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Home My WebLink AboutBuilding Miscellaneous 1999-2-24 "LEVATION CERTIFICATE. FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM A_TION: Use of this certificate does nol provide a waiver of Ihe flood insurance purchase requirement. This form is used only to pr elevation informalion necessary 10 ensure compliance with applicable community floodplain managemenl ordinances. 10 determine the proper insurance premium rate, andlor to support a requesl for a Letter of Map Amendment or Revision (LaMA or LOMR). Instructions for complellng Ihls form can be found on the following pages, ' O.M.B. NO. 3067.0077 Expire. May 31. 1996 SECTION A PROPERTY INFORMATION BUILDING OWNER'S NAME 13 a. ve: e (;.,z,4 //,4 ~ C' W,4/2. n rlETZ.. ,J./OM~ S STREET ADDRESS (Including Apt., Unit, Suite anellor Bldg. Number) OR P.O. ROUTE AND BOX NUMBER ,'z, Z. 4- /) ~L/2LJS' ~ D,I2./ v"c OTHER DESCRIPTION (Lot and Slock Numbers, etc.) L/'J-r /3 /)/z'G'/./4/2-D 1///.3",/ S'p /Z I ;v G ~ I E L.-b CJ/l c cO C?-U SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION FOR INSURANCE COMPANY USE POLICY NUMBER COMPANY NAle NUMBER F 7-5- S' t-J&. - t,,, I CITY STATE ZIP CODE 974- 7 7' Provide the following from the proper FIRM (See Instruclions): 1. COMMUNITY NUMBER 2. PANEl NUMBER 3. SUF:FIX 4. DATE OF FIRM INDEX 5. FIRM ZONE 6. BASE FLOOD ELEVATION (in AQ Zones, use depth) 44 C:. Z- 4/S 5'9/ {)'370 c /z-/f-9r /1-G 7. Indicate Ihe elevation dalum syslem used on the FIRM for Base Flood Elevations (BFE): 0 NGVD '29 ~ Other (describe on back) 8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this buiiding site. indicate the community's BFE: I I I I I I.U feet NGVD (or other FIRM datum-see Section B, Item 7). SECTION C BUILDING ELEVATION INFORMATION Leg Ihe Elevation Certificale Instructions. indicate the diagram number from the diagrams found on Pages 5 and 6 that best ribes the subject building's reference level-.S!... . 2(a). FIRM Zones A1-A30, AE, AH, and A (with BFE). The top of the relerence level floor from the selected diagram is at an elevation of ~.~ feet NGVD (or other FIRM datum-see Section B, Item 7). (b). FIRM Zones Vl-V30, VE. and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from the selected diagram, is al an elevation of I I I I I I.U feet NGVD (or other FIRM datum-see Section B, Item 7). (c). FIRM Zone A (without BFE). The floor used as Ihe reference level from the selected diagram is W.U feet above 0 or below 0 (check one) the highest grade adjacent to the building. (d). FIRM Zone AO. The floor used as the reference level from the selected diagram is W.U feel above 0 or below 0 (check one) Ihe highest grade adjacenllo Ihe building. If no flood depth number is available, is the building's lowest floor (reference ievei) elevated in accordance wilh the community's floodplain management ordinance? 0 Yes 0 No 0 Unknown 3. Indicate the elevation datum system used in determining Ihe above reference level elevations: 0 NGVD '29 ~ Other (describe under Commenls on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than that used on the FIRM [see Section S, Item 7], then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) 4. Elevation reference mark used appears on FIRM: 0 Yes ~ No (See Instructions on Page 4) 5. The reference level elevation is based on: ~ aclual construction 0 conslruction drawings (NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which case this certificate will only be valid for the building during the course of construction. A post-construction Elevation Certificate will be required once construction is complete.) 