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Home My WebLink AboutFEMA Application 2002-1-23 .., .1 Fl:uERAL EMERGENCY MANAGEMENT AG, ,Y NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE -,~ ~o~ .11) a.M.B. No. 3067-0077 Expires J~ly 31, 2092.. Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION ~~~~;!:~~H~~-;~~@Q~j)~QX;'Q~'~iE:~<:",:': BUILDING OWNER'S NAME . Mp\"T'\ '~ L.\ ,." ' Dup\.e"'C BUILDING STREET ADDRESS (Induding Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. ~1Q~ "P\~~ U\~c CITY 5fil.INaE=l6..o Otz. ~TATE ~1;C~D1& PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Numbj!r \.~gal Description, etc.) '\.,C, 41 l..c.\!\ I.-".,U:~I '-1 ~ l..w= "Q~\1'\b~ BUILDING U.SE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.) R~ '> I ()e,.."T'~ LATITUDE/LONGITUDE (OPTIONAL) ,~ HORIZONTAL DATUM: SOURCE: U GPS (Type): ( ##0 _ ##' _ ##.##" or ##.#####") L::.J'NAD 1927 U NAD 1983 U USGS Quad Map U Other: SECTION 8 - FLOOD INSURANCE RATE il/1AP (FIRM) INFORMATION B3.STATE o~. B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME -s.pR.I~~F'IC\....c +1"$ ~~ 1. ~E B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. fL068 NUMBER _ DATE EFFECTIVE/REVISED DATE ZONE(S) ~\o~'" C w...1 r J~e: tJ 1'",,",,\ J \I...c 2., \ '9"i' AE B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in 89. U FIS Profile U FIRM ~Community Determined U Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: ~GVD 1929 U NA VD 1988 U Other (Describe): B 12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Designation Date: SECTION C.. 8UILDING ELEVATION INFORMATION (SURVEY REQUIRED) B9. BASE FLOOD ELEVATION(S) (Zone AO, use depth of flooding) SU. +- U Yes IbNo - C ,. ,juilding elevations are based on: UConstruction Drawings. LIBuilding Under Construction. UFin:shed CcnstnJet:on . A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number..8.- (Select the building diagram most similar to the building for which this certificate is being completed ~ see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations -Zones A1-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, ARIA, ARlAE, ARlA1-A30, ARlAH, ARfAO. Complete Items C3a-i below according to the building diagram specified in Item C2. State 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 fi~ld measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum . Conversion/Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? U Yes \Cl. No Q a) Top of bottom floor. (including basement or enclosure) is 1 ~ : 2- ft:(m) co Gl Q b) Top of next higher flodr '5 Ie.. . ...L ft.(m) ~ J1 REGISTERED '" :: V) :":!V;" ;,;[ Iowes{ horizontal s{ructUli:lIIlI..;trlJj~ ?'J-=s':''?~ ~,} . --- - ft.(m) j ~ ~ PROFESSIONAL Q d) Attached garage (top of slab) "5 ~4- . ~ ft.(m) ~_:ec_ J ,LAND S"U, RU;' .~R Q e) Lowest elevation of machinery and/or equipment - ... ' servicing the building ~'I f\ . _ ft.(m) ~ ~ ~ \.-, - ( Q f) Lowest adjacent grade (LAG) 5 \ 4- . ~ ft.(m) ~ ~ \J' QtfEGaN Q g) Highest adjacent grade (HAG) "5 1"- . ~ ft.(m) ~ ." FEB. 19, 1999 Q h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade ~ ~ i JAMES \"1. COLTON o i) Total area of all permanent openings (flood vents) in C3h \ ~ \ \ sq. in. (sq. em) , #58756 J SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION ax.?\(t.E"; t'2./~1 f o} This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. IIIllderstand that any false statement may be Dunishable by fine or imprisonment under 18 U. S. Code, Section 10.0.1. - ~IFIER'S NAME C LICENSE NUMBER ....>1\Y\e~ "" . O\,.,TON , ot, t..':l. *' '5~1~~ TITLE L~o :StJe...s e:"(oYl. COMPANY ~\U) - 14E '5t~ - F"- ':> ~~~Oe(t.. ADDRES~.6, ~)C "2.'2."~'S CITY E.uG~c S~l. ZIP COD~ -, ~1.. SIGNA11JR~ ~. (' () _ DATE I f2!>fo1.. TELEPHONES4-I. :.#. \aSL FEMA Form 81- ,AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS '~4" .'".'" .' IMPORTANT: In these spaces, copy the co ponding information from Section A BUILDING STREET ADDRESS (Including Apt.. Unit. Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. (P~'l~~ ~c.~ LA~e: CITY r:::, STATE ZIP CODE ,-uG.&4E O~ . c::n41~ : . .:.... I~;r.;~~~~:!~~k;:f! . .. ;......:...+~ t... 4 ";'(',7~t SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official. (2) insurance agenVcompany, and'(3) building owner. , COMMENTS I_I Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO and ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1 through E3. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed _ see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph~) E2. The top of the bottom floor (including basement or enClosure) of the building is " Ift.(m) I I 'in.(ern) L::..I above orU below (check one) the highest adjaCent grade.' , E3. For Zone AO only:U no flood depth number is available, is the top of the bottom floor elev~ted in accordance with the community's floodplain management ordinance? I_I Yes' LI No I_I Unknown. The local official must certify this information in Section G. 'SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFIGATION The property owner or owner's authorjzed 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. PROPERTY OWNER'S OR OWNER'S AUTHC?RIZED REPRESENTATIVE'S NAME ADDRESS CITY 'STATt:: ZIP CODE SIGNATURE COMMENTS DATE TELEPHONE SECTION G - COMMUNITY INFORMATION (OPTIONAL) "he local official who is authorized by la...: or ordinance to administer the community's floodplain management or,linance can complete ,ections A,Bi C (or E), andG of this Elevation Certificate. Complete the applicable.item(s) and sign below. ;1. U The information 'in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, , , engil'!eer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the eleVation data in the Comments area below.) , . . ,2. 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. i3. U The following information (Items G4-G9) is provided for comrT)unity floodplain management purposes. "G4. PERMIT NUMBER I G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCElgCCUPANCY , ISSUED . , i7. This permit has been issued for: U New Construction U Substantia/Improvement 'i8. Elevation of as-built lowest floor (including basement) of the building is: i9.BFE or (in Zone AO) depth of flooding at the building site is: LOCAL OFFICIAL'S NAME I_I Check here if attachments ' . _ ft.(m) Datum: . _ ft.(m) Datum: TITLE COMMUNITY NAME SIGNATURE TELEPHONE DATE COMMENTS I_I Check here if attachments ::MA Form 81-31, AUG 99 QJ:DI ll.('J:C ^' I nnr:\I''''''''C' e'"",..',.....,...