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Home My WebLink AboutElevation Certificate I FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE e Important: Read the instructions on pa~es 1 - 7. SECTION A - PROPERTY OWNER INFORMATION BUILDING OWNER'S NAME -- / C I. D { + C- Q.. '1 e ,-e.e. t:- J -f2 II e.- 0,0 ~ I BUIL~ING ~TREET ADDRESS (Including Apt., Unit, Suite, andfor Bldg. No.) OR P.O. ROUTE AND BOX NO. P 'f G, z... "1- OC1--):.J c.... ~ 6..l2.c).. c:. ~ ./J v ert u e... CITY - 1/ :--- -/ I. --- AA. STAfE"--- r rtvl C-~(c..e. /~;tJ PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) U/ /(;,. OAi<:-L..4/JD BEAGfi BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc, Use a Comments area, if necessary.) Res i (Jei/l.'h'a.( LATITUDEfLONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: 1-.1 GPS (Type): ( ##0 _ ##' _ ##.##" or ##.#####") 1-.1 NAD 1927 LI NAD 1983 1-.1 USGS Quad Map /) / a.M.B. No. 3067-0077 Expires July 31, 2002 For Insurance Company Use: Policy Number Company NAJC Number ZIP CODE .s-,J- 3' 7 2... LI Other: SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER I B2. COUNTY NAME I B3, STATE M' I prl"or ~a..J:;...e.... 2 Sea Tt- L4>lA. ^ t I{ (V 84. MAP AND PANEL B5. SUFFIX B6, FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER /-' DATE EFFECTIVEfREVISED DATE ?;ONE(S) (Zone AO, use depth of nooding) 000 L L- II - / I - 7 7 rt E. 909 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. I_I FIS Profile I ~RM I_I Community Determined I_I Other (Describe): B 11. Indicate the elevation datum used for the BFE in B9: I ~VD 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)? LI Yes L~ Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: L-IConstruction Drawings. I-I Building Under Construction. IJdffnished Construction . A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number '7 (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagra~ accurately represents the building, provide a sketch or photograph.) C3. Elevations - Zones A 1-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, ARIA, ARlAE, ARIA 1-A30, ARlAH, ARlAO 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 Commen}s area of Section 0 or Section G, as appropriate, to' document the datum conversion. Datum.A/6 YiJ Conversion/Comments /V.:1~ Elevation reference mark used Does the elevation reference mark used appear on the FIRM? I_I Yes I_I No . o a) Top of bottom floor (including basement or enclosure) 9/0 .::t- ft.(m) ~ '1A~:~\\f. "ft o b) Top of next higher floor 9 2.2- . _L ft.(m) ~ .. . '< 0 E. }A1~,\ o c) Bottom of lowest horizontal structural member (V zones only) . _ ft.(m) ~ ~ 'v 0 /. :~~"h:~.. o d) Attached garage (top of slab) 9 21 . 8 _ ft.(m) ~ -g ~ 'Z. 't,'<f.1. o e) Lowest elevation of machinery andlor equipment . ~ : . R GISTERED ~ servicing the building (Describe in a Comments area.) . __ ft.(m) ~ ~ i LAND ~k o f) Lowest adjacent (finished) grade (LAG) '9 cJ <1 . _~ ft.(m) ~ ~ ~ SURVEYQR ~~1 o g) Highest adjacent (finished) grade (HAG) 9 z... I . _0 ft.(m) ~ \v, 18421 ~.:' o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade ~' .' --8 - 0 . '.~ ..~~ o i) Total area of all permanent openings (flood vents) in C3.h sq. in. (sq. cm) ...:" ,.~,~....5~ ~. e 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. / certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. I understand that anv false statement mav be punishable bV fine or imorisonment under 18 U.S. Codej, Section 1001. CERTIFIER'S NAME t::'.- /~ Y d ~ ~ 4/ LICENSE NUMBEK /8' 9- c:... / TITLE L..' ~c/ Surt/ ~ (.7'-- COMPANY NAME If TI'::>O f /'7 C . ADDRESS 7S/0 H~/c..ej- ;.:J..1:zc.e Dn'v(.CITY Ede;J /J-~/r;es-lATEf11J ZIPCODE.s-~-3'''fc-f SIGNAT~R~."..../ C' ~~ DATE 3 -,3 - a 2- TELEPHONE.95 Z - 8' 2-7 - 070cJ I=I=MA I=mm A1_~1 .1111 nn ~I=I= RI=\II=R.C:1= ~Inl= I=nR r.nl\ITIl\IIIATlnl\1 RI=PI Ar.I=.C: All PRI=\IlnllC:: I=nITlnl\l.C: e e IMPORTANT: In these spaces, copy the corresponding information from Section A. . BUILDING STREET ADDRE~S (Including,Apt., Unit, Suite, andfor Bldg. No.) OR P.O.jWUTE AND BOX NO. /4- b'2 cr Oc>.-/c:.../a.PLc/ 8 ea.ch At/-€. n fA e CITY ? /. f STATE L./ A / ZIP CODE Company NAIC Number I rtov {..-LA..JL-e. r/IV SS-sT2..... SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenUcompany, and (3) building owner. COMMENTS For Insurance Company Use: Policy Number e '-_I Check here if attachments SECTION E - BUILDING ELE,VATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1. through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E 1. 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.) E2. The top of the bottom floor (including basement or enclosure) of the building is L-I-I ft.(m) 1__I_lin.(cm) I_I above or I_I below (check one) the highest adjacent grade. (Use natural grade, if available.) E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is 1_/_1 ft.(m) '-_'--lin.(cm) above the highest adjacent grade. Complete Items C3.h and C3.i on front of form. E4. 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 floodplain manaqement ordinance? I_I Yes I_I No I_I Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, C (Items C3.h and C3.i only), 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, C, and E are correct to the best of my knowledge. PROPERTY OWNER'S S'R OWNER'S AU]l-lORIZED REPRESENTATIVE'S NAME L/oyd E. /-ew ADDRESS 76?/J Hc..r-ft-er ?k ce. f/r/t/~ CITY c?d~ jJrtt t'rr'.e. SIGNAT~RE \././'.fi' _ / ___ u?.... .-- DA{E.~__ / ~--f::'Ii?>?,,64' "':l.- /-:~ ..J e --0 '"'Z-- COMMENTS ,/ STATEf1 Ai ZIP COD~_,.s- 3" <(4- TELEPHONE :7S2 - B'2-'l -Q 700 '-_I Check here if attachments 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. G1. L-I The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. I_I A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zone AO. G3. '-_I The following information (Items G4-G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER I G5. DATE PERMIT ISSUED I G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been issued for: 1__1 New Construction I_I Substantial Improvement G8. Elevation of as-built lowest floor (including basement) of the building is: G9. BFE or (in Zone AO) depth of flooding at the building site is: LOCAL OFFICIAL'S NAME . ___ ft.(m)Datum: . __ ft.(m) Datum: TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS e L_I Check here if attachments. I=F=Mh I=nrm A1_q1 .1111 nn RI=PI hr.F=~ I'll I PRF=\Ilnl J~ I=nITlnl\I.C: