HomeMy WebLinkAboutElevation Certificate
MAR. -20' 98(FRI) 09:33
03/10/98 14:09
PROBE ENGINEERING CO
5'611 B8& 4775
TEL:612 432 3723
Garbarg's
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P. 002
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ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTIONi Use 01 this cenific:ato does not provide a waIver of the flood Insurance purchase requirement This for~ 19 used enly to
provide elevation Information nocesliQ/)' to ensurlll compllanco with applicable community floodplain mane.gsme"t ordll1ances, to
dalarmlne the proper Insurance premIum rate, and/or to support a requ881 for a l.att8r of Map Amandrne"t or Revision (LOMA or LOMA).
IrH~lructlonB fel' completing thlll form can be 'ound on lhe foll~wlng page..
C.M.B. NO. 'J067<tJn
Elt'lr-. M"131. 1996
SECTION A PROPERTY INFORMATION
FOR INSURANce COllOlPANY US!!
POLICY NuloleEA
BUllDlroIG OWNE"'S r-IAME
~~~ + 0 g~o~~
STReer ...OCRE5S (lnc:ll.ldlng Api., UnlL Sulte and/er Blelll, NUrTl~rl OF! P.O, ROUTE ANC BOX NUMBER
.111 I.l. 0 s ff A' 6-1 ..@. II.-
OTHER DESCRIPTION (ll'l BTId BICld\ HIoImber:s. Ille,)
COt.4PAH'l' NAle NU~~eR
STATE
ZIP COO!!
Cln'
Prt.t Oot. L.A-~if
14f~ ~ S-.3 ~2
SeCTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Ins\1Uctlons):
e. aASl!. A...OCC ElE."t'"nON
II" 1-0 Ze~, 1/'. d11l1h)
CffJ8.' ft.
7. Il'\dlcal'" the elavatlcn datum system. usee:! on the FIRM for Base Aocd Elevations (8FE); .~GVD '29 0 oth~r (descrlbli em back)
B. For Zone!! A"cr V. where nc BFE is provided on the FIRM, and the cicmmunity has established a 8FE for this building site, IndIcate
the ccmmunitfs BFE: I 1 I I U.U feel NGVO (or other FIRM datum-5ee Secllon B, Item 71.
e. SECnON C BUILDING ELEVAnON INFORMATlON .
1. CQlwlhlU!'ilIT'f NUMBeR
z. PANEL NUIoI5ER
:I. SUFFIX
.I, OA11: OF FlRt.1INOEX
~. FIRIo4 ZONE
2"70 "132-
000 ;2.
C-
1. Using the Elevalion Certificate Instrucl1ons, indicate the diagram number from the diagrams found e" F'aglil5 5 and B that bS$t
dS5cribas the subject building's reference lave I ~ .
2(a). FIRM Zones A1~A'30. AE. AH, and A (wilh aFE). The tOi:! of the reference level floor from the selected diagram is at an elevallon
ef l I RII1QJ.~ feet NGVC (or other FlAM datum-1leG Sec:tlcn 8. Item 7).
(b). FIRM Zones V,-V30. VE, and V (with 8FE). Thll bottom of'the lowest horizontal structural member of the referancelevel from
the selected diagram. Is at an elevation ot I f I I I I.U feet NGVC (or other Fl RM dst'um-$ee Sectlen B. Hem n.
(c). FIRM Zona A (without BFE). The flcor used al!i the referenc:a level from IMe selected diagram 1s W.U feet above 0 or
below 0 (check olie)' ths highest grade adjacent to the bu[ldlng.
(d). FIRM Zone AO. The flocr U5BD as the referencs lovel from the selected diagram 1a W.U 'aet above 0 or belcw 0 (check
one) the highest grade adjacent to the buildIng, If no flood depth number Is available, 15 the building's lowest floor (reference
Il!Ivel) elevated in accordance with the community's floodplain management ordInance? 0 Yes 0 No 0 Unknown
3. lndicatillhe elevation datum system l.Jsed In determinIng the above r9ferenea level elevatiOM:lit' NGV!:I'29 0 Other (describe
under Comms"ts' on Page 2), (NOTE: If Inti s/el/atlon.datum us9d in measuring the a/el/allons is different than thaI usod on
the FIRM [se9 Saerlcm B, Item '1, then convert Ihe elsvstlerls to the datum'system used on the FIRM and shaw the cgnv9rslon
. equation under Comments on Page 2.) .
