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Home My WebLink AboutELEVATION CERTIFICATE U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE OMS No. 1660-0008 EXDires Februarv 28. 2009 Important: Read the instructions on pages 1~8. SECTION A - PROPERTY INFORMATION k! :21.8/rx:.k 1 1St.AIt/O lItew 5'711 /IIl{J/1"I<?A) A4. Building Use (e.g., Resident I, N n-Residential, Ad ltion, Accessory, etc.) A5. Latitude/Longitude: Lat.. . 2- 2.;' 2.4 Long. -Q3,J.?t eO"?JbOf'S" Horizontal Datum: o NAD 1927 ~NAD1983 A6.. Attach at least 2 photograPh':r the building If the Certificate is being used 10 obtain flood Insurance. A7. Building Diagram Number A8. For a building with a crawl space or enclosure(s), provide: I. I!: ,_ AS. For a building with an attached garage, provide: A. a) Square footage of crawl space or enclosure(s) ~ sq fl a) Square footage of attached garage 7o+. sq II b) No. of permanent flood openings in the crawl space or 0 b) No. of permanent flood openings in the attached garage enclosure(s) walls within 1.0 foot above adjacent grade _ walls within 1.0 foot above adjacent grade () c) Total net area offlood openings In A8.b ---11- sq in c) Total net area of flood openings In A9.b -0-- sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B10. B2. County Name $( B6. FIRM Index B7. FIRM Panel Date A I EffectivelRevised Date 1.611-. f IVDV. ItJf!1 91/'7 Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. o FIS Profile IZI FIRM 0 Community Determined 0 Other (Describe) Indicate elevation datum used for BFE in Item B9: tiZf NGVD 1929 0 NAVD 1988 0 Other (Describe) Is the building located In a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPAl? Designation Date 0 CBRS DOPA B3. State MN' B8. Flood Zone(s) B11. B12. DYes 0 No SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: 0 Construction Drawings. 0 Building Under Construction. QS[ Finished Construction .A new Elevation Certificate will be required when construction of the buHding is complete. C2. Elevations-ZonesA1-A30. AE, AH, A (with BFE), VE, V1-V30, V (with BFE),AR, ARIA, AR/AE, ARlA1-A30, ARlAH, ARlAO. Compete Items C2.a-g below according to the building diagram specified In Item tJ7. L Benchmark Utilized t:JJ.J./. 3r;cFf 50/!. pf 4. r n.--rf'f Vertical Datum fqZq Conversion/Comments :1'~k.,J /eJ a) Top of bottom floor (Including basement, crawl space, or enclosure floor) b) Top of the next higher t100r c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment in Comments) f) Lowest adjacent (finished) grade (LAG) g) Highest adjacent (finished) grade (HAG) Check the measurement used. q 10 .JL l2?l feet 0 meters (Puerto Rico only) qoz.O .-Laa feet 0 meters (Puerto Rico only) AUk 0 feet 0 meters (Puerto Rico only) Cll f"J ..s:...[ig feet 0 meters (Puerto Rico only) /oJ. A..-D feet 0 meters (Puerto Rico only) , ~ ~ Il6F~T(Q) ts q I 0 ..k.....~ teet 0 meters (Puerto Rico only) , {B . 0 0 feet 0 meters (Puerto Rico only) 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. I certify that the infonnation on this Certificate represents my best efforts to interpret the data available. / understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1()(1f.""- o Check here if comments a~ provided on back of form. (Jefer ,;: 1.JfA.wr</fIt Seo" 41.2.1/" Certifier's Name I I J ~ 11 Ucense Number " /7 hrJ PI' ~~f"'o'I(J "'~'1 Vrve J"eor J r,'ol/t'",.. ~11!;/11 ~"r""9 r.lf. Title...(4A ,cf'lHr I7r"~e /Jrt~;panYNam1Yl"'1d/.4 l/tI'9~1s ,111M 55/20 Address 'j I I- City I 512~/"B Stat,C! (65/) &j)~7f~4 Signature Date Telephone FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions IMPORTANT; In these spaces, copy the corresponding Infonnation from Section A. Building Street Address (Including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. l!is4 r ~",.f '" c.Ie ~~ L ~ /rlo..- Ilk MAl SECTION 0 - SURVEYOR, ENGINEER, OR ARCHITECT CERnFICA nON (CONTINUED) ZIP Code Copy both sides of this Elevetlon Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments Signature o Check here If attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) Date For Zones AO and A (without BFE), complete Items E1-E5. If the Certificate is Intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items E1-E4, use natural grade, If available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation Is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor rlllcluding basement, crawl space, or enclosure) is _' _ DO feet 0 meters 0 above or 0 below the HAG. b) Top of bottom floor (including basement, crawl space, or enclosure) is _' _ feet 0 meters 0 above or 0 below the LAG. For Building Diagrams 6-8 with permanent flood openings provided in SectiQI!./'. Items 8 and/or 9 (see ~e 8 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is _' _ 0 feet U meters 0 above or U below the HAG. Attached garage (top of slab) is _' _ 0 feet 0 meters 0 above or 0 below the HAG. Top of platform of machinery and/or equipment servicing the building is _' _ 0 feet 0 meters 0 above or 0 below the HAG. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? 0 Yes 0 No 0 Unknown. The local official must certify this information in Section G. E2. E3. E4. E5. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or community-issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E aTe col7'eCt to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments o Check here If attachment!! SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who Is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable Item(s) and sign below. Check the measurement used in Items G8. and G9. G1. 0 The Information In Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. 0 A community official completed Section E for a buDding located in Zone A (without a FEMA-issued or community-issued BFE) or Zone AO. G3. 0 The following information (Items G4.-G9.) Is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: 0 New Construction 0 Substantial Improvement G8. Elevation of as-built lowest floor (Including basement) of the building: G9. BFE or (In Zone AO) depth of flooding at the building site: o feet 0 meters (PR) o feet 0 meters (PR) Datum Datum Local Official's Name Title Community Name Telephone Signature Date Comments o Check here If attachments FEMA Form 81-31, February 2006 Replaces all previous editions