06-5948 (2) - Laserfiche WebLink

Browse Search

I IMP<'~RT ANT: In these spaces, copy the corresponding infonnation from Section A For Insuranoo Conllany Use: BUILDING STREET ADDRESS (Including Apt, Unit, Suite, and/or B\1;j No) OR P.O. ROUTE AND BOX NO. Pot.y Number . 4843 SlIZANNE ST. CI1Y STATE - ZIP CODE Company NAIC NlJfrber ZEPHYRHILLS FL 33542 SECTION D . SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy ooth sides of is Elevation Certificate for (1) community offidal, (2) insurance agenVcompany, and (3) building CM'Iler. COMMENTS 1). BASE FL(x)D ETERMINA TION BY CITY OF ZEPHYRHILLS BUILDING DEPARTMENT 2). AIR CONDITIO ING UNIT IS WINDOW TYPE I NONE AT GROUND LEVEL o Check here if attachments SEdlON E . BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOllT BFE) I For Zone AO CIld zori:l A (withoot BFE), cx:mpIete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information fa" a LOMA Or LOMR-f, Section C must be caI1pleted. E1. Building Diagr;m Number _(Select the building diagram most similCl" to the building for which this certificate is being completed - see pages 6 and 7. If no diagram acx:;urately . represents the building, provide a sketch or photograph.) E2. The top of the OOttPm floor (including basement or enclosure) of the building is _ ft.(m) _in.(an) 0 aOOve or 0 beIcM' (check one) the highest CKljocent grale. (Use natural gra:le, WatciIOOle). E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) ct the building is _ ft.(m) _in.(an) above the highest CKljocent grale. Complete~ems C3.h CIld C3.i on front ct form. E4. The top ct the p1~ ct mcd1inery CIld'or equipment servicing the building is _ ft.(m) _in.(an) 0 above or 0 beIcM' (check one) the highest CKljocent grale. (Use natural grCKle, WatciIOOle). E5. For Zone AO only:11f no flood depth number is avcilOOle, is the top ct the OOttorn floor elevated in cmxdance with the oommunity's fIoo:lpIcin mroagement ordinance? o Yes 0 NoI 0 Unkoo.vn. The kx3 ctficial must certify this information in Section G. SECTION F . PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION I The ~ 0NI'1er cjr a.vner's aJlhaized representative who completes Sections A, B, C (Items C3.h and C3.i ooly), CIld E fa" Zone A (withoot a FEMA~ssued or oommunity- issued BFE) or ZoodAO must sign here. The statements in Sections A e, C, and E are oonect to the best of my kooNledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS o Check here if attachments SECTION G . COMMUNITY INFORMATION (OPTIONAL) I The Ioca official who is iauthorized by law or ordinance to CKlminister the community's fIoodplcin mroagement ordinance em complete Sections A, B, C (or E), CIld G ct this Elevation Certificate. Complete tt/e applicable item(s) CIld sign beIcM'. G1. 0 The informalior\ in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authoIized by state or kx3law to Certify elevation information. (Indicate the source CIld date of the elevatioo data in the Comments <rea beIcM'.) G2. 0 A community qJidal completed Section E for a building located in Zone A (without a FEMA~ssued or community~ssued BFE) or Zone AO. G3. 0 The fo/loNing information (Items G4-G9) is provided for community floodplain management purposes. G4. PERMIT NUWBER G5. DATE PERMIT ISSUED GG. DATE CERTIFICATE OF CCJMlLIANCEJOCCUPANCY ISSUED G7. This permit has issued for: 0 New Coostruction 0 Substantial Improvement GB. Elevation of as-buiffi IoNest floor (including basement) ct the building is: G9. BFE or (in Zone Ad) ~ ct flooding at the building site is: LOCAL OFFICIAL'S ~ME COMM""lY NAME SIGNATURE COMMENTS . I I -I _._ft.(m) _._ft.(m) Datum: Datum: TITLE TELEPHONE DATE - I FEMA Form 81-31, January 2003 o Check here if attachments Replaces all previous editions