|
<br />'."",-",+"
<br />
<br />ELEVATION CERTIFICATE ~M~,~/tia~oJr?g:J
<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 following pages,
<br />
<br />SECTION A PROPERTY INFORMATION
<br />
<br />FOR INSURANCE COMPANY USE
<br />POLICY NUMBER
<br />
<br />
<br />COMPANY NAIC NUMBER
<br />
<br />STATE
<br />
<br />ZIP CODE
<br />~~YI
<br />
<br />c
<br />
<br />SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
<br />
<br />Provide the following from the proper FIRM (See Instructions):
<br />
<br />1, COMMUNITY NUMBER 2. PANEL NUMBER 3, SUFFIX 4, DATE OF FIRM INDEX 5, FIRM ZONE e, BASE FLOOD ELEVATION
<br /> /;2 - /1- 91 A ~ (In AO Zones, use depth)
<br />/ ;2..0 ~3..i- 6 ~o --.S -- C r C-s-
<br />
<br />7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): 0 NGVD '29 o 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 1X15T:U feet NGVD (or other FIRM datum-see Section B, Item 7),
<br />
<br />SECTION C BUILDING ELEVATION INFORMATION
<br />
<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 _ .
<br />2(a). FIRM Zones A1-A30, AE, AH, and A (with BFE), The top of the reference level floor from the selected diagram is at an elevation
<br />of I 1 1 18171, ~ 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 />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 W, LJ feet above 0 or
<br />below 0 (check one) the highest grade adjacent to the building.
<br />
<br />(d), FIRM Zone AO. The floor used as the reference level from the selected diagram is W.U feet above [J 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 0 No [J Unknown
<br />3, Indicate the elevation datum system used in determining the above reference level elevations: 01IlGVD '29 0 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,)
<br />4. Elevation reference mark used appears on FIRM: 0 Yes G}r:Jo (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.)
<br />
<br />6. The elevation of the lowest grade immediately adjacent to the building is: I I I 18I51.~ feet NGVD (or other FIRM datum,see
<br />Section B, Item 7).
<br />
<br />SECTION D COMMUNITY INFORMATION
<br />
<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
<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).
<br />2. Date of the start of construction or substantial improvement
<br />
<br />FEMA Form 81,31. MAY 90
<br />
<br />REPLACES ALL PREVIOUS EDITIONS
<br />
<br />SEE REVERSE SIDE FOR CONTINUATION
<br />
|