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FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE a.M.B. No. 3067-0077 Expires July 31,2002 1m ortant: Read the Instructions on a es 1 - 7. SECTION A - PROPERTY OWNER INFORMATION FotlnsuranceCompany Use: BUILDING OWNER'S NAME CITY STATE H. Numbers, Tax Parcel Number, Legal Description, etc.) ZIP CODE -3'3" f:) 4/ LATITUDE/LONGITUDE (OPTIONAL) ( ##0 _ ##'. ##.##" or ##.#####0) SOURCE: I_I GPS (Type): LI USGS Quad Map I_I Other: SECTION B. FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B3. STATE _ 1~2 ?6 B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding) ()OO{) C. I I I GOO ~ to B 1 0, Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. 1-1 Frs Profile 1-1 FIRM ~ Community Determined I_I Other (Describe): B 11. Indicate the elevation datum used for the BFE in B9: I_I NGVD 1929 I_I NA VD 1988 I_I Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1-1 Yes I){I No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C 1. Building elevations are based on: I_I Construction Drawings. I_I Building Under Construction. I)(JFinished Construction .A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number ~ (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations - Zones A1-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, AR,/A. AR/AE, AR/A1-A30, AR/AH, AR/AO Complete Items C3.a-i below according to the building diagram specified in Item C2, State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section 0 or Section G, as appropriate, to document the datum conversion. Datum N~)1I0 '21 Conversion/Comments Elevation reference mark used CFD ,1$.'1- Does the elevation reference mark used appear on the FIRM? I_I Yes I~ No o a) Top of botto~ floor (including basement or enclosure) ,17 . 4 ft.(m) ii e:>.. . " o b) Top of next hrgherfloor /\//A ._ft.(m) ~ IZ~ /'-' u 54c /~. o c) Bottom of lowest horizontal structural member 01 zones only) /VI A . - ft.(m) ! 'j. IJ"U . ') o d) Attached garage (top ofslab) C4ao()/LT.. I?S".!L ft.(m) f c .''^ ~ . nu,~ r WOl" . - 1...z..U"^'"'"~' o e) Lowest elevation of machinery and/or equipment ..: oj . servicing the building (Describe in a Comments area.) 4c. UIIi / r · ,~5 ,.J::... ft.(m) ~ ~ 7/24/63 o f) Lowest adjacent (finished) grade (LAG) tf'f;; , Z. ft.(m) ~ ~ o g) Highest adjacent (finished) grade (HAG) B-S ,~ft.(m) ~ o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade ~ ~ o i) Total area of all permanent openings (flood vents) in C3.h ".J!)/' sq. in, (sq. em) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information, / cerlify that the information in Sections A, B, and C on this cerlificate represents my best efforls to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME ~U N I-/. Q IE t1-1M 01'\15 c;I.t2. LICENSE NUMBER ?~ '/ 5~ 7 Z. TITLE COMPANY NAME _ (!, ffle D L €U/i -;/ .soG, "2/VC. CITY oh STATE;::z, ZIP CODE ~-5~41. DATE 7 2 TELEPHONE ~/-3 76'2- G,. 7/7 SE SIDE FOR CONTINUATION REPLACES LL PREVIOUS EDITIONS