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HomeMy WebLinkAboutBLD2006-00511 Flood Certificate a U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency Management Agency Expires February 28. 2009 National Flood Insurance Program Important: Read the instructions on pages 1 8 SECTION A-PROPERTY INFORMATION For Insurance Company Use: Al. Building Owners Name �� N Policy Number AN. 3'c>►-cNSTe,'./ A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.C.Route and Box No. Company NAIC Number -Fr '7_3 PtcGtiis.11 L. A,.Ia P City 1312,t N tit o I•l Stat a ZIP Code. AIA. . . , �$°3Zc3" . , - N. Property Description(Lot and 91ock Numbers,Tax Parcel Number.Legal Description.etc.) Lei-r 2..o F Fat 4.c.<N i S t-r o I'�,-t P{..A '. .4P nl_- .1s.+0'2. Ss 3 o'S`3 . n IPt_A z.A A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)_ Co 1,4 e2 Ci At.. - 5.1'oec.A 40 el A5. Latitude/Longitude:Lit.47.C.9 31 c N Long. t 2 2. 9 0 2.-'I q- o \A/ Horizontal Datum: ❑NAD 1927 N.NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 1 A8. For a building with a crawl space or enclosure(s),provide: A9. For a building with an attached garage,provide: b)a) Squ are footage of crawl space or enclosure(s) sq ft a) Square footage of attached garage sq ft permanent flood openings in the crawl space or b) No.of permanent flood openings in the attached garage enclosure(s)walls within 1.0 foot above adjacent grade • walls within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION Bl.NFIP Community Name&Community Number B2.County Name I B3.State an r,.,MON 53004o9 l 2 3S 13 '3•C:t=r-' IC re--Sor.-1 \AlA B4.Map/Panel Number 85.Suffix B6.FIRM Index B7.FRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone Date Effective/Revised Date Zone(s) AO,use base flood depth) t Z•3S of 14 ZS 13 7- 1 9-198Z 1•1o,‘.r8 A 4 20. Z. B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. 0 FIS Profile g FIRM ❑Community Determined ❑Other(Describe) B11. Indicate elevation datum used for BFE in Item B9:21 NGVD 1929 ❑NAVD 1988 ❑Other(Describe) •ng laaatcd in a .a,.au., 3a ricr Resources System(C3 S)area or Otherwise Protected Area(OPA)? Li Yes K No Designation Date ❑CBRS ❑OPA' ' ' SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Cl. Building elevations are based on: ®Construction Drawings* ❑ Building Under Construction* E] Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations-Zones Al-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO. Complete Items C2.a-g below according to the building diagram specified in Item A7. Benchmark Utilized Q•t`1 "p"(22 S Prce-r 1,4 L i'.HT Par-a- Vertical Datum NI OM O 1.92 9 ConversiorVComments S 1< S P_c,T r o,-i .• Q Check the measurement used. "" . -- r i .rrf� r- a) Top of bottom floor(including basement,crawl space,or enclosure floor)_ 2 3 .5 El feet ❑meters(Puerto Rico one !/ _ I 1 I b) Top of the next higher floor hi A . El feet ❑meters(Puerto Rico only) _ ..______ i 1 c) Bottom of the lowest horizontal structural member(V Zones only) - A. ❑feet ❑meters(Puert• •' • o I ;II i d) Attached garage(top of slab) _ H A . ❑feet ❑meters(Pue {f: 1 e) Lowest elevation of machinery or equipment servicing the building _ Z 3 .S 0feet ❑meters(Puerto Rico only) i "'�(Describe type of equipment in Comments) i f) Lowest adjacent(finished)grade(LAG) _ 2 0 .51 K feet meters(Puerto Rico only)., t g) Highest adjacent(finished)grade(HAG) ❑ Q 1 _ 21 . O ©feet ❑meters(Puerto Rico onlyjY s<'z 1,f' .Ijp;;;FtiT 1 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 elevation71'I�1 ��\���• information. I certify that the information on this Certificate represents my best efforts to interpret the data ave;,ab!e. �T- c•• f.-.. