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Home My WebLink AboutFEMA Application 1985-12-18 rl I ELEVATION CERTIFICAt FEDERAL EMERGENCY MANAGEMENT AGENCY . NATIONAL FLOOD INSURANCE PROGRAM , ATTENTION: Use of this <;:ertificate does,not provide a waiver of the flood 'insur'anc.e purchase requirement. This form is used only to provide ~Ievation info.rmation necessary to ensure'comP!iancf3 with applicable community floodplain management, ~rdinances;to determine the proper insurance,premium rate, and/or to support a request for aLetter of Map Amendment or Revl~lon (LOMAor LOMR), . ,,' Instructions for completing this form can be found,on the following pages. Q,M,B. NO." 3067-0077 ~ Expires May 31, 1.996 , -SECTION A PROPERTY INFORMATIOf{ , FOR INSURANCE COMPANY USE I POliCY NUMBER . COMPANY NAIC NUMBER BUILDING OWNER'S NAME "Sv~0 ,~ '~J<-b': STREE'T fi6DRESS (I~cluding Apt., Unit, Suite and/or Bldg, NU~r) OR P,g, ROUTE AND BOX NUMBER "2, :=s 3 s . P-AL1l V {/I E\N LN. ' , OTHERDESCRIPTION(Lot-a~dIBlock Numtfers, etc,) , . . . ", 17rJ3 2-3n, /tD n/0~~2.;, CITY , ',' ,?9/</~t=/~L) / STATE ZIP CODE 97c177 " ' rJ7('; SECTIONB FLOOD INSURANCE RATE MAP (FIRM) INFORMATION . Provide the following from the proper FIRM (See Instructions): 1. COMMUNITY NUMBER 2, PANEL NUMBER -3, SUFFIX 4, DATE OF FIRM INDEX 5. FIRM ZONE '6. BASE FLOOD ELEVATION ..:: ((n AO Zones, use depth) 4P;;-S-4' /9'370 G pee.. IE;, '/'185. ~ . '-4 '7 i !2- . 7, Indicate the ele~ation datum system used. on the FIRM for Base Flood Elevations (BFE): It] NGVD '290 Other (describe on back) 8., For Zones A or V, .where no BFE is provided on the FIRM, and th'e community ha~ established a'BFE for this building site: indicate, _ the community's BFE: I i U I I:U (eet NGVD (or othe~ FIRM datum-see Section B, Item 7), SECTION C . BUILDING' ELEVATION INFORMATION ( . , . 1, Using the Elevation Certificate In~tructions, indicate the diagram number from the, diagrams found on Pages Sand 6 that best . describes the subject building's reference level" , . ' , ' . , .'.. - , 2(a), FIRM Zone,s A 1-A30, AE, AH,: and A (with BFE), The top of the reference level floor from the sEllected diagram is at an elevation of I, I 1.:1-1 ~qJ. L1i-feet NGVD (or other FIRM datum-see. Section B, Iterh 7),. " . . (b), FIRM Zones V1N~O,VE, and V (with BFE), The bottomof the lowest horizontal structur'almember of the reference level from' the selected diagram, is at an elevation of II I' I I I.Wfeet NGVp (or other FIRM d~tuin-see Section B, 'Item 7), (c), FIRM Zone A (without BFE), The floor ,used as the reference level from the selected,diagram is_ 1 i I,U feet 'above 0 or belowO (check 'one) the highest grade adjacent t,o the build'ing, . , - (d): FIRM Zone AO, The fl;or used as .the reference level 'from the selected diagram is 1 I, I, U feet above 0 ~r below tJ (che;k one) the highest grade adjacent to the building, If. no flood depth number is available, is the building's lowest f1o.or (reference level) elevated if'] accordance with th~ community's floodplai~ manageme~t ordi'nance? 