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Home My WebLink AboutMiscellaneous Compliance Report 2002-4-4 O~-078 eEDERAL EMERGENCY MANAGEMENTANCY NATIONAL FLOOD INSURANCE PRO'-M ELEVATION CERTIFICATE O.M.B. No, 3067-0077 Expires July 31, 2002 Important: Read the instructions on pages 1 _ 7. SECTION A. PROPERTY OWNER INFORMATION For Insurance ~ompany Use: Policy Number Company NAIC, Number ZIP COOn L1 77177 -1/ PI'., fTd\xlot 'l.ooo SECTION 8 - FLOOD INSURANCE RATE MAP (ARM) INFORMATION B1. NFIP COM~UNITY NAME"" COMMUNITY NUMBER uO B2. COUNTY NAMEC .'. : . + !U STATE .0 ,+ at s..~ 'e.\cf4155 ZLa e' 0(..,("0",-- I 84. MA F- AND PANE~ ' 85. SUFFIX 86. FIRM INDEX tIE' ,,,. ~;M. ; ~~ ' DO. .~wu ~B9. BASE FLOOD ElEVATI.. ONeS) I NUMBER -c . DATE EFFECTlVEiREVISEoDATE {O~) ", ,(Zone AO,;pse depth ofllccxfing) 1 Ljl()~ T TI..t'lef.l1t}q '-Ie '[, 1111 . L e.+v....~,._ X 810. Indicate the source ~ Base Flood EL,o;;":~ (BFE) data or base flood depth.. ~~~w~ in B9. U FIS Profile " F)RM U Community Detennined '. '. LJ Other (Desaibe): Bll. Indicate the elevation datum used for the BFE in B9: !)4NGVO 1929 U NAVD 1988 U Other (Desoibe): B12. Is the building located in a Coasta,1 Barrier Resources System (C8RS) area or Otherwise r....;_.J Area (OPA)? U Yes" '):ttNo Designation Date: SOURCE: U G?S (Type): U USGS Quad Map U Other. SECTION C - BUILDING ELEVATION INFURMAnUN r.>lIRVEY REQUIRED) C1. Building elevations are based on: UConstruction Drawings', . g Under Conslruction' UFinished Construction . . A new Elevation Certificate wiD be req.,ired when construction of the building is complEi!e. , C2. Building Diagram Number..J2.. (Select the building dia,gram most simiiar to the building for which this certiticate is being completed _ see pages 6 and 7. If no, diagram accurately represents the building, provide a sketch or photograpM C3. Elevations - Zones A l-A30, AE, AH, A (with BFE), VE. Vl-V30, V. (with BFE), AR, ARIA, ARlAE. ARIA l-A30, ARlAH, ARlAO Complete items C3a-i beiow according to the building diagram specified in Item C2. Slate the datum used, If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field meaSurements and datum conversion calculation, \.!se the 'space provided or the Comments area of Section 0 or Section G. as appropriate. to dOQJment the datum conversion. Datum NIO II 0 ' '2.'1 ConversiOn/Comments . . '. , Ei~tion reference mark used,:R .':ee. tQc"c"': ':.... Does the elevation reierence marl< used a~pear on the FiRM? U Yes rf:I-No al'',p) Top of bottom floor vncluding basement orendosure) "'21"3 .211.( : . IU"b) Top of next higher floor c:; I f." ..1-. 11.( ~ ( REGISTERED I ~) Il.~g- ~I I~,~~., "-~;;...'" <'",sMal 'll7~c.r (II tooes e"I); , '-c( ~ ~ PROFESSIONAL d) Attached garage (top of slab). t:; 1 4 ,1l 11.( ~ i1 ~ SURVEYOR o e) Lowest elevation of machinery aneUor equipment .";; ~ q: /~ servicing the building .5/ U:> .::3 11.( ) ~ i1 _ _... o f) Lowest adjacent grade (LAG) '5 I "" ...:2. 11.( ) ~ ~ l JU~~g~~ o g) Highest adjacent grade (HAG) S I LJ .8...11. ) ~ REX A. BElZ o h) No, 01 permanent openings (flood vents) within 1 fl. above adjacent grade I I ~ . ~ ./ o i) Total area of all pennanentopenings (flood vents) in C3h_q~,Lj. sq. in. ( L?.. 13 Y/7 I Z./31 /03 , SECTION 0 - SURVEYOR. ENGINEER, OR ARCHITECT CERIJACATlON This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certiiy elevation infonnation. I certify that the information in Sections A. 8, and C on this certificate represents my best efforts to interpret the data avaHable. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code. Section 1001. CERTIFIER'S NAME I ,J 'J'::> -l LICENSE NUMBER 'T>L S rJ /, / -~ e.x 'De \ 2-- I. t.<oO<.t" TITLE C'> COMPANY NAME B . \ r, ..,--., <.'\1,' Y've V UII14C,(2 YC;."'c.~, t:'>1 .'y,eer,,;... .J.."C, ADDRESS-~io ttFtt...\ $:.