HomeMy WebLinkAboutBLD2004-00670 Flood Certificate v„ii3,yt,-L.?( • •
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FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Expires December 31,2005
ELEVATION CERTIFICATE
Important Read the Instructions on pages 1.7.
SECTION A-PROPERTY OWNER INFORMATION For Insurance CorrparyUse:
BUILDING OWNER'S NAME Policy Number
L.it.,DA E.YC.E
BUILDING STREET ADDRESS(Indtrding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
91 C.or2E'( LAn, is
CITY STATE ZJZ CODE
(3 441/v f a o tid W A4 B 3 a c)
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
ASSaz530R.' S PAfaCEL.. NIP 94 ( — 7oo — 3Z
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,If necessary.)
R.E51 pLz..s Tt4a,c.-
LATiTUDEJLONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: 0 GPS
( ##'-SW-mar or ##.##tt##°) ❑NAD 1977 ❑NAD 1983 (TYPe)
❑USGS Quad Map ❑Other:
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B NF1P COMMUNITY NAME if COMMUNITY NUMBER 82.COUNTY NAME B3.STATE , A
%, R. ? a., ,v NI S 30 o c, MIS a J C i= t=CfG Sc.v Vv A
B4.MAP AND PANEL 137.FIRM PANEL
NUMBER 85.SUFFIX BB.FiRM INDEX DATE EFFECTNEIREVISED DATE B8.FLOOD ZONE Be.BASE FLOOD ELEVATION(S)
EVATION(S)
12 3 S'e e 1( Z S R a .4-ZONE(S) (Zone �p�,olaood�c)
B10.Irrdcate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9.
0 FIS Profile (8 FIRM 0 Community Determined 0 Other(Describe):
B11.tndcate the elevation datum used for the BFE in B9:®NGVD 1929 0 NAVD 1988 0 Other(Describe):
Bi 2.Is the biking located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes EST No Designation Date_
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
Cl.Bui sing elevations are based orc 0 Construction Drawings° 0 Bulking Under Construction' 0 Finished Construction A V S E C>
'A new Elevation Certificate will be required when constriction of the busking is complete. 2.•4:X (0 O' d.Jl o t31 L.a A.,...c n,, I S i o C3'
C2 Bunking Diagram Number_(Select the building dagram most simlar to the building for which this certificate is being completed-see pages 6 and 7. If no diagram
eccuratey represents the busking,provide a sketch or photograph.) N.A o d d 0 1 ti.
C3.Elevations—Zones Al-A30,AE,A ,A(with BFE),VE,V1 V30,V(with BEE),AR,ARIA,AR/AE,AR/A1-A30,AR/AH,AR/A0
Complete Items C3..a4 below according to the building diagram specified in Item CZ State the datum used.It the datum is dfferent from the datum used for the BYE in
Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use the space provided or the Comments area of
Section 0 or Section G,as appropriate,to document the datum conversion.
Daum Z2 Conversion/Comments —T R M " e"
Elevation reference mark used �Does the elevation reference mark usedon the FIRM? (4.
appear ❑Yes �No iiriiiiiir`
0 al 0 b op of bottom floor of nett hihi floor ng basement or enclosure) 2_J__2ft(m) —��' , 0v ?t()t. . 4
Top gi N6_,_nlm) O ,�,(ON '�•4. 0 k.
0 c)Bottom d lowest horizontal structural member(V zones only) �._fl(m) / .. r
0 d)Attached garage(top of slab) N A . ft.(m) F< v r. ' '.—to " `N
Cl e)Lowest elevation d machinery and/or equipment w m a)!- • <7. •
se the buff (Describe In k C1 N` •
servicing dng a Comments area) N A ._tt m '� � -� � V r
O • 0, '� C
0 t)Lowest actacent(finished)grade(LAG) 17.�f t.(01 z =• Ir. A�lo t% ��\1" w •
0 9)Bg�ac4acerrt(finished)grade(FAG) I �. 4 Mai b lr%� ¢ rr
CI h No.d Ykv d y
permanent openings(flood vents)within 1 R above ac;acarit grade_P 'at<e/��,friiii..\\\•\••....�^ ���
01)Total area d all permanent openings(flood vents)in C3.h iiJ A sq.In.(sq.cm)
li
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION '-
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 Con this certificate represents my best efforts to interpret the data available.
1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001.
CERTIFIER'S NAME.,{
AK NI O1--•p ... \4 o o A LA,"3,,, . V L SLICENSE NUMBER2391 1
.c.v t`y o Q° ± Pa 2. COMPANY NAME
\/l t>O la. Sc.3/t,vE.V1itsGig Nc.-
ADDRESS
21S.5 (DISC-0V1 Y 2oAD. NATijNSg.J(J 41A. c3 ZIP CODE
SIGNATURE c. L(J a...e2._1 DATE TELEPHONE
,b fo Z-/o6" &Go — 38S— 6-9G8
NAT I% : 7 H t 6 \AsJA 5 AM C . r 0 5"/L 3/0 S. Q.C. w.
