HomeMy WebLinkAboutBuilding Miscellaneous 2010-4-21
04/21/2010 23:03 FAX 5414e55e~4
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U.S. DEP/lRTMENT OF HOMELAND SECURITY
FedeIaI Emetgen<y """'_'11_
NIlticll'ae FIDod rnsuranee Progra'!'
ELEVATION CERTIFICATE
OMB No. 1660-0008
Expi.... Marcil 3'. 2012
Important: Read the in&1rWions on pages 1-9.
SEC1lON A. PRun:;K' r INFOIUIATION
I I '. '\;:;.l::.-:-:;;~~.-' ,,'.:: .:;-~~ -,
__<h _ ,_ _h .~_........---.
~~- ~.""--
: .~.~~ .~'~~F-' ':. . --~
--------~.__..
Al. BulldingOwnet'.--... '
,. 0 l...'o.lbA ~Lr<2.-lC.K-
A2. BlJlldlnQ. S~tAddreS$(tndvdingApt.. Unit. Suite. anlflor Bidg. No.) 01 P.O. Route and Bo)CNo.
-z.~~ I ~ ""l.O>!: '~'-~T
CIty ". s""
"':>4> 12.1 ~ f'" lf4-b AD -l< ... Q..I.
A3. ?_ ~Ian (1.01 and B_ __. Tax P_ Number.le98i Desaiplion. ""'I
R' (,> <'It' \ '-"">-L1I) p,o.LT'ITIO'" PLI'-'r' -.J.D. ~ClO"" - P 'Z."';idZ..
A4. Building U..la..:. R_ntlal, N.....RosIdenli... Addition, A""""-V. ""'.) ~..J.Q.r,<."'" TIA-L-
AS. W!lJdeJ~tude;LsL ~ W1'2><>(....) Long. \'2.1...'1~ (Vol) Hori<ontalllaturn:"ONA01927 ~1W
A6. Attacn at lea&! 2 photogrephs of the buiId~ if the C.rtificatB is being used to obUf,i" flood in&ur3na:rt.
A7. B_ 01_ Number q
AS. F..-. bu"';ng with. Crawlspace or endosure(.), A9. For a building wtth an atlactle<l garage: .....
a) _foolagGoIcraw1sI>aceorendoounll') Z'5'35 sq. a) Squa..foolagOofatladted_ ~ sq.
b) No. of perm...... flood openitlgs in the crawtspace of "7:=;' b) No. Df pennanenl1k>od openingf. in the atta~nge
end05ure(s) wi"'", 1.0 fOOf abow adlac:ent grade ~ _ within 1.0 tJot above adj;Kent grede
c:t TobIl net illVa of flood openingS in M.b ~~~ sq en c) Total net area oftlood openi1gI in A8.b ICI in
d) Engineen>d lead openings? D V.. 0 ND OJ EnginolllOd flood opening.? 0 V.. .
Z1PCode",,4,.,
SECTION B _ FLOOO IHSlJRANCE RATE MAP (fIRIol) INFORMA11ON
62. County Name
L.-J>.l-l E-
. 93.' ate
,~O~
87. FlRM Panel
EffectivslRevilad Dale
410 IS? (O.O'Z-'<::\
810. Inclice1e the 6QUl'CB of tM Base Flood Elevation (BFE) d~\a or base flood depO'l entered irlltem aQ.
DFlSProflle DFIRM COrnmunityOe1ennined ~(D_) P'JP-ol.-\""~ OI-l Pl.Jl;'\
Bl1. lndicale_..",musadfotBFEinllemB9Ji5UlC3V01B29 DNAVO,988 Ooa-(DaWIbe)
812. Is the bUiding ~d in a Coa!>tal Banter Re~ SYlitBm (CBRS) area ~fWi5e p,tJCeded AroB (OPA)? 0 Yea tQ'1 No
Oe$ignalion 0.", . D CBRS U D?A r
98. Flood
Zone(.)