4. Elevation relerenCB mark used appears on FlAM: 0 Vl!9 ~No (Se8 In6trucllcns en Pags 4)
S. The referance la~BI elevallo~ Is based on:~ctU~1 CXlnstl1Jr:tlon 0 consU'Uolon drawIngs
(NOTE: Use of constflJcr/on drawings Is only vl1lid " Ihe bul/a'ng does not yet hB.V8 the rsfersnCB level floo, In p/acs, In which
case tMs =n/ficalll wlfl only btJ va"a for Ihs building during tho CDrJrsfJ of canstroc1ion. A pasH::rmstn.Jctl"n Elevation Cer:ifics.ta
will be required Qnc.8 e;onstruction is eomplst9.) .
6. TI'le lllevadcn af thelowllst gradllllmmgdlately adjacent to the building Is: I RIIIDI.liJ rElet NaVO (or olher FIRM datum-158ft
Section B. Item 7);
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SECTION D CCMMUNllY.1NFORMATIOH
,. If Ihe community official responsible for verifyIng ~I.llldlng elevations Iipe~Elll that 'Lhe referenCe level Indicated In Sactie" Co ltam 1
. I:!J net tho "lowest "oor" as deflnad In the community's floodplain management ordInance, 'tie elevation or the building's -'owesl
flcor- as donned by the ordlni!lnca Is: L I 1 I I J. U feat NGVO' (or other FIRM datulTHive SectIon 8, Item 1).
.. _ _.. ____L_._..~__ __ ........,...":I....1c:z1 r~fII\l'''VA".,.I"t
MAR. -20' 98(FRI) 09:33
PROBE ENGINEERING CO
'8'61.2 SSS 4775
Garborg's
TEL:612 432 3723
p, 003
@009
03/10/98
14:10
SECTlON e CERTIFICATION
_hiS certilic:alion \s 10 be signed by a land 8urveyor. engineer, or architect who is aLlthor1zed by slale or local law to certily elevatlol'1
~formation when the elevation informallon lor Zones A1-A30. Ae, AH. A (with BFE).V1-V3D,VE, and V (wllh IaFE) ill required,
Community officials who aro authClrlzid by local law or ordinanca to provide Iloodplatn management information, may also lilgn the
c:eltification. In the caso of Zones AO and A (without a FEMA or community Issued BFE), a building official, a property owner, or an
owner's representatlvQ may also sign the I;:ertlflcatlon.
Reference lavel diagrams 6. 7 and B . Clstlnguishlng Fsaturi5-1' the cltr1ln.r 15 unable to certify to breakaway/non-breakaway wall,
enclosure size, location of sel'ficing a~uJpn'len[, aria U5t!1, wall openings. or unt1nl5lhLld GreiS Feature(s). then IiSl ths FOlllure(s) not
Il'1c:uded In the certification under CommLlnls below. The diagram numblilr. Sic:1icn C, Item 1. mUGt still be entered,
I r;erl/fy thar rhtf informarion Tn Soctions B ami C on this cfirtlfiCits represents .my best flfforls to inrerprflt zlls data al/al/aD/s.
I understand that any fa/s8 statement may bs punishable by flnfl t;lr imprlsonmsnt under T B U. S. Code, Seer/an 7001.
?~ nQ~L.o
L4"'c! S ~...v
~-. (tl.,s . L'-OBb
L.ICENSe NUIolE1EA (or AIIIa Seal)
.,. 0 fa cz.. e f\. .
COMPANY NAME . l[
,",11" "'S., ..
- ZD -,So
O.TE
SIGNATURE
SS3l1
ZIP
000
CopIes should be mads of thla Certlflr::als for: 1) community offIcIal, 2) InSll.lran~ a;enllcompany, and 3) building Clwner.
COMMENTS:
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lIAS EIIIENT
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ZO/olEB
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lO/lllliS
P\.cac
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ON l"1U!B,
PlEA'I!I, OJIII;IOL.UW...
l'l.CI:Il
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'.',-/.' '''~l,(u~'I.~t"",,,,,r.
,..,,,,-\'. ',~~"i""'j' "..;I"l
'f'~;l; :.~ At~;;~:~~-:ilr~,:~f::'\:';J:
";.:.",.l.mt "0:;-, ,Jo......l.,.;;,J.".\,,O. ~
The diagrams above lIIus1ralli the polnls at which thli eieYatiQn6"5ho~ld be 'mea~ured in A Zenes and V Zones.
Elevations for all A:. Zone:i'.s~uld be meBsured at the lop of1he reference 18\'81 floor.
Elevations fer all V.Zones should be mea,sured allhs bat:lom of the lC1wesl horIzontal s\nJctU,r~1 member,
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