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..., " - " '.........- ELEVATION CERTIFICATE ~~~~~s~fiJ~oJ1.'?g~J FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to determine the proper Insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA o. i .OMR). Instructions for completing this form can be found on the following pages. ' SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE POLICY NUMBER COMPANY NAIC NUMBER Provide the following from the proper FIRM (See Instructions): t.J 0" t!JO- Old-.O Lur. 72 I<I~~~ ~~r "" #~ATE SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION PIIIJ~I'Sz_ e7T' ZIP CODE <-.3 3~s~Y iL- 1. COMMUNITY NUMBER 2. PANEL NUMBER "3. SUFFIX 4. DATE OF FIRM INDEX 5. FIRM ZONE 6. BASE FLOOD ELEVA!~O-;-r (in AO Zones. use de, (~) ! JY.f': .1 I:J. ()J3};;- t.:J 0 0 ....s- c. /~ -/7-7/ A-E 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): D NGVo '29 D Other (des ribe on :), 8. For Zones A or V, where nO BF~rovided on the FIRM, and the community has established a BFE for this building site, ir';ai'3 the community's BFE: I I I I .U feet NGVD (or other FIRM datum-see Section B, Item 7), SECTION C BUilDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that besl describes the subject building's reference level ......1.- . 2(a). FIRM Zones A 1-A30, AE, AH, and A (with 8FE). The top of the reference level floor from the selected diagram is at an r,!: .. ion of I I I I~I'I. L~~ feet NGVo (or other FIRM datum-see Section 8, Item 7). (b). FIRM Zones V1-V30, VE, and V (with 8FE). The bottom of the lowest horizontal structural member of the reference leve: the selected diagram, is at an elevation of I I I I I I.U feet NGVo (or other FIRM datum-see Section 8, Item 7). (c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is W .LJ feet above D or below D (check one) the highest grade adjacent to the building. (d). FIRM Zone AO. The floor used as the reference level from the selected diagram is W. U feet above 0 or below 0 (check one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference level) elevated in accordance with the community's floodplain management ordinance? DYes 0 No 0 Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations: B' NGVo '29 0 Other (describe under Comments 'on Page 2). (NOTE: If the elevation datum used in measuring the elevations .i$'fiifferent than that used on the FIRM [see Section B. Item 7J, then convert the elevations to the datum system used on thti FIRM and show the conversion equation under Comments on Page 2.) " 4. Elevation reference mark used appears on FIRM: 0 Yes G-No (See Instructions on F;'age 4) 5. The reference level elevation is based on: [a-actual construction 0 construction df~~ingS (NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place. in which case this certificate will only be valid for the building during the course of construction. A post-construction Elevation Certificate will be required once construction is complete.) . 6. The elevation of the lowest grade immediately adjacent to the building is: I 1 I Idl41. ~ feet NGVo (or other FIRM datum-see Section 8, Item 7). r SECTION 0 COMMUNITY INFORMATION 1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1 Is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest floor" as defined by the ordinance is: I I I 1 I I.U feet NGVo (or other FIRM datum-see Section S, Item 7). 2. Date of the start of construction or substantial improvement FEMA Form 81-31) MAY 90 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION