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<br />ELEVATION CERTIFICATE ''-'
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<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 />O,M,8, No3067-0011
<br />Expires May 31, 1993
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<br />SECTION A PROPERTY INFORMATION
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<br />BUilDING OWNER'S NAME(/'"
<br />/,
<br />STREET ADDRESS (Including Apt., R P,O, ROUTE AND BOX NUMBER
<br /><.... ?1'-.3 c;f/ A ./L-.
<br />OTHER DESCRIPTION (lot end Block Num , ate,), <;;> ~ .
<br />/ t.9.- ~ 6 -:11 ~ 0/,2 0 - 0 c/ ZJ 0 6 -- LJ i" r' U
<br />CITY ~~ . 7?)TE
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<br />r;-r-7 SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
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<br />Provide the following from the proper FIRM (See Instructions):
<br />
<br />
<br />COMPANY NAIC NUMBER
<br />
<br />FOR INSURANCE COMPANY USE
<br />POLICY NUMBER
<br />
<br />ZIP CODE
<br />c..33~s---Y /
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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 />,- j,;2 A E- (in AO Zones, use depth)
<br />/.:J..O,], 3 S (5 8 0 -..S.~ c -/7 - 7'/ cf.s - /
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<br />7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): 0 NGVD '29 0 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: I I I 19-1sl.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 _ .
<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 18~ 1.121 feet NGVD (or other FIRM datum-see S<;clicr: EI, Item 7),
<br />(b). FIRM Zones Vl.V30, VE, and V (with BFE). The bottom of the lowest florizontal structu;al 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 referen~e level from the selected diagiam j~ L~J.U feet above 0 or
<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 tho 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: ~GVD '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 8, 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-J;;Io (See Instructions on Page 4)
<br />
<br />5. The reference level elevation is based on: 0-'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 lelSl.W 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 building elevations specifies that the reference level Indicated in Sect/on 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.U feet NGVD (or other FIRM datum-see Section B, Item 7).
<br />2. Date of the start of construction or substantial Improvement
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<br />f';MA Form 81-31, MAY 90
<br />
<br />fH,PlACES ALL PREVIOUS EDITIONS
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<br />SEE REVERSE SIDE FOR CONTINUATION
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