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HomeMy WebLinkAboutBLD2010-00323 Flood Certificate! % U.B.DEPAa:';yFNT OF HOMELAND SECURI'! ELEVATION CERTIFICATE 0M8 No, 1660-0008 Federal Emergency Management Agency National Flood Insurance Program Expires March 31,2012 Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION iiFi9'ta;3yPr ;Al. Building Owners Name -.•, ,.1„„,�,.,, l `:)r -TO N`(;A SIB RVM �I(>}it's leq'�1,�s• t��j�•:«�, uur� ,�,�t..Y, AZ Building Street Address(including Apt„Unit,Suite,and/or Bldg.No)or P.O,Route and Box No. i P je ' `"I h'iM[Lh �81 1 76Z MOuryT I�1 TRtL rscp, toil d�' 1 ki5f5 I 1 {' ,° �r City l(C I�VtJQ1�J State •.•,dr,••1 i h �i l z c t :�rkn ZIP Code Cln-ZO A3. Property Description(Lot aria-Block Numbers,Tax Parcel Number, C� 1-art7 66 67 �SLOi✓yt; 1t-1 OLYIIPYG - to Legal Description,etc.) AIr AND, -4 LPN.v- g B t- 9 0 t- t-I D b A4. Building Use(e.g„Residential,Non-Residential,Addition,Accessory,etc,) l'js� [> AS. Latitude/Longitude:Lat. 431 1&7.f78e Long. 1IV .6' A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain insurance. Horizontal Datum: 0 NAD 1827 NAD 1983 A7. Building Diagram Number 8 flood A8. For a building with a crawlspace or enclosure(s); a) Square footage of crewispace or enclosure(s) 847 For a Square footage with of attached garage; b) No.of permanent flood openings in the crawlspace or fl ba) permanent flood attached openings in WA sq ft enclosure(s)within 1.0 foot above adjacent grade 0 b) No.withino ,0ff above adjacent grin the atta garage c) Total net area of flood openings in A8.b et foot adjacent grade NA, d) TotalEngineered flood openings? si Yes No --�sq In c) Total net area of flood openings In A9.b Nt sq in d) Engineered flood openings? Cl Yes ❑No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 81.NFIP Community Name&Community Number 82.Count Name 53OO6° .FSFRSaN ! 83.State { t1 N it.i c4 RtTa R l,e-T>rb WA, Bd.Map/Panel Number B5.Suffix 136,FIRM index 67.FIRM Panel 88.Flood B9•Base Flood Elevation(s)(Zone 00bCi (�W Date Effective/Revised Date Zone(s) AO,use base flood depth) 7- 1P%-• 19BZ A_ 1 17, 0' 810. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in item 89. ❑FIS Profile ix FIRM Community Determined ❑Other(Describe) 611. Indicate elevation datum used for BFE in Item B9:'NGVD 1929 ❑NAVE)1986 Other(Describe) 812. is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected _Area(OPA)? 0 Yes No Designation Date ❑CBRS ❑OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on; a Construction Drawings. ❑Building Under Construction` *A new Elevation Certificate will be required when construction of the building Is complete. Finished Construction 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-h below according to the building diagram specified in It m A7. Use the same datum as the SEE. Benchmark utilized cNlMA(A1}i c.o.(�-�t, pU1`TP�O 0-R_ Gowv,cs�rtb Benchmark Comments to at ( R-� _c' $- Vertical Datum 1q/k VD fro �60. •Zq' Coi.it/Wr4t. -i-n N6vp II' .9i GOMI E NGKr_ GE- Check the measurement used N GVt , Ni°i) a) Top of bottom floor(including basement,crawlspace,or enclosure floor) 18 _ 1 feet CIb) Top of the next higher floor meters(Puerto Rico only) '2-1 0 feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) WA d) Attached garage(top of slab) ..`❑feet ❑meters(Puerto Rico only) hJ!A .—T❑feet meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building . } feet(Describe type of equipment and location in Comments) ® ❑meters(Puerto Rico only) t) Lowest adjacent(finished)grade next to building(LAG) (rj ' t- g) Highest adjacent(finished)grade next to building(HAG) •7 feel ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs,including I , 3-x feet meters(Puerto Rico only) structural su arty®feet ❑meters(Puerto Rico only) SECTION D-SURVEYOR,ENGINEER,OFt ARCHITECT CERTIFICATION yri This certification is to be signed and sealed by a land surveyor, enortiltect information. I certify that the information on tins Certificate represents my best efforts to interpret by law to avrtify elevation I understand that any false statement may be punishable byR spit t the date lion 100• t S line or imprisonment under f8 tl.S. Code,Section f 001, �,`� GF��;,�St�,� �� 7 Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a c. ///ZE(��� licensed land surveyor? ❑Yes ❑No -_• . r Certifier's NameY //( �i�e� License Number Title /��D S���E�O/2 Company Name �� g� b4 / Addre65 r city /E2(7.