|
<br />",' -'~ ili...'
<br />
<br />ELEVATION CERTIFICATE
<br />FEDERAL EMERGENCY MANAGEMENT AGENCY
<br />NATIONAL FLOOD INSURANCE PROGRAM
<br />AnENTION: Use o' Ihls certlfica.. does not PlOylde a waiver 01 tha lIood tnsuranca _ raqulra........ ThIa Iorm la"",,,!: onlX;\I( ;~;~
<br />provide elevation Information necessary to ensure compliance with applicable community floodplain management ordln8l1C88;,to .Vi+"'1"" :':
<br />determine the proper Insurance premium rate, and/or to support a request for a Letter of Map Amendment or ,Rev~~!.!SIS~'9~, ~g~f.U~~
<br />Instructions for completing this form can be found on the fOllowing ~ge.. " , ".~, : ,TI.:,~' ::.:. . [' ,;
<br />
<br />-!
<br />
<br />O.M,S; NoJ067-0077
<br />EICpiresM.y3" '993
<br />
<br />BUILDING OWNER'S NAME
<br />
<br />SECTION A PROPERTY INFORMATION
<br />
<br />FOR INSURANCe COMPANY USE
<br />;'1
<br />POl.lCV NU~""4 ;'1
<br />,;I l.
<br />
<br />
<br />
<br />COMPANY NAIC NUMBER
<br />
<br />OTHER DESCRIPTION (Lot and Block Numbers. ete,)
<br />I 0 - {).'b -.:l-J - OJd-.O ... 0 LJ C) c::) 0
<br />
<br />CITY ~.d-
<br />
<br />SECTION B
<br />
<br />'- .r'\
<br />- O.3~ v
<br />
<br />
<br />~f1. STATE
<br />FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
<br />
<br />ZIPCOQE
<br />33~-'/;'
<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 8. BASE FlOOD ELEVATION
<br />(In AO ZanN, ... dIpIh)
<br />/ d- OOL~-.S- {9 CJ 0 -S- L /;2-/?- 9'( If- E g-..s '-
<br />
<br />7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ONGVD '29 OOther(descrIbeMbtlqh,i:}
<br />B. For ZoneR A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building slte,lndlcate
<br />the community's BFE: L I I 18t6TU feet NGVD (or other FIRM datum-see Section B, Item 7).
<br />
<br />~.
<br />
<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 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 />of I I I ISI5/. ~ feet NGVD (or other FIRM datum-see Section e, Item 7).
<br />(b). FIRM Zones V1-V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the referenceleveJlrom
<br />the selected diagram, is at an elevation of l I I I I I.U feet NGVD (or other FIRM datum-see SectIon 8, Item 7). ,
<br />(c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram Is W.U feet above Oor'.
<br />below 0 (check one) the highest grade adjacent to the bUilding. ....<...< _
<br />
<br />(d). FIRM Zone AD. The floor used as the reference level from the selected diagram Is W.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 lowestll~,(refere~
<br />level) elevated in accordance with the community's floodplain management ordinance? 0 Yes 0 No 0 Unknown;
<br />3. Indicate the elevation 'datum system used In determining the above reference level elevations: lY-NaVD '29 0 Oui8"(de8Cl'Ibe
<br />under Comments on Page 2). (NOTE: If the elevation datum used In measuring the elevations Is different than thai used Of1i;.t,;,< '
<br />the FIRM [see Section 8, Item 7), then convert the elevations to the datum system used on the FIRM and show ,the COIMItS/on..,
<br />equation under Comments on Page 2.) < 1 ',,~' , , ,
<br />4. Elevation reference mark used appears on FIRM: 0 Yes 0 No (See Instructlons on Page 4) '!,
<br />
<br />5. The reference level elevation is based on: 0-aClu~1 construction 0 construction drawings
<br />(NOTE: Use of construction drawings is only valid if the building does not yet have the reference level f(oor In place, In whlch~<-
<br />case this certificate will only be valid for the building during the course of construction. A post-constructlon< Elsvation CfHtificate
<br />will be required once construction is complete.)
<br />
<br />6. The alaYdon 01 tha 1--1 grada Immadlataly adjacanllo tha building Is: I I I 181 lr. [j"aet NGVD (or _ F.RM da!u'"1""
<br />Section B, Item 7).
<br />
<br />
<br />i-~-..~:j...
<br />
<br />SECTION D COMMUNITY INFORMATION
<br />
<br />1. If the community official responsible for verifying building elevations specifies that the reference level 'ndicated In SeQtion.C;;.;I~jli2
<br />Is not the "lowest floor" as defined in the community's ~Ioodplaln management ordinance, the elevation of the bu!ldlpg's ~Iow...t " .
<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). ""~' 'r.t 'f~,"'!' ,'.,
<br />2. Date of the start of construction or substantial Improvement
<br />
<br />FfMA Form 81-31, MAY 90
<br />
<br />
<br />REPLACES All PREVIOUS EDITIONS
<br />
<br />SEE REVERSE SIDE FOR CONTINUATION
<br />
|