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<br />ELEVATION CERTIFICATE ~~~,~/:Ja~oN.-?~tf
<br />
<br />FEDERAL EMERGENCY MANAGEMENT AGENCY
<br />NATIONAL FLOOD INSURANCE PROGRAM
<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 (LOMA or LOMR).
<br />Instructions for completing this form .can be found on the fol.!owing pages.
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<br />SECTION A PROPERTY INFORMATION
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<br />FOR INSURANCE COMPANY USE
<br />POLICY NUMBER
<br />
<br />BUilDING OWNER'S NAME
<br />$,
<br />
<br />
<br />OODHAM
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<br />STREET ADDRESS (Including Apt., Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER
<br />525/ SCOT/,4
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<br />OTHER DESCRIPTION (lot and Block Numbers, etc.)
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<br />COMPANY NAIC NUMBER
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<br />CITY
<br />Zt;;PHYR/-IILL S
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<br />STATE
<br />R
<br />SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
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<br />ZIP CODE
<br />33S'
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<br />Provide the following from the proper FIRM (See Instructions):
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<br />I. COMMUNITY NUMBER
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<br />2. PANEL NUMBER
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<br />3, SUFFIX
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<br />4. DATE OF FIRM INDEX
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<br />5. FIRM ZONE
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<br />6 BASE FLOOD ELEVATION
<br />(in AO Zones. use depth)
<br />
<br />~Ff
<br />
<br />/2.02-35
<br />
<br />00 c> S-
<br />
<br />~
<br />
<br />12-:/7-9'/
<br />
<br />,1-F
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<br />7. Indicate the elevation datum system used on the FIRM for Base Fiood Elevations (BFE): [!{NGVD '29 [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 />
<br />the community's BFE: I I I ~~.l:::J feet NGVD (or other FIRM datum-see Section B, Item 7),
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<br />SutJQ...yor SECTION CBUILDING 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 ,5" ,
<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
<br />
<br />of I I I 18151.LlI feet NGVD (or other FIRM datum-see Section B, Item 7).
<br />(b), FIRM Zones V1-V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from
<br />
<br />the selected diagram, is at an elevation of I I I I I I,U feet NGVD (or other FIRM datum-see Section B, Item 7),
<br />(c). FIRM Zone A (without BFE), The floor used as the reference level from the selected diagram is LlJ, LJ feet above 0 or
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<br />below 0 (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 LU.U feet above 0 or below 0 (check
<br />one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference
<br />level) elevated in accordance with the community's floodplain management ordinance? 0 Yes D No [J Unknown
<br />
<br />3. Indicate the elevation datum system used in determining the above reference level elevations: la'NGVD '29 D 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 FlAM (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.) .
<br />4. Elevation reference mark used appears on FIRM: 0 Yes B"No (See Instructions on Page 4)
<br />
<br />5, The reference level elevation is based on: g- 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 I I 181=1 1.13J feet NGVD (or other FIRM datum-see
<br />Section B, Item 7).
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<br />SECTION D COMMUNITY INFORMATION
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<br />1, If the community official responsible for verifying butlding elevations specifies that the reference level indicated in Section C, Item 1
<br />is not the "'owest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest
<br />
<br />floor" as defined by the ordinance is: I I I I I I.U feet NGVD (or other FIRM datum-see Section B, Item 7),
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<br />2, Date of the start of construction or substantial improvement
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<br />FEMA Form 81 -31, MA Y 90
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<br />REPLACES ALL PREVIOUS EDITIONS
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<br />SEE REVERSE SIDE FOR CONTINUATION
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