A."E-
Bll.1las8 Flood EkMItion(s) (Zone
AD. use bue tiood dop1h)
4sZ-.1
SECTION C. BUILDING ELEVAllON INFORMATION (SURVEY REQUIRED)
C1. Building Blevat40N are based on; 0 Con,truc.1ion Dtawlngs. 0 Building Under Constt'UCdotl"' (if Finished Construdion
.A new eJevallon Certificate will be required.when eonswaion of the building i$ compJete. r
C2. ElevatiOnJ _ Zones A1-A30, AE. AM. A (Wirh BFE). ve, V1-V30. V (w1U1 Bt:E). AR. ARIA, ARJAE. ARJA1-A3D. ARJAH. ARlAO. Compete Items C2.a-h
'beIow ,ccording to.the buUdl:nQ di:Ollgmm specified In Item A7. Use It'e Silme ditum as tt're 8FE.
BanchmarkUIIIlled' lZ..M 4?-, V,rlIc:BID_
Com/eI'SktntCommetdS
.1 ChKk (he meas...-ement u58Cl.
~4-~ A i:31i,;, B ...... (1'uefto Rico only)
~'!!>"!> . z.. [31;., mote.. (""""" Rico only)
~. bl-" 0 me.... (1'uefto Rioo only)
4 . '2.. trlllfl' D meters lPuello Rico only)
4~30 ~ Orne1... (1'uefto Rico only)
~ ,4-.~ 0...- (Puer1o Rico only)
<r.5O .~I 0 "'a"'" (PUOtIO Rico only)
~ ~~1 0 mete.. (Puer1o Rico only)
.) Top of boll... _ r""""""o baSotIlllnt. craw1sp8Ce...- ~ Ilocr)
b) Top afthe oaxt higher noor
cj _ of the iOwesl horizontal 5InJdUrai member (V 2..... only)
d) AU_d ....go ~op of slab)
.) Lowest etevetion of machina'y or equipment senridng the buicdng
(Delia"ibe type of equipmeot DtId location in C~)
~ ~.~ (finishedl.,me'-" building (lAG)
III H;ghn1"'~n' (tinislledl grade nexI to building (HAG)
h) Lowest aq)acenI goade at _51 ........ 01_ or s1an.lndlOIing
_....port
SECTION D _ S~OR. BIG_I'D, OR ARCHITI!CT CER11FICA11ON
This cet;ti6<:8Pon i... 10 be Ilgned and R3Ied by a land s..wyor. efllPneer, or archited auIhottzed by ta~ to certify eIeva1iDf1
Infatmation. , carlily thM the ir2IonnatiotI Of) this CatfJlkaro repmsents my befit ~ (C Jnt9tJ'f8l rtJe dlIt8 8V11i1sb1e. .
, understandth"8IlyfajsQ~emetJ'maytaepunislJiJbIobYfineOl'imprisonmentum1Bl 'lJ U.S. Code, Section 1001.
o Check hG~ If comments ~ provided on ~ of farm. VIIere laItude and IofViIude ir\ Section A provided by a
Iicensed..........yor? Dy.. 0 No
CeAifie(.NIme lo""~' A.. A &'\. , Uamso_ber'. -1/>...,,-
~ ~T'1""1--"~-~ a2Jjj.f...OF-1-L..<:.,. LAOS
Company Name L
~_~s.V,,\I~i..e4!..l~ '"( ~e>.LE:tI~ I~.
. L- ~ ZIP Cod
~e .(0 Tefe .~.
see reverse side fer continuation.
Tide
C-M.I.r. ><:::J..)0t~-
Addrul
Signo....
Rapl.... .ti pnMouS
FEMA Foon'B1-31. Mat 09
04/21/2010 23:04 FAX 5414~5".4
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I1III'ORTAJlT; In lIIese spaces, ~ theconespondlDg Information - - A.
BuIId~ _....d.....l-..!in; AI>L. Unit. SUlle, """"" Bldg. No.) or P.O. Roue _ Bolt No.