--}.r.U... CI~,"'",,-he\J SfATEOR- ZIPC "'Q7477 SIGNATURe' -it ~_ __ DATEAp-ril 11r Z?,J~ELEPHONE(5'LfI 74-0-0&37 "::MA Form 81-31. AUG 99 - SEE R1:VERSE SiDE FOR CONTINUATION - Ccn, ,~__ .., __ . ., - ~ .. .. " . IMPORT ANT: In tnese spaces, copy the co.onding infonn~tiOn from Section A. . BUILDING STREET ADDRESS (Induding Apt.. Unit. Suite. andior Bldg. No.) OR P.O, ROUTE AND BOX NO, (,72 I ,\'\ose S "PC? ss" . CITY c:::. ( \ 0 STATE .L? q LIP CODE ..Jp'1'"yY...')Fe.. ,,\ 01'- '7477 For Insurance Company Use: Policy Number Company NAIC Number SECTION U _ SURVEYOR, ENGINEER. OR ARCHITECT CERTIFlCA TION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) bUIlding owner;. COMMENiS i' l' /, b . . I d 1 ":f Cif_-1 cr S~'f~')J'~\d Be"c.~v>tt<y"1L-: C'IV\:, c, C~(<;cl~ ..s;\A<<~'e..(1I.<.TI",-Ke.iq.a furl" J-" ('-",../0 ,d'-_IMI:JpQ\~-T "p (l", v'~ Y'e.:rL{....~ d -jt,-z S;D",-\ttl.{)'~r('{)("o!.Y- vJ' Ji]+t.., .!t-nLl.M,:>Tl/\-'\ ~tlV~5 {{VI eclevait~ tN 5(2.0\ ed",: l>4-tu",,^ ('LMJ. . ~I\t.>ted.. --m ~\e-vt<.i-t.w-.. 513.\ ~GVot I.o<S.e.} -"5 ~tu... ^!f'~'5, oiF '21 w <11:\ ?'I1.S sko ",-,,,-, \.., ~<' tcPl^.' U Chea ~~re if attachments SECTION t: _ BUILDING ELEVATION INFORMATION (SUR~ NOT REQUIRED) FOR ZONE AO and ZONE A (WITHOUT BFE) , For Zone AO and Zone A (without BFE). complete Items E111UDugh E3.. If the Elevation Certificata is intended for use as supporting information .for a LOMA or LOMR-F, Section C must be compIeIed. " E 1. Building Diagram Number ~'(Seled the builcfmg .-..~,' most similar 10 the build'mg fur Which'1Iiis .:. ~:_;., is ~g:comPleied :. . see pages 6 and 7. If no diagram accUrately represen1S the building, provide a sketch or photograPh.) . . ez: The top 0.1 !he bottom ~oor.(md~din9 b8Semeirt or~) Of the building is . cD ll(m) Luin.(an):U above !lr::U beloW ~'. . (checkone)thehighestadjaCenlgrade:.:. ': ..".,;. .'..' ,,', . "'.. :",'" " ','.":. .- E3. For Zone AO only:' If no flood depth number is avaiIabli is the tcp,of the bottom floor ~ in _';"...,wilh the commuhity's". - . floodplain managemeniofdinariee? [;,J Yes,:' I oJ No 'I "I UnknciYni~:',The Iocid ofIiciaI must cei1ifv1ltis bau",~lion iri:section G. ,Co,:. . 'SECTION ~ _ ~ROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFIC':AJlON, ""~:. ;', The property owner or owners authorized representative who completes Sections A. B. and E for Zone A (without a FEMA-issued or, ' . community-issued BFE) or Zone AO must sign here. '. . . . I. ' . (b,r~;! 60 !=VMS . Q, '-' ,1r.Af' (- '" u"c1<4_ .{;'L;,e,.,/" PROPER OWNEI'\SUt<OWNER'SAlJTHdRIZCDREPRESENTATl\IE'SNAME '..i- ,t.. ;, '. r::J7"'~ <iL<-J.s:?.<::I-< Q,,\.~L<~:...L/l- ,;J"'f',d Y'E"ftSA--n' bRtf O.L '7 4>",? ADDR~S C' .. '-. ' , ' I crTY. . STATE, ZIP, CODE . ,~-,t?. (D,4..,.-L <; ,,~;. t.j1:.!:~1r:.1) ;,;,- "'7 H~ <If/I') ":? SIGNA;D<l E ' ' . DATELEPHONE COMMENTS U Check here if ':lttachmenis SECTION G _ COMMUNITY INFORNIATION (OFTlONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E); 'lnd G of this Elevation Certificate. Complete the applicable ~em(s) and sign below. G 1. U. T11~.information in Section C was taken fiom other doaJlnentation that haS been signed and embosSed by a ticensed surveyor, engineer; .or architect Who is authorized by state or \oC311aW to certify elevation information. (Indicate the source and date of the ' ,elevation data in the 'Comments area below.) , G2. U 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: U The. foUo",ing information (Items G4-G9) is provided for community floodplain management purposes. \ G4. PERMIT NUMBER \ G5. DAlf ~=:<M' r Issubi \ Go, DATE CERTlFICATE OF COMPLIANCE/OCCUPANCY , ' " ISSUED G7. This permit has been issued for: U New ConstnJdion U Substantiallmprovemenl G8. Elevation' or as-builtlciwe'~t floor ~ncluding basement) of the building is: Gg. BFE or ~n Zone AO) depth of flooding at the building site is: LOCAL o~;:iCiA~'~;,;,wE . _ll(m) Datum: . _ll(m) Datum: TlTl.E COMMUNITY NAME SIGNA TU'Ki:. TELEPHONE OATE COM"'ei-i TS . .'. ,~'.: ";,;;.' L.J Check here if attachmentS - ,.- REPLACES ALL PREVIOUSEDITIONS: . . :~:- ".,r':~~~-t~"~'~',!," ; " ,~.