6. The elevation of the lowest grade immediately adjacent to the building is: UJ4L~ .lSf.feet NGVD (or other FIRM datum-see Section B, Item 7). __ SECTION D COMMUNITY INFORMATION 1.We community official responsible for verifyin9 building elevations specifies that the reference level indicated in Section C. Item 1 is not the "lowest floor" as defined in the community's floodplain management ordinance. the elevation of the building's "lowest floor" as defined by Ihe ordinance is: I I I I I I.U feet NGVD (or other FIRM datum-see Section B, Item 7). 2. Dale of Ihe start of construction or substanlial improvement FEMA Fonn 61,31, MAY 93 REPlACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION ~ . SECTION E CERTIFICATION . This certification is to be signed by a land surveyor. engineer. or architect who is authorized by slale or local law 10 certify elevation information when Ihe elevation informafion for Zones A1-A30. AE, AH. A (wifh BFE),V1-V30.VE, and V (with BFE) is required. . Community officials who are aulhorized by local law or ordinance to provide floodplain management informalion, may also sign the certification. In the case of Zones AD and A (without a FEMA or community issued BFE), a buiiding official, a property owner. or an owner's representative may also sign the certificalion. Reference level diagrams 6, 7 and 8 - Distinguishing Features-If Ihe certifier is unable to certify to breakaway/non-breakaway wall. enclosure size, locafion of servicing equipment, area use. wall openings. or unfinished area Feature(s), then list the Feature(s) not included in the certification under Commenls below. The diagram number, Section C, Item 1, must still be enlered. I certify that the information in Sections 8 and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under t8 U.S. Code, Section 1001. LICENSE NUMBER (or Affix Seal) P-L - 5-- #' /C, 47;' COMPANY NAME P/Z-Ef II.) .G~v/ 02.<./5// ~ A fj'" 'c//7-n= 5 ADDRESS CITV .:> 4 C /3"", TIE N.-v~.1-L LoOP SIGNATUREMn......~~ ----2' - }L~ CERTIFIER'S NAME MJ4tZ-VIN TITLE S'. k'/7..(/!'~ /E'v 0 ,,::.'>./6 DATE 2-Z,4- <)1 L.-r.L> # STATE ZIP 0/2/:&0.v 9740/ PHONE. / S-.:'d - c.,pC,. - 'I z.. /.' Copies should be made of this Certificate for: 1) community official, 2) Insurance agentfcompany, and 3) building owner, COMMENTS: J3t-r-(./~TI(.).vs.' J?'//Lc.I> fh?O.rV crT7 of,' " St:M.tN{~ ri-=,~/') [)4ru/l.7'. C/!;!Lr-rO S-61v/,l"z,;..::, I P:~~~:;~~'~~AL " .......u "UKVt.TUR CI#rc.l-/ /::f;1,//J /AI -nk .v'//J// . I 1./ ... '//1/1.......... "';':;'/~ N\.fF..:,z ),#~'TI()/V ON I I \ o/V 'rCJP ~F C c:.J/Z,g /1-T n/'c Jl} if Co/Z..-vp/(" 0 P J-IA/z-vp{r L'J4-v&: A.v I:> 'l'vLj4.vD.,':? ~O~';.QU .JULY 14, 1978 MARVIN S. KRUSH li43 ~L';; v,~ T/ a.v 4Er 7_ i9 >>,/drL;V~ ON SLAB WITH BASEMENT A ZONES V ZONES A 1T ZONES . ~~ ---- -==1 8.foSE II FLOOD dt ELEVATION ilti,_ I~ ~i1! ADJACENT ".~:~ REFERENCE I :'~;:~. "i~.. ., :l~~~,~; . " ,:.'1 .', 1",,"'~NC,'h LEVEL, \ , J' ,il:", ' ',,~, . ~ , ''rWl'.'' ~,~~ ~ r ----: f;~'ijl~'i"'''''it',!''','''''''m ~l 1 ",t:ti,";;; .:;r \"\i1',""'\' ~, " I~~'I' . "i.~L:-:-Q~I)E' >,,-..:'1,,"",,....'"'.- :-,'..;;t.tr ... ON PILES, PIERS, OR COLUMNS A ZONES V ~ONES lif .EIREFL~~El -, , 1\ '1\ IR""'NC'~ lEVel '~ ~~ \~ \~ ~~\ 'I~"!\;t",",,,,.,,\.~ l' ,':!i'~ll \ ":~?\'l}l~ht ~;\ti))\: I (~~ . 'r(~.;a;{l:': '~.,~,\ \8~\i~!:Wi'\.~t'i~:I' i:./;"~' \\1 ~(~\~ ..?I"tN.'P/IIJI; ,f.;h 'I.q 'd).;-'Cfm~: '\:l~' t(1 t.,.t~:'11~\'/{.:\::.~;{: ~ ,;.~::~l. t -.... ' f\~. !i.Lf:'~TIbN ~...,~ ~r" , ~ "".' .' ".-',......-{ '.' .....e'.. The dlagrama apove iIIUe1rl;lte the polnta lit which thl! al~vatlons shoyl\l I;le measured In A ZDn'!s IIn~ V Zon~s. . , : '. , :. " " . , ' " , ~ Elevatloo,s for a:1 A Zonee should be meaaured at the top of the reference level floor, ' '. ~. . ( .. -. - " -"\0',.,' - _: J '. Elevations f~r !I!' V Zone~ should be ma~~urecl at the bottom of the low,'!st horizontal structural mSFTlber. ...", " ",:,'.,.. . .,,' ,~.. .., P.~se 2 . .. ':r,' f;" \1!;;.; ".'