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Home My WebLink AboutBLD2007-00621 FLOOD ELEVATION CERTIFICATE U.S.DEPARTMENT OF HOMELAND SECURA" ELEVATION CERTIFICAT• 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 Owner's Name Policy Number IdN ik► M,i oS t/'IQitffrlNl A2. Building Street Address(including Apt.,WI it,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number 4-1 Ifti.4LR ' ,12 . City State ZIP Coderam //4DL oc{C k f s4 9$339 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal t!escription,etc.) Lo7 l3 //c 4 Et+R IS W A'rE r FRoW7r 'l C•r•S , V 3 of fEo'GS C v�'ry W rl pi, To �F of ✓ A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) A5. Latitude/Longitude:Lat. Long. /22 • 73 Horizontal Datum: ❑ NAD 1927 lg 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 I . A8. For a building with a crawl space or enclosure(s),provide A9. For a building with an attached garage,provide: a) Square footage of crawl space or enclosure(s) sq ft a) Square footage of attached garage sq ft b) No.of 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 B1.NFIP Community Name&Community Number B2.Co ny Name B3.State 53004/ 0/90 B County �r1ff tmq'Tof‘! B4.Map/Panel Number B5.Suffix B6.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone Date Effective/Revised Date Zone(s) AO,use base flood depth) i a i�d B !f[1GY l7r i�' a (1. 2 FT. 1JGrVb�`l B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑FIS Profile ❑FIRM ❑Community Determined VI Other(Describe)C.At for (Ns1 t At EEC ,Z& 77-Ee B11. Indicate elevation datum used for BFE in Item B9: JNGVD 1929 ❑NAVD 1988 ❑Other(Describe) B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes XNo Designation Date ❑CBRS ❑OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: ❑Construction Drawings* ❑Building Under Construction* 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 4 Vertical Datum J4 V t' i9Z-9 Conversion/Comments �+ Ot/V'T psi 7/44 Ci ' It r)/t'<FFEk$d t'q GO tJIIT}�I Gf ��T��G Check the measurement used. _, = T C`. a) Top of bottom floor(including basement,crawl space,or enclosure floor)_ 23 . 1.F feet 0 meters(Puerto Rico onl 71 b) Top of the next higher floor . ]feet ❑meters(Puerto Rico onl o CV c) Bottom of the lowest horizontal structural member(V Zones only) . ❑feet ❑meters(Puerto Rico onll e-1 d) Attached garage(top of slab) ❑feet (Puerto❑meters Rico on ..- . c+'J e) Lowest elevation of machinery or equipment servicing the building . ❑feet ❑meters(Puerto Rico on6) (Describe type of equipment in Comments) -�` W _ y f) Lowest adjacent(finished)grade(LAG) t / . 9 (A feet ❑meters(Puerto Rico ort p l-- g) Highest adjacent(finished)grade(HAG) .27.. 7 Ntfeet ❑meters(Puerto Rico or ,- 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 WIWZZOMM,...\.\....,N.W,•., information. I certify that the information on this Certificate represents my best efforts to interpret the data available. s !� I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. � P+S R00 4.04.as vras , i, ❑ Check here if comments are provided on ba k of form. �A 9 P• 32z.c * °a Certifier's Name l�'le t�1ct��9L �[JIe Vtt=yD - License Number �� iwtC• % ,,,, , .. . 9 - :•i is Title t • rE A So A Company Name T /AtaFZF j, l f T/� ;% Y 'i J/ f4/ 7fy 36825 Address City State ZIP Code .� ,,,. , /Z/! 457e, '' OR Signature Date Telephone ii.�.� i11114117 r��r. 1 .'4%;.° .- ;:. IMPORTANT: In these spaces, copy th•e t. esponding information from Section A. • For Insurance Company Use: Building Street Addre (including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number W 41 ' ' ER R . City State ZIP Code mr, , Company NAIC Number oler H/ADGacK ) 1,04 Ts337 SECTION D-SURVEYOR, ENGINEER, ORARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner. r Comments �, �-`+ :'� L a .= y N Signature Date • ❑ Cheek here ftachm6t§' SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A;WITHOO11 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,corrif4ete 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 page 8 of Instructions),the next higher floor (elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or ❑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 0 meters 0 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? ❑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 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 -r ,..-..._1('F1 n,' 7 /-/C3r/4 r S ��/1/11 � Address City r ,,.- State ,ZIP Code cl 5ri V - lii Ad/it)/• v - V A �� tee-lei (1 . r f: 3 Signature r„__ - Date Telephon 7C) Comments • D 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.) G2.0 A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.0 The following information(Items G4.-G9.)is provided for community floodplain management purposes. 04.Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7.This permit has been issued for: 0 New Construction 0 Substantial Improvement G8.Elevation of as-built lowest floor(including basement)of the building: . _❑feet ❑meters(PR)Datum 09.BFE or(in Zone AO)depth of flooding at the building site: ❑feet 0 meters(PR)Datum Local Official's Name Title Community Name Telephone. Signature Date Comments -