wall openings, or unlinislred.area Feature(s)' llrerr list ltre Fsature(s) ttot
irrclu<Jed in llre cerrilicati"n *0", c-*imlnts rr.[*. fr,r'oiagrain nun]t er, soction c. ltom l, ntusl slill tle enlered
I cetlily tlr,t the inlormation in Sections B and C on tlris cetlilicalo rcpresenls nty best oltorls lo kile(prcl llrc data available'
I utrdors tand tltat any (alse slalemenl tnay bo putlishablo by lirttt or irnprisonnrcnt under lB U.S. Code. Seclion l00l
4z,azas il a?uzzE o2E 6a,<z F5 472
Al{ir Soal)
CERTIFI ER.S NAMEfuA /Erdz /85 6u./LE Za,
TITLE
COMPANY NAME OrA 35Z-/?Z
CITY STATE ZI?
'/ z-t-54t- J43 -_%fs-
O^TE PIIONE
SIGNATURE
Cople s should be rnade ol uris certilicate lor:'l) comnrunity olliclal,2) lnsgranco pgenucornpany, and 3)bulldirtg owner
COMMENTS
Land
oar PlfEs.
Pr€R5. OR CO(UaltlSoa{WITH
aAs€L€r{rSLAA
ZONES ZON€S zoilEs ZON€S ZON€S
&(scfro@
oaa€(r
GruG
ft(n
fr@
tr €v^10{Orc{NJ
Grw€
Tlro diagrams abovo illustrato the points at which the olevations sltould be lnoasured in A Zonos and V Zonss
Elevations lor all A Zonos should be measured at the top ol lhe rslerenco levsl lloor.
Elevations (or all V Zonos should bo meiasurod at lho bottom ol tho lowssl horizonlal struclural member.
Loop
oREGISTERED
l,AY A. tatg
Pago2