- 1 �/?fit .5 -,,C,cfr�- Ns� ' w'f 1 Zl h/ State . /}7] as/ /tG/2� ZIP Code Signature /. DLG� 9 gr ) �/ %G���� / Date Telephone /0(.2- (1 FEMA Form 1-31,Mar09 — . . _ _. ._.. See reverse side for continuation. R 4 IMPORTANT' In these Spaces,Copy a corresponding information from Section A ; Building Street Address(Including Apt.,Unit,Suite,and/or Bldg.No.) P.O.Route and Box ��11 ! i! �c11 TAtf� or P No. 11gg�� 5 City �R N��� State ZIP Code iicld�71114ipf1tl �- 4�(�iil k�„ �itd .:RIC ttbA' i .rr8 it W A CI��Z O la•�_'__ 7,i;' 1 "� ar l I it' yu.(' . Ai; SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) .Copy both sties of this Elevation Certificate for(1)community official,(2)Insurance agent/company,and(3)building owner, Comments A\ `r MrORW( 1 a-1 1-1ARK, w ., \r, 01.I s, 3i 12.t7,5, Msi'rtiv.-roEw .A Rt1AN9ty i 13S14-tMNRK WA 1--:-. 1- --V of Rea '1,hy1+'E I- tt t vp&T- �pE. o r©W 1�. 10LE °' �d✓I�► PE LIi4E _Ccor OF FOOD=t(3,boitmvp`29 t.S� 4'k sYcfM(.Wc,R Signature Date 0 Check here if SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONEA(WITHOUTtBFE)ents For Zones AO and A(without BFE),complete Items El-E5. If the Certificate is Intended to support a LOMA or LOMR-F requesst,complete Sections A,B, and C. For Items El-E4,use natural grade,if available. Check the measurement used. in Puerto Rico only,enter molars. 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,crewispace,or enclosure)is b)Top of bottom floor(including basement,crawlspace,or enclosure ❑feet ❑meters ❑above or ❑below the HAG. )Is '� [Meet ❑meters ❑above or ❑below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Secti MA items 8 and/or 9(see Rages 8-9 of Instructions),the next higher floor (elevation C2.b in the diagrams)of the building is ❑feet L_.1 meters ❑above or U below the HAG, E3. Attached garage(top of Slab)Is . ❑feet Q meters 0 above or D below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑feet 0 meters ❑above or 0 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 Ei 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 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,9,end E are correct to the best of my knowledge, Property Owner's or Owners Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments i .utr}> IQ, ) , t VA _Co tNCR ,�r:CAU12Y 51,0614,5'„ i C1 t16Nr PAt? TeDA! h NM Tish_ ❑_ 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), end G of this Elevation Certificate. Complete the applicable Item(s)and sign below. Check the measurement used in Items GO and G9. G1. icy ,he information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who YY�� is authorized by taw 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. 03. X The following information(Items G4•G8)is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit Issued I GB, DatetCerlifleat@Of Complta ce/O apancy Issued GT. This permit has been issued for: ,'New Conyttruction Substan+iar ❑ Impm.bment G8. Elevation of es-bunt lowest floor(Including basement)Of the building 2I 0 .L/feet ❑meters(PR) Datum G9. BFE or(in Zone AO)depth of flooding at the building site Co.:G10 nity's,design fl elevation �`� . 5- ' `-t ❑meters(PR) Datum ❑feet meters(PR) Datum Local Official's Name i le ::r:tYNam3 O� Telephone © — --C �j V Date Comments ❑Check here if attachments FEMA Form 81-31,Mar 09 Replaces all previous editions I, 411 0 Building Photographs See Instructions for Item A6. For Insurance Company Use: Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number 762 Moor;lAit l `-FRNiL RP CityZIP Code Company NAIC Number I R\M\J ON State q e- z o If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to the instructions for Item A6. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." If submitting more photographs than will fit on this page, use the Continuation Page on the reverse. F L. w y.; • :y ti km!'tY', � _. _. - • ar.`,- ,;'" it, R., Alitriiiiia RA vtE� -- 416„ r' w. 44' M 4 , . fi ' AP,, y ,. 11 a4 f Laii ,t i./ I 41..'1•..L4 ' s R.• .� tip! ....... ..- rkoN VI \rv' .---/`