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<br />ELEVATION CERTIFICATE
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<br />FEDERAL EMERGENCY MANAGEMENT AGENCY
<br />NATIONAL FLOOD INSURANCE PROGRAM
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<br />ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to
<br />provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to
<br />determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LaMA or LOMR).
<br />Instructions for completing this form can be found on the following pages.
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<br />a.M8. No 3067.0071
<br />Expires Mdy31. 7993
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<br />SECTION A PROPERTY INFORMATION
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<br />,OOR INSURANCE COMPANY USE
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<br />BUILDING OWNER'S NAME
<br />G-~ A-CLC 0 t+O tJ t
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<br />~OLlCY NUMBER
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<br />STREET ADDRESS (Including Apt., Unit. SUite and/or Bldg, Number) OR P.O ROUTE AND BOX NUMBER
<br />~\ ~DS \Nc:.C~WOO~ U~\v-c:...
<br />OTHER DESCRIPTION (Lot and Block Numbers, otc,)
<br />t D ' 2.\c;:> . z..t - c> \. 20 - 60C;JOO - Cl., 3 0
<br />CITY
<br />--='e.-p I-ty rch ~ L l s.
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<br />:OMPANY NAIC NUMBER
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<br />r-\ .
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<br />STATE
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<br />ZIP CODE
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<br />SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
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<br />Provide the following from the proper FIRM (See Instructions):
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<br />1. COMMUNITY NUMBER 2, PANEL NUMBER 3. SUFFIX 4. DATE OF FIRM INDEX 5, FIRM ZONE 6. BASE FLOOD ELEVATION
<br /> A~ (in AO Zones. use depth)
<br />/20235 OtJOS c.... DGC. I~ /9!!J j 8..5
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<br />7, Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): NGVD '29 L_J Other (describe on back)
<br />8, For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate
<br />the community's BFE: !, U feet NGVD (or other FIRM datum-see Section B, Item 7),
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<br />SECTION C BUILDING ELEVATION INFORMATION
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<br />1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
<br />describes the subject building's reference level L '
<br />2(a), FIRM Zones A 1-A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
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<br />of Ll~J8IG! ,i cj feet NGVD (or other FIRM datum-see Section B, Item 7),
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<br />(b), FIRM Zones V1-V30, VE, and V (with BFE), The bottom of the lowest horizontal structural member of the reference level from
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<br />the selected diagram, is at an elevation of L--.LlJ~ ,U feet NGVD (or other FIRM datum-see Section B, Item 7),
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<br />(c), FIRM Zone A (without BFE), The floor used as the reference level from the selected diagram is . ~_~. ___ feet above_ or
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<br />below (check one) the highest grade adjacent to the building,
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<br />(d), FIRM Zone AO, The floor used as the reference level from the selected diagram is ,U feet a80ve '~ or below == (check
<br />one) the highest grade adjacent to the building, If no flood depth number is available, is the buildings lowest floor (reference
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<br />level) elevated in accordance with the community's floodplain management ordinance? Yes = No !J Unknown
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<br />3, Indicate the elevation datum system used in determining the above reference level elevations: ~NGVD '29 I , Other (describe
<br />under Comments on Page 2), (NOTE: If the elevation datum used in measuring the elevations is different than that used on
<br />the FIRM [see Section B, Item 7J, then convert the elevations to the datum system used on the FIRM and show the conversion
<br />equation under Comments on Page 2.)
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<br />4. Elevation reference mark used appears on FIRM: 0 Yes 0-No (See Instructions on Page 4)
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<br />5, The reference level elevation is based on: G1' actual construction 0 construction drawings
<br />(NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place. in which
<br />case this certificate will only be valid for the building during the course of construction, A post-construction Elevation Certificate
<br />will be required once construction is complete.)
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<br />6, The elevation of the lowest grade immediately adjacent to the building is: I_LL_~J,sr,!?J feet NGVD (or other FIRM datum-see
<br />Section B, Item 7),
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<br />SECTION 0 COMMUNITY INFORMATION
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<br />1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
<br />is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest
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<br />floor" as defined by the ordinance is: L..I I I I ], U feet NGVD (or other FIRM datum-see Section B, Item 7),
<br />2. Date of the start of construction or substantial improvement d /12/ 9 3 ,
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<br />FEMA Form 81-31, MAY 90
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<br />REPLACES ALL PREVIOUS EDITIONS
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<br />SEE REVERSE SIDE FOR CONTINUATION
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