FEMA Form 81.31,January 2003 See reverse side for continuation. Replaces all previous editions
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IMPORTANT: In these spaces,
I IMPORTANT:$ copy the corresponding information from Section A.
) 'a Apt,�L suite,andkv fi N F PA.ROUE AND BOX NO.
CRY pp For InsuresCompany Use:
!62!N N 0A7 Poky Number
STATE ZIP CODE
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) CorrpanyNAJC Nut
SPY both sides of this Elevation Certificate for 1
()community official,(2)insurance agent/
�1L E`NT3 ro?�Pany�&1d(3)°bc�lang o�v,•>�c . .
Ri~FE(ZANcE, tilArLt{g
L3 M " yna r r?E eAu e;z..
I u sEO —[' [3_�.t2.R. SPtr«/r.s. l-r;av>� .��r.1, �ETfZp�y�
.20 <04 z �-2on+� 2 lrl. �• g'9 �:5-c.4,F3t,is�/,�D
P4..tt' Z�4. r4 ;Sctow,v o�
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOTE �P.
JEFF.� �, � 1 •• �'A Z A StlorC?-
�7one AO and Zone A(rritftotrt REQUIRED)FOR ZONE AO AND NE A(WITHOUTCheck here d attachments
ForZo e O a be co;tt A(1,t 'complete items E1 through E4. U the Cevation Certificate is Wended for use as OMA orBFE)
El.Bulking����j��the supporting Warmatio fora LOMA or LOMRf,
represents the bt Num proms aa sketch & g dag m most to the buldng fors h this certificate is bet ng F2lhe lop ci the bottom loot(Inducing basement or ) the boil completed-see pages 6 and 7. If no dagram accurately
•
r�htra!grade.t<avafiabie}' — •(m)i;Gt(cm)C7 above or;[�below(:heck one)tiaq highest ac)acent grade
E3.ForBttddng pages g•,g With Openings(sea Page�, . . ,� (Use �,
grade. Complete 1terrts Cah and Cal on trot of tad higherdooror elevated floor(elevation b)of the bufidng `�(m) W
E4.The top of the piattorm of. form .«
Machinery and/or equipment se _la(cm)above the highest ac�acertt.
the to grade,i<available} g the buDdng Is ft.(m)-h(cm)0 above or
ES ForZone AO�Lino flood depth ❑below(check one)the highest adacent grade. (Use
❑yes ❑t b L rxunbec is available,Ls the top of the bottom floor elevated in The local official must certi Ws'donation in Section 4 accordance with the cor[murutys n management ortinarxep
SECTION :PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The PoPeltY owner a!
Td Zone AO must sign honed The o�� A,B,C(items C3.h and C3J
PROPERTY OWNERS OR OWNER'S AtflHO sii S EN D I and Fare corrsa to the bell of my ),and ElorZone A(without a FEMA Lssued or corrmtuiity.
RLZED REPRESENTATIVE'S NAME
ADDRESS
'NA CITY STATE
ZIP CODE
commENiS DATE TELEPHONE
oat ` •- SECTION G-COMMUNITY INFORMATION(OPTIONAL)The local ❑Check here rf attachments
CertlScate, °f° b administer the
Cei[] • �?� (S) pn bebw Ids fbodPlairi mana9err►ent ordnance can
Ir�totsj b C lakeri otter documentation complete Sections A.B.C(or E).and G of this
:. h Jo onn•a io certify osoo 1pW as t•
o attort Elevation
that has been signed and embossed by a tensed surveyor,
�' A ° npleled 3ecllen E for a buldngs source and date W the elevation data In therea engineer,or architect who Is authorized by state
0. .i0 ! D�(ortlttlon(tjems G4 G9 boated tyZorie A( a FEhWassuod or one
4 ) provided for flood nmanagerrientpurposes. . or Zone AO
EPEHMfTtED
37• Issued for: G6.DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED
0 New
'8.Sevatio of lowest floor Dent)on 0 Substanthe buildng tial Improvement
9.BEE orGnZoe AO)depth of Eo yg )uildng s a _h(m)
OFFICIALS NAME _ _�(m) Datum
•
caftan'NAIE I Daturrr_
SIGNATURE . . TELEPHONE
'• , • I •r e• •• •. .• • ,, , . •� ..
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MA Form 81,31.January 2003 Check here if attachments
Replaces all previous editions
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