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code, Section 1001. �L✓ `�fj `� ��'ASI jf, O N,Check here if comments are provided on back of form. k, : . I� .� 4 A2i.1ot..fJ C„ WooU w/A 9.L.S• Z. 1j ' ' Certifier's Name ti ``" SV/�.r£�lort -} PR£S. �,r./oop LicenseNumber n _ . n, • r,' Title Sv2va-/ rNr� -� r`.!C• 'F Company N me G 1 t1� n at S S b t 5 c,f,./e R V/ R.0 A.o V a 47-Ta�..4n{S F:.v p \.�/y►, 9 E� 3` g IX.4,, �--r 2 s-I ,j; w Address .tr . wr�ty / State I ZIP Code y, slU,` _. -.`�$` /7/07 3c-o_ Af.t #. Signature Date Telephone • Pa EXPIRES 1/17/C?e FEMA Form 81-31,February2006 , '� See reverse side fcr continuation. Replaces all previous editions IMPORTANT: In these spaces,illy the corresponding information from Section. For Insurance Company Use: Building Street Address(including Apt it,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number No. 73 elF Picc,"ii LA, City State 2�hl n!�/� ZIP Code Company NAIC Number A 98 3(-& SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community offiaal,(2)insurance agent/company,and(3)building owner. Comments A L c. Cz..M.3 \a./ER& Da T 4 0--d a � /�/ "1-1-Its�: s /,,zEAJ Us4p'"Tt3tK" G3" ( R r, 51'il,c,rm ,N L. c.a!r !>oL.a l.5TA i4• StFt_O 13y P. [•.S . ZoC,.94Z. •F;Zon.L (�, \ Z.c AL& A $ $ Jow.•a 0^.1 `'jcc ,NI. PLAZA .. . PLAT IJoe... Z OF S. PL»a75 e ?9--So Signature (e Date G Check here if attachments SECTION'E BUILDING ELEVATION INFORMATION(SURVEY ivOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items El-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C. For Items El-E4,use natural grade,if available. Check the measurement used. In Puerto Rico only,enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). a)Top of bottom floor(including basement,crawl space,or enclosure)is _❑feet ❑ meters ❑above or ❑ below the HAG. b).Top of bottom floor(including basement,crawl space,or enclosure)is . ❑feet ❑meters ❑above or ❑ below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9(see dgge 8 of Instructions),the next higher floor (elevation C2.b in the diagrams)of the building is ._❑feet [ meters ❑above or LI below the HAG. ' E3. Attached garage(top of slab)is ❑feet❑meters 0 above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑feet ❑meters ❑above or ❑below the HAG. E5. Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? 0 Yes 0 No 0 Unknown. The local official must certify this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's authorized 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. The statements in Sections A,B,and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name 'S TAB nl. So 44 nt 5 7-01.-1 Address n City State ZIP Code .0. 30X, V7 Co. (3i2.1,1/40/.)oN W.4 ', 8 3z.o Signature rate Tc.ipiiun:: Comments ❑Check here if attachments - ' SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E), and G of this Elevation Certificate. Complete the applicable item(s)and sign below. Check the measurement used in Items G8.and G9. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3. M The following information(Items G4.-G9.)is provided for community floodplain management purposes. G4.Permit Number / O.5'f I G5. Date e i�Issued G6. Date,Certlfi ate f Compliance/Occupancy Issued KIR00-©te 75t,Qao- . 1�4 I/ 107 G7.Th' prtittta5`beued for: New Construction ❑Substantial Improvement fi ✓ G8.Ele a bn of as-built lowest floor(including basement)of the building: :23 . ,t feet ❑meters(PR) Datum + G9.BEE or(in Zone AO)depth of flooding at the building site: 20 . 2 L feet ❑meters(PR) Datum Local Official's Name L.�� Hl s/(((G i, e c�-6 Title?iann i la ridl na �' r. Community Nam Te Coo n�y — Telephone zoo y s_O Sig 1 Date ^�f,,/ `J 1 u.,.... I Commen . 07 :, (,I/ `f' ❑Check here if attachments FEMAi p m'81.31,February 2006 Replaces all previous editions