0 Yes 0 No' 0 Unkno~n', 3: Indicate the elevation datum system us~d in determining the above reference leve/,elevations:!24 f'JGVD '29 0 Other (describe under Comments on Page 2). (NOTE: If the eievation datum used in measuring the elevations is different than that used on the FIRM (see Section B, Item 7J, then convert the elevations to the datum system used on ,he FIRM and show the conversion -equation under Comments on,Page 2.) I ' . , 4, Elevation reference mark used appears on'.FIRM: O. Yes IKI No (See Instructions Or! Page 4) 5. The reference level. elevation is based on: III 'actual construction 0 construction drawings ,(NOTE: Use, of construction drawings is only valid if the building does not yet have the reference level f/oorm 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 reql.!ire,d once construction is cOf}!plete.) ", , 6, The elevation of the lowest grade immediately adjacent to t~e building is: i Section B, Item 7), . , / 14;' 3: 71, Wfeet NGVD (or other FIRM datum-see , . SECTION D COMMUNITY INFORMATION , " 1.,1f the community oHiciai responsible for verifying building elevations specifies that the referenge level. indicated in Section C, ltem'1 is not the ';Iowest floor" as defined in the community's floodplain management ordinance:the elevation of the bui,lding's "lowest floor"as defined by the ordinance is:' i I II II,U feet, NGVD (or other FIRM datum-see Sec.tion B"item 7), 2, Dateo.f the start of construction or substantial improvement . , '- FEMA Fon,n 81-31, MAY 93 REPlACES ALL PREVlqUS EDITIONS SEE REVERSE SIDE FOR CQNTlNUAllON SECTION E CERTIFICATION This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation information when the elevation information for Zones A1-A30, AE, AH, A (with BFE),V1-V30,VE, and V (with BFE) is required, Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the certification. In the case of Zones AO and A (without a FEMA or community issued BFE), a building official, a property owner, or an owner's representative may also sign the certification. Reference level diagrams 6, 7 and 8 _ Distinguishing Features-If the certifier is un<;lble to certify to breakaway/non-breakaway wall, enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not included in the certification under Comments below, The diagram number, Section C, Item 1, must still be entered, I certify that the information in Sections Band 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 18 U.S, Code, Section 100t. . 1 CERTIFIER'S NAME ?c=<1\ :::r E1~ LICENSE NUMBER (or Affix Seal) TITLE COMPANY NAME ~1,,1~1 ~ & SVrL."F-'I....t('~ {f."JC~ STATE ZIP '7u\Z.vey=fa.. ADDRESS f"~,06"""'\ ~ CITY \4C12- ~e--I~ ~ ~(x.:;e-J'E- O~ CC740 \ SIGNATURE o. iJ t2/ /J () DATE PHONE > ~' -f ....---J~' I NoV (CjC{(o C t?41) 067-00'4-Z Copies s'hould be ~e of this Certificate for: 1) community official, 2) insurance agentlcompany, and 3) bUild~9 owner. r REGISTERED '" PKUt-t:~~lONAL , LAND SURVEYOR ?,~r~' - . $~~~~67 SCOTT J. GOEBEL ~BG " ".., ,,' ~ ~,,,t:::,,v: <O\3n1.::;-r COMMENTS: ON SLAB WITH BASEMENT A ZONES V ZONES A '\tr ZONES . ~~- Ji1. . BASE FLOOD ELEVATION ~::"".; ~I r"~1 GRADE " f:;!; . LEVEL .!:":,,,., ~~~t: Ji!1iY:!L/LT I REFERENCE I lIIir I LEVEL '\ Il~ l =-< '-' l' ~\W,fI~;~~ BASE FLOOD ELEVATION 1JL, , -:.---~, , ";'!i;;";i';";\'!."':~:'<"{;"'. f,.:~.)':(,I,}",.""..,...., ,;'." . .. j' ,o-v 'U/:!!" I REFERENCE I ADJACENT LEVEL GRADE ON PilES, PlERS, OR COLUMNS A ZONES V ZONES lli\\r ~.l~. )REFERENCE\ t- ,-::;:; LEVEL p- I '\., \1 \ ~ ii00\ ~'}; .',',:' ADJACENT ::. /i:.:::;':,::;.i;: i1\1':::'/.:: GRADE IREFERENCE~ LEVEL . --. ~~(1 ~\ &1\' ii~.~~@i;~;) , )" BASE FLOOD ELEVATION The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones, Elevations for all A Zones should be measured at the top of the reference level floor. Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member. Page 2