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Home My WebLink AboutBLD1999-00757 Flood Certificate FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 ELEVATION CERTIFICATE Expires July 31, 2002 Important: Read the instructions on pages 1 -7. SECTION A-PROPERTY OWNER INFORMATION BUILDING OWNER'S NAME For Insurance Company Use: b- �3 L►2 i- M o R f2,O`,�,/ Policy Number BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg. No.)OR P.O.ROUTE AND BOX NO. 17 0 M O a. c A ni L,q,.r...r E C_ L"Z Y "c,' Company NAIC Number CITY 2.O.N G N I-3 2.1 IV N O>v STATE ZIP CODE PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,)) 9 g 3 z U L o-r 1 1 L A Z y "C" R.A ry [.N Dt v. 1 =y.1 S•./1/a- Ni w /4- BUILDING USE(e.g., Residential, Non-residential,Addition,Accessory,etc. Use Comments section if necessary.) s Ec' 34'2 6 N-Z W (ZGS 1 DE..ti 'iAi--. LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: ( ##°-##'-*kW or ##.#####°) L I NAD 1927 SOURCE: —I GPS(Type): Li NAD 1983 LI USGS Quad Map I__I Other: SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1. NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME I B3.STATE 134. MAP AND PANEL B5.SUFFIX B6.FIRM INDEX NUMBERB7.FIRM PANEL B8.FLOOD B9.BASE FLOOD ELEVATION(S) DATE EFFECTIVE/REVISED DATE ZONE(S)A (Zone AO, use depth of flooding) 5-3 c)eD co 9 12-3 5 6 7—t 9 --8 Z. _ B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9. 3 I_I FIS Profile IJ FIRM I_I Community Determined B11. Indicate the elevation datum used for the BFE in B9: 1, .1.NGVD 1929 I—I Other(Describe): ther(Describe): B 12. Is the building located in a Coastal Barrier Resources System(CBRS)area or OtDherwise lProtected Area(OPA)? I_I Yes Designation Date: IN No SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) 01. Building elevations are based on: '_'Construction Drawings* I,'Building Under Construction* *A new Elevation Certificate will be required when construction of the building is complete. Ndo rt I,�IFini-on-Construction C2. Building Diagram Number CA (Select the building diagram most similar to the building for which this certificate is bei g completed-see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C,3. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30, V(with BFE),AR,ARIA,AR/AE,AR/A1-A30,AR/AH,AR/AO Complete Items C3a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE 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 D or Section G, as appropriate, to document the datum conversion. Datum 19 Z. 9 Conversion/Comments Elevation reference mark used 5+=a Con^ME.N.a-s Does the elevation reference mark used appear o-� ,,,� I o ❑ a)Top of bottom floor(including basement or enclosure) f+?.: ,,� �,,,, ��ix0 ❑ b)Top of next higher floor 5 ft N �Ol ll V' ❑ c) Bottom of lowest horizontal structural memberft.(m) ty�, �4�pY ��'.as,�tr r0 ❑ d)Attached garage(top of slab) (V zones only) ❑ e) Lowest elevation of machinery and/or equipment a \ C ( ) Wco 0Yf : z servicing the building °; � ❑ f) Lowest adjacent grade(LAG) —ft.(m) le-,. Q�r r' .o6ft. �Nr�r�Frls9�11 �~),`� f� ❑ g) Highest adjacent grade(HAG) ❑ h) No. of permanent openings(flood vents)within 1 ft. above adjacent grade ) . 1.05 �� ' ❑ i)Total area of all permanent openings(flood vents)in C3h sq. in. (sq. cm) s EXPIRES 1 17/20Oo SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION,\"""! a — /` This certification is to be signed and sealed by a lane,surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. 1 understand that any false statement ma be punishable by fin or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME LICE SE NUMBER TITLE {� OLO C. WOb �/ . P.L. . Z 3 91 1 r'Z 4= g i 0 e N Z S' COMPANY NAME ADDRESS U2-Va-`/o2 /Dom Sv �VE-/ r►..� 6 JtiL , Z/ SS D's GoVE#C-,y a 0. CITY:-., f r o STATE ZIP CODE SIGNATURE WNS e�� /q 8 3 g ..,- DATE TELEPHONE FEMA Form 81-31,AUG 99 SEE /Z—/_ 9 � 360— 3Ss-S9G.8 REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS l7Q !DEC =- 1 1:, C p� 1. T_'OF COMMUNITY P� T IMPORTANT: In these spaces,copy the corresponding information from Section A. For Insurance Company Use: BUILDING STREET ADDRESS(Including Apt., Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Policy Number CITY STATE ZIP CODE Company NAIC Number 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 IZoA.�� II AVE 3EE�� A tL 2�-F'e A► i c. MAR 41-S A4-o N to 1 r+E Dc>s \,.iA1..Ll P S - DeS1rLo4E-1' . _ . USE-0 -1-13NA "13" (j ("Z. L, 4.wr Pouf- ER..E✓. ij.9`J' £. rA/SvscHE.l) (3y L.S . Z0(04.2. PitoM QM Z((0 A S. S1+O•.,.r, 4 o t--I 7� GC.1 N 1 PLAZA 5r1-o2T 4 A'T, VOL_ Z o F SN 04.3- Pz--I4r 5 P. 79- Boo, RE-G.oa- 5 o F TE-i=F. Co �`aA. I Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO and ZONE A(WITHOUT BFE) For Zone AO and Zone A(without BFE), complete Items El through E3. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. El, Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed— see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2. The top of the bottom floor(including basement or enclosure)of the building is 1-1-1 ft.(m) I_I above or I_I below (check one)the highest adjacent grade. E3. For 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?I I Yes I No II 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. ,1 ,.) a L.U C. . O sop PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE S E4 I �� 5 i1)a_ TELEPHONE // o ,�+� ] DATE SIGNATURE /��J�/4. . Vr .. / / /Z-/— �}S COMMENTS ( �l II 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. G1. II The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer,or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ;_I 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. Li 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 37.This permit has been issued for: II New Construction II Substantial Improvement 38. Elevation of as-built lowest floor(including basement)of the building is: —ft.(m)Datum: G9. BFE or(in Zone AO)depth of flooding at the building site is: _ft.(m)Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS I Check here if attachments FEMA Form 81-31,AUG 99 REPLACES ALL PREVIOUS EDITIONS