'l..e> . t-!.00f2..T'-'\ -=~ ?...-n~T
C"" SOl.. ZIP Code
~I2JFIE.l-h. ~ <\14-'1'1
SECTlON D - SURVEYOR. I:NGINEER, OR ARCtIITECT CERTIFICA nON (CONTINUED)
copy ba" sldos of this _n c..,;r""ta fa, (1) com"""" a_, (2) .....anal agentI<Ompally. snd (3) bUlkIlng ......r.
Comment>-n:t1;' UTiL.I" 2-4i<.1"-~~ "1'0 V~~ ~"0J.4 c.-Z(s.'> \<-,,' ~ b~ ~
\ltL ~T \<./.~ ~--':;'1Il- '
S~A.~OCk ~21\C o Che<l<hen>h.ach......
$I!CT1ON E. BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE! PC AND ZONE A (WITHOUT BFE)
For Zoncs AO 8m1 A (wi\t1<iut BFE). complete 110m. E1-ES. 'INlCertlficalOls ittended'."4'P.rt .lO...... or lOMR-F ""1_ canplOl8 S..-A, B,
and C. For IWII'!$ E1-E4. uae natufal gracIe. if svoilabJe. ChBdC the measuremeni used. In Puerto Rka Oft~. enter meters.
E1. Pr_ _ntnfDmll1lonf<<lhe_ng.... cnedc!he ~ boras" _wno"""'" e_..""" ..._the hisf'esl oolja.....
g.... (HAG) .nd Ihe _ adlllCl!nt !l'ma (lAG). .
0) Top ofbollomlloor(1I1dud01g _, c:rawIqlaCO, ..............ps_._ 0- 0.- 8= or 8-1ho HAG.
b) Top of bottom ftoo'('''''''''g basomenl. """""""oe.ora-""")is_,_ [)eel 0- or _IhoLAG.
EL FotBuilding DiogqI... 8-II..h .-I"a"..d_ open.... ~ in SediQ!!/o _8 ~81-1l!lI'" 8-11 of 1_), tho null1igtel'lIoor
(elevationC2.bin"'BcIiagtarnS)of1nebulcfjng~ _._0 teet Urneten;. UabOveor UbeIowtheHAG. .
51 A__(lopof-).. ._._0.... 0-1> 0 _or 0 below IlloHAG.
64. Top of~,," olma_ .ndJ.requi~....w;ng "abullding is_,_ 0 - 0- 0 -... Obelowlhe HAG,
Es. Zone AO only: If no IDod depth nLmlber . ...,..W&.. i$1he top of the bottom Ioor eI8vatBd in accordance Witt1 the comfDlJrify's f100dptain Jt1llnag.mca'lr
_ne.? 0 Ves 0 No 0 UnIc..... Th.Iaca'offi6aI....' C8IlIfy.thIs Infonnation" So<IIOn G.
SECTION F _ PROPeRTY OWNER (OR OWNER'S REPRESENTAllVE) CERTlPICATION
Thlt prDperty owner or owner'5 authorirad represent81ive wOo complot8S $edlons A, 8, JInd e rDr Zone A (wllhOUl a FEMA-tssuecl or c:onvnunlty..fssued BFE)
or Zr;ma AO m~ sign~. 7lJe ~nts In Sections A, S, and E BtO comICI to the be.st 01 my Ivlo~ '~.
Property Owner', or ().mef', AuI1oriz8d R8~tltive'a Name
~'~i.~.:.~l;-"~::..--:,-,-., ' :.-:::_ ~~~;
'I__=;:j~_,':_...:....~;._{_____._'_' H~,
I, .
~-.-. '..':. <,' ..... :I~-;t:-:';~; : ,:;' ~.-:-::
. , - .
---- -.---------'. -_._~-
SlgnallJre
COmments.
City
DaIll
State
ZIP Coda
Address .
