HomeMy WebLinkAboutBLD2007-00198 Flood Certificate • 0
U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Federal Emergency Management Agency
National Flood Insurance Program Important: Read the instructions on pages 1-8. Expires February 28, 2009
SECTION A -PROPERTY INFORMATION
Owner's Name
_ For Insurance Company Use:
Al• Building
Policy Number
A2. Building Street Address(Including Apt.,Unit,Sur e,and/or Bldg.No.)or P.O.Route and Box No
No. �� Pr'V T•o L n,., � Company NAIC Number
City •-. _
k•JILr N/J orJ, --gij-------------------
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Desciptio a c.)j Z lP Code
Lu 5 83 -t 8 83c-e
4. nF TN r• L-.Ar
Az�1' C R-A•./G.w Dr v. 1
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)i'
A5. Latitude/Longitude.Lat.14 7 . "y p i `a iw E N T r A c
A6. Attach at least 2 photographs of the building if the Certificate is beingLong. v used obtain flood insurance
------_ Horizontal Datum. ❑WAD 1927
A7. Building Diagram Number_5 IAA t. ` G o M r) T ® NAD 1983
A8. For a building with a crawl space or endosure(s),provide: rz A r_ �� ~ S r E. N o �'
a) Square footage of crawl space or enclosure(s) A9. For a building with an attached garage,provide
b) No.of permanent flood openings in the crawl space or sq h a) Square footage of attached garage _
enclosure(s)walls within 1.0 foot above adjacent grade b) No.of permanent hood openings in the attach de g ra asq
gen
c) Total net area of flood openings In A8.b walls within 1.0 toot above adjacent grade
sq in c) Total net area of flood openings in A9.b
SECTION B -FLOOD INSU ---- sq in
131.NFIP Conununity Name t►Community Number Numb RANCE RA fE MAP(FIRM)INFORMATION
Co • B2.County Name
2. 3 S v F(to2 t FF El,.s o r.r 63.State
64.Map/Panel Number B5.Suffix \,.1A.
B6. •FIRM Index
87.FIRM Panel
530cti`9-t 2.' ,.S-' (� Date Effective/Revised Date f38 Flood 89.Base Flood Elevation(s)(Zone
t 9/ B Z Zone(s) AO,use base flood depth)
B10. indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9 A
❑FIS Profile R.FIRM 0 Community Determined
811• Indicate elevation datum used for BFE In Item 9: 9 ❑Other(Describe)
812. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)�
Designation Date ❑Other(Describe)
❑CBRS OPA ❑ Yes ® No
SECTION C •BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ci Construction Drawings''A new Elevation Certificate will be required when construction of the building is complete
❑ Building Under Construction'
C2. Elevations-Zones Al-A30,AE FinishedConstruaion
AH,A(withfliedBFE),) VAV30,V(with BFE),AP,AR/q ARrAE.AR/Ai-q3p,gWgH A�4�`�
below according to the building diagram specified in Item A7.
Benchmark Utilized "T(15 r� [1 AR/AO. Complete Items C2.a-g
Conversion/Comments Venice Datum l Z� �E.r>~R S.A:
Lull° �.'�
• �AtiAGC Rk.J r 1`'1' ez St+A-� Check the measuremeht used.
a) Top of bottom floor(including basement,crawl space,or enclosure floor) p
b) Top of the next higher floor �= C]feet ❑meters(Puerto Rico only) _,
c) Bottom of the lowest horizontal structural member(V Zones only) 4, �-�feet ❑meters(Puerto Rico only) -_+-�
d) Attached garage(top of slab) Qfeet
0 meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building _���®feet El meters(Puerto Rico only)
(Describe type of equipment In Comments) feet []meters(Puerto Rico only)
f) Lowest adjacent(finished)grade(LAG) C.
