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<br />IMPORTANT: In these spaces, copy the ")responding information from Section A. ~~
<br />BUILDING STREET ADDRESS (Including Apt, Uni~ Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
<br />';L t1- .~ +re<. 4-
<br />CITY I. \ STATE ZIP CODE ~~~~~:?~.N.~J:~ ~~mber.";.~
<br />Z-c::.. hr k.., L., "}"}S'-/I ~?r.~:-r..,".t"':' ,.
<br />SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED}
<br />
<br />Copy both sides of this Elevation Certificat~ for (1) community official, (2) insurance agent/company,. and (3) building owner.
<br />COMMENTS
<br />
<br />
<br />
<br />1-1 Check here jf attachments
<br />SECTION E- BUILDING ELEVATION INFORMATION (SURVEY NOT RECUlRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
<br />
<br />lr Zone AO and Zone A (without BFE), complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting
<br />'ormation for a LOMA or LOMR-F, Section C must be completed. .
<br />'. Building Diagram Number _ (Select the building diagram most similar to the building forwhich ~is certificate is being completed-
<br />see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) ./
<br />. The top of the bottom floor (including basement or enclosure) of the building is' L-L.l item) LLJin.(cm) U ,above or U below
<br />(check one) the highest adjacent grade.
<br />. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is
<br />LU ft.(m) LUin.(cm) above the highest adjacent grade. .
<br />For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's
<br />floodplain management ordinance? LI Yes LI No Lf Unknown. The local official must certify this information in Section G.
<br />. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
<br />
<br />e property owner or owner's authorized representative who completes Sections A. B, and E for Zone A (without a FEMA-issued or
<br />nmunity-issued 8FE) or Zone AO must sign here. .
<br />
<br />:JPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
<br />
<br />)RESS
<br />NATURE
<br />IIMENTS
<br />
<br />CITY
<br />DATE
<br />
<br />STATE
<br />TELEPHONE
<br />
<br />ZIP CODE
<br />
<br />U Check here if attachments
<br />
<br />SECTION G - COMMUNITY INFORMATION (OPTIONAL)
<br />
<br />leal official who is authorized by law or ordinance to administer the commun!tYs floodplain management orcf~ce can complete
<br />IOS A, 8, C (or E), and G of this Eevation Certffieate. Complete the applicabie item(s) and sign below.
<br />-1 The information in Section C was talcen from other documentation that has been signed and embossed by a licensed surveyor,
<br />engineer, or architect who is authorized by state. or 10~1 I~ to certify elevation information. (Indicate the source and date of the
<br />elevation data in the Comments area below.) .
<br />J A community official completed Section E for a buDding located in Zone A (without a FEMA-issued or community-issued 8FE) or
<br />Zone AO.
<br />J The following information (Items G4-G9) is provided for community floodplain management purposes.
<br />
<br />:RMIT NUMBER G5. DATE PERMIT ISSUED Ga. DATE CERTIFICATE OF COMPUANCElOCCUPAb.I~~ .
<br />ISSUED .
<br />.. .
<br />
<br />is permit has been issued for: U New Construction Lf Substantial Improvemer,rt
<br />lvation of as-built lowest floor (including basement) of the building is: . . -. ..
<br />E or (in Zone AO) depth of flooding at the bwlding site is:
<br />
<br />. OFFICIAL'S NAME
<br />
<br />d. _ item) Datum:
<br />-~.--:.. item) Datum:
<br />
<br />TJTJ.E .'
<br />
<br />UNITY NAME
<br />
<br />TELEPHONE
<br />
<br />., ~ ',.-.." ...-, .,:,...... ,
<br />-.'-~-'..,:-.,'-....';...........,~~:......,. ...,....
<br />
<br />iURE
<br />
<br />... -_.... .- --,. ..- ."~ .
<br />'-....- ',"- --' - .,-;---'-,,; ..'....'.....--.-.':- -."': 7::::~:..~....--:-:
<br />
<br />DATE
<br />
<br />.. .--- ---'---"""""'-'-.---------'--.- .-.--'
<br />--~. --.-"- .,'-,-
<br />
<br />. , ~~~d~:,,-.;b2~~;~~i~~:~ "
<br />
<br />..-.......,...".,.,-. ,.,..-,......
<br />._,.. ..._--- .-
<br />
<br />,rTT"tR"f_"2of l\11~nn
<br />
<br />....._. a _ _ _ ~ ~ _ .---.- ----.--.-
<br />
<br />.._"_.___._,..""'"....~_~__~A~"........,.<.. ""'._".,_.",..~.._,..-"_"_,"',.".,,,,'~."',.,'".~_._...",.,,,""
<br />
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