T.leph....
o Check hBtft If anachmerQ
SECTIDH G. COI/iMUNITY INFORIIA TION (OPTIONAL)
Tho _ .fficial wtlo is _ by tow at _10 admin_the cummunlly's ftoodplain menogoment ....- csn CllflIOe\e - A. B. C (or El,
and G ofthill EIeya1ion ~... Complo!ll lheapp6cable ilem(s) and sign below. Cl1ed<1t>o.....- US<d1n ttoms G8 .....Ga. .
tal. 0 The Informetion in $ectian C wa& take~ from other doaJt\'IenUIIiO that hat been $ignad and ati~d by a kensed' aurveyor. tnglneer. f7 sn:hitajJd who
Is IUIhoftud by ~ ID C8f'tify eleva1ion infonnatiDn, (lMIca1e the SOU"Ce and d(dlf at 1hD eleva!lon data to tl-.e Comments area below.)
(;2, 0 A oommUJliI)' oftlda' ~ted SedIon E lor. building _.... .. Zone A (wIIhout . FEMMssUOd at camrnuri1y.i.....d BFE).. Zone AO,
G3. 0 TIW' foUowing infonnatiort (Items G4-G9) ts provided for carnrnonfty~oodpl8io management putpD&8S. .
I Gl. Permit Number I G5. 0'" I'otmh ,...... '---1 Ga. Oate CertiIIJ;aIo 01 ~DsnoeIOccuponcy Iso'"
GT. Thl> Pf""'it has .... issued for; 0 Now Conslludion 0 s_a1lmplOllOmonl
Ga, e_ of as-buiIl_ .... (""'udInG ....mon\) 01 the ........
'G8. IlFE at (In Zone AO) doplh 01 ft~ 11\ tllO bulding "'"
. G10. COmmunity's design lIood ~levatioo
D-
O-
0_
o moIerslPR)
O-(PR)
0...- (PR)
0.....
0._
Datum
~OCIII OIiciat"s. Name
. c;;;n7tr:ily Name
To""
T."'P""""
. Sign_
0...
eomments
o Cl1oCl< h"'" ff oftachmonbJ
Replaclis all preomu. edilionft:
'FEUA:FOlTT1 81-31, lIIar 09
Apr 20 2010 9:11AM
LOWES WEATHERIZATION INC. 15414852292
pac:e 1
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Q;r GUARDIAN
FlBERGLASS INSULATION
1000 East North Street Albion. MI 49224
PREMIUM LOose.4'lLL FIBERGLASS INSl/lAllON
INSULATION CER IFICATE
. . -. ".
- :su -
2II.lI 7
11-44 au D.IIOlI
- 2lL2 lI.IilI4
R-aO 111.6 0
tU 0JI48
Ulll U75
11-11 tJI 7.171 7-'71.
-1 U GMI' lI.OO 5.00
1 U 111 4.25 . .us
I
I ."1NOIlI ~lOtINI"lhI,.,..DNIR-v11Dt. ........tholrlluld'1l....,.yoar.......hfcl......OOR.._....
bQVRIglI::,......aaua.~$Ous..I'ar~"'*'*'Olip.Nat_=~.,...,1IhIMt _be 1nIZIIW.._venla.1lwnllII,.-...___ .
I 1rt~.."BTUCUJ'_ASTuC51..TNt~_Clf'_...... &adl#lSTlllC1'lW"'1~1.
li'..'.-... .:.~.'...'-...h...(.a,..-..".........;..:.....................;Ift...:.~............)... '~'.' . . r" . ... ,. " ,,~,. ,
.W.... ......."......... UUA . <.V.iie', .,~:~~~ }i~~~. 1L/;. "
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- - Fall - a.-AII
CeIlings Q Q Q Q r& ...1L Jj.1} CI '/101
Q Q Q Q Q
F100ra Q Q Q Q
a Q Q Q
Walls Q Q Q Q
Q a Q Q
Builder's and Applicator's Certification Signature
ThIs Is to certify the Insulation as InstaUed confonns to the requlremelilB indicarad on this card 10 provide thermal
resistance value 01 R...11.. using ..!l- bags of Insulation 10 ~r: ., L t/ square feet area.
Depth of previous insulalion!1.L.. fI Iff . Type of insulallOl1; ...t~ OUpgrade ~ew Consfruction I
InctIIa fIowlu. . ~Eto.
fI:. J"/~ oJ /,~. ~ i
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