g) Highest adjacent(finished)grade(HAG) • -- `�.��feet (�meters(Puerto Rico only)
- . g feet E meters(Puerto Rico only)
Thk C�Ltrficabon k to be signed and seCTIOby aDland SURVEYOR,
ENGINEER,
er,or architect Oct ___ __ by law CERTIFICATION V.I '
r ri�i ii Yrri.♦���»>���
w0 fin• f certify that the lnformeL'on on this Certificate represents my best efforts to interpret the data available \ n �1'
I utrstand that any false statement maybe punishable by fine or imprisonment under 18 U S Code, Section r�00eva tion • L>J �+
�4� aF K�sfr�U� f
®Che here If comments are provided on back of form. •� _ r
Certifiers Name �y � 9 Y
Title a c�Z R q S Al o S u�.vGyr U` lrce,tse Number - % j` 1�
2;c CSS o V Oat- 2 Company Name s` _ i �;r `'
Address City
o -co t.va.r s rzNp WA , e 3 G8 % `ts Q,is 11*gyp
Y �i v
-signatur •
e
Sale ZIP Code ��l �'�._a r; �� i
Date •
C. t.e1 Telephone -
m18131,February 2006 _ �- tt\\\N` ".N\\Visit r/,,/r t
See reverse side for continuation.
Replaces all previous editions
•
IMPORTANT: In these spaces, copy the corresponding,information from Section A.
BuildingStreet Address(including Forl InsuranceyNumber Company Use:
L.�, S (� 9 Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy
Y� "A -4- a1-• C'rruro LAP-5 NO. 4r0 Pi4,v7-o L4NE
City State
1312 t r./NON ZIP Code Company NAIC Number
wA 8 3 G 8
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner.
Comments
Aa~t. 2C�F , aKs A -o..c. 4-4e sev.lAcrtPs RD NAviE
11€EN
DEST[3„9`tE0 t+Ew (>411.1..E5 ".4w4Q SET) I use O -T 13H c' R, R.
Set /N 1- *-Cr FOLC
EL.,. I S.,' I`s-.,(14..ri4st) By t�l.S. 204.4z F��- 2.iA c.. z t.oc,A 6 n r H
� it NA.;t onf Signature •
aA•St--.44, . ; f 1/ Date
�J c93sp�+ • g f�b��8 ❑Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED) FOR ZONE AC AND ZONE A(WITHOUT BFE)
L.
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 b)Top of bottom floor(including basement,crawl space,or enclosure is ❑ below the HAG.
enclosure).is �feet ❑meters ❑above or ❑below the LAG.
E2. For Building Diagrams 6-8 with permanent flood openings provided in SectiQa,A Items 8 and/or 9(see a e 8 of Instructions),the next higher floor
(elevation C2.b In the diagrams)of the building is . Q feet L__I meters ❑above or 1 below the HAG.
E3. Attached garage(top of slab)Is feet[]meters above or 0 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 he community's flood pia n management
ordinance? ❑ Yes ❑'No ❑Unknown. The local official must certify this information in Section G
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owners 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,8,and E are correct to the best of my knowledge.
Property Owners or Owner's Authorized Representative's Name
Address
City State ZIP Code
Signature _
Date Telephone
Comments tro L 3 0 2008
El•
SECTION G-COMMUNITY INFORMATION(OPTIONAL) Check here if altecFujten s
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).
end G of this Elevation Certificate, Complete the applicable Item(s)and sign below. Check the measurement used in Items G8.and G9.
G1. 0 The Information In Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who
G2. 0is authorized by law to certify elevation Information. (Indicate the source and date of the elevation data in the Comments area below.)
G3. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO.
The following information(Items G4.-G9.)is provided for community floodplain management purposes.
G4.Permit Number G5. Date Permit Issued
G6. Date Certificate Of Compliance/Occupancy Issued
G7.This permit has been issued for. D New Construction
❑Subs(antial Improvement
G8.Elevation of as-built lowest floor(including basement)of the building:
G9.B ❑ feet El meters(PR) Datum
BE (In Zone AO)depth of flooding at the building site: • ❑ feet ❑meters(PR) Datum
Local Official's Name
Title
Community Name
Telephone •
Signature
Date
Comments
•
•
•
❑Check here if attachments
FEMA Forrn 81-31,February 2006
Replaces all previous editions