HomeMy WebLinkAboutElevation Certificate
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CE FICA"'E O,M.B, NO 3067.0077
ELEVATION RTI ,I Ellpir.iM~yJr. r993
FEDERAL EMERG!NCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATTE/'fTlON: Use 01 lhls certificate doe, nOl provide a waiver 01 Ihe flood Insuranco purehaGe requirement. This form is used only \0
provida elevation inlormalion nec;e&Sary 10 emours compliance with applicable communily floodplain managemenl ordinances, to
de18rmlne the proper inS\Jran~ premium rate, and/or 10 support a request for a Lener of Map Amendmenl or Revision (LOMA or LOMA).
instructions lor completing lttls form can be found on the tollowlng pages.
SECTION A PROPERTY INFORMATION
FOR INSURANCE CQMPAIN USE
poLICY NUloI8EJ'I
BUILDING OWNER'S NAME
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STREET AOO?E9S Ilnd\ldl7!'Q Apt.. Unit. '~..,.uDf BIdi, NlImbet) OR P.O. ROuTE AND BOX NUMBER
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OTHERDE~RII'TION(lol..,~N""-";Ie-)L: I- /13 tJOtL--MlU1Jd k~ I CtkJ /khL4rL/rl.J
CITY ~ \ / A/J ~ r/STATE ' I ZIP CODE .
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SECTION 8 FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
COMP4N'I' HAle NUMBE.R
Provide lhe following Irom the proper FlAM (See Inslructlons):
" COMIoIUN\'TY NUMBeR
2, PAlIIEL NUMBER
], SUFl'IX
S, FIR"" ZONE
6. BAse f\.OOO E.lEV"TION
(in 100 ~, UN cIeOlIIl
'108, I
.. CATE O~ ~IFl"'INDEX
;)10 LHL ()M '3 C- /J,1(} I? ./ 791 jt-G
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7, Indicate tho el8\18110n datum system used on the FIRM 10( Base Flood Elevations (6FE): ~ NGVD"'29 0 Other (describe on back)
8, For Zones A or V, where no BFE is pl'ovlded on the FIRM, and Ihe community has established a BFE tor this building site, indicate
the community's BFE: LI I I I I.U feet NGVO (or olher FlAM dalum-see Section B, 11em 7).
SECTION C IiIUILDING ELEVATION INFORMATION
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1, Using the Elevalion Cer1ifica\8 Instructions. indicate Ihe diagram number trom lhe diagrams found on Pages 5 and 6 lhal bast
describes the subject building's relerence level =.L .
2(a). FlAM Zcnes A1-A30,@AH. and A (wilh BFE). Ths top 01 the rslerence level floor Irom the selected diagram is al an elevation
01 LLff 1/1/1. dJ feel NGVD (or olher FIRM datum-see Sadion B. Ilem 7),
(b). FIRM Zones V1-V30. VE, and V (wilh BFE). The bonom oflhelowest horizontal stnJdural member ot the retere"CliIleVIII Irom
the selected diagram. Is at ao elevetion of I I I I I I.U feot NGVD (or olher FIRM dalum-see SacUon B, lIem 7).
(c), FIRM Zone A (wilhoul BFE). The 1I00r used a; lhe relerence levellrom lhe lielected diagram is W.U leel above 0 or
below 0 (checll. one) Ihe highelit grade adjacant to the building. '
(d), FIRM Zone AO. The 1I00r used as Ihe reforenclI level from !he selecllld diagram is LD. U IlIst above 0 or below 0 (chuck
one) the highest grade adjacent to the building. II no llood depth number is available. islhe building's lowest nOOf (ralerenco
level) elevQI9d in accordanca wllh the community's floodplain managemenl ordinanC1l7 0 Yes 0 No 0 Unknown
3, Indicale Ihe elevation datum syslem used in delermining Ihe above relsrence level elevations: 8.. NGVO '29 0 Olher (describe
under Comments on Pege 2), (NOTE: "tlHf elevation dsrum used in mBlJsurif1{J 1M elevafionlls'di"flr9nt thBn that used on
the FIRM [SBB 5Bction,B. IIsm 7J. rhen conVfltf the elevations 10 ItI6 darum system used on me FIRM and show the conversion
equation undBr Comments on Page 2.) ,
4. Elevation referenca mark used appears on FIRM: 0 Yes ~ No (See lnatructions on Page 4)
5, The relerence level elevalion is based on: ~ actual construction 0 conslrudion drawings
(NOTE: Use 01 COI1struction dfawlfl{}6 Is anTi valid if the bulk11ng does not yel have the fe/ef"nce/QV'QI flcor In pl.clf. in which
caso /his 08t1ificatfl INIfI only be valid for thfJ bulldlno duJing ttre coutS8 C1f construction. A post-construction Elevation Certificale
will bfl18!lulrod onCB construction Is complete.) ,
6. The "Ievalion ot the lowest grade immedialely adJacenl 10 the building is: LLJ1ll.ill. L/J f_1 NGVD (or other FlAM datum'6ee
SlICtion B, Item 7),
SECTION D COMMUNITY INFORMATION
" lithe community onicial responsible for verifying bUilding elevallons Gpctcifies thallhe reference level indicaled in S.dlon C. Item 1
is nOllhe "Iowesl floor' as dehned in !he communily's floodplain management ordinance, the elevation ollhe building's "Iowesl
Iloor. as defined by Ihe ordinance i&: I I I I I I.U f&tll NGVD (or other FIRM dalUm-6ell Section B, Ilem 7).
2, Dale 01 the 6\art of conslruction or 5ub&1al'lllal improvement
seE REVERSE SIDE FOR CONTINU"TION
.
FEMA FO'In 11.;n, ""AY 90
AEPLACE5 All PREVIOUS EOITIONS
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612-947-0117
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R~an Engineering, Inc,
SECTION E CERTtACATlON
This certification is to be signed by a land surveyor, engine.r. or architect who is authorized by state or \ocallaw to certity elevation
information when the elBV&tion information for Zones "1-A30, AE, AH. A (with BFE),V,-V30,VE, and V (with BFE) is required,
Community officials whO are authori~ed by local law or ordinanCB 10 provide floodplain management Information, may also sign Ihe
canlllcation. In the case of Zones AO and A (without a FEMA or community issued BFE). a building onicial, a property owner, or an
owner's representative may also gign lhe certification,
Reference level diagrams 6, 7 and B . Distinguishing Features-If the certifier is unable to cer1ify 10 breakaway/non.breakaway wall,
enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s). then tistth8 Feature(s) not
included in the cartiHcatlon under Comments below. The diagram number, Section C, !Iem 1, must still be entered,
I c8rtify that me information in Sections B and C on this c:,rti(iCare represents my best sHorts ro Interprer rhe data ilvailifblfJ.
I understBnd rhllr any fals8 statement may be pfJnlSllstHe by fins or imprisonm.nr under , B U. S. Code, Sec:tion , 00 , .
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CERT~R'S NAM~ / bl / ___ LICENse NUM81!R (or Alii. S~al)
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rlTLE / / I. ~ j COMPANY NA~ . /J' ~
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SIGNI<TURE'" - /' . DATE
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ST"TE ZIP
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PHONE
Copies should be made of this Certificate for: 1) communlly onlclal, 2) Insurance agent/company. and~) building owner.
COMMENTS:
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The diagrams above lIIuslrale the points at which the elevallons should be measured in A Zone6 and V Zones,
Elevations lor all A Zones should be measured allhe top 01 the reference leve' floor,
Elevations for all V Zones should be measured al the bottgm of thll IgwClct horizontal structural member.
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