HomeMy WebLinkAboutElevation Certificate
: ; 06/28/~9,
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ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
\TIENTION: Use 0/ thi's cel1l1lcale does net provide a .....alver or the /Ioed Insurance purchase requlremenl. This /grmls used only to
. ,rovlde elevation in(ermallon necessary to ensure compliance whh applicable ccmmunlry 1I0oclplain management ordinances, to
., delermine the proper Insurance premium rata, and/or to support a request lor a Lener 01 Map Amendment or RevisIon (LOMA or LOMR).
, Ihstrucllons /er completIng thIs form can be found on Ihe following pages.
a.M.B. No)067.00n
Expirp!sMiJy.J/, /993
SECTION A PAOPERrr INFORMATION
BUILDING OWN En'S NAME \\ <. \ '
~ p..'-l\~ ~ "",'\\~
STReET !\OC?RESS (Incluaing ApI.. U"II. S,UUI Bndlor Bldg. NUlT\bQr) ORAD. RoutE AND ~UM8ER .. \ .
f \'-lL..S'~ Sh~t,)~ \:JE-A:Co:-l+ \R~\' NJ;: .
OTHE;R DESCRIPTiON iLo7"and ~ NUl1)tlllla. 81t) - \ - - - --
rR~uR Po- \< G ' , \('f\,J
CITY STA.TE
"OR INSURANCE COMPANY USe
POLleT NUMBER ,
I COMF'''NY NAIC NUMBER
t?S~'l2-
. -,' ZIP CODe
SECTION 8 FLOOD INSURANCE RATE; MAP (FIRM) INFORMATION
Provide Ihe lollowing from the proper FI,RM (See Instructions):
I, COMMUNITy ,NU"lBE~
a,'BlIse FLooD eLEv!\TIOrol
rJ (In AQ ;:OI\u. UI. d'PII1I ,J'
o n€ =9,..H....,.J 0
{:::::-, t:? tv\ /'VI A- P
7. Indlca'te Ihe elevation dalum syste~ used on Ihe FIRM lor 8ase Flood Elevations (BFE): ~NGYD '29 0 Other (describe on back)
B, For Zones A or V, where nO 8FE is provided on the FIRM. and the community has eSlabllshed a BFE tor thIs building sIte, IndIcate
lh~ community's 8FE:' . Iq Oi ~ .' ql reet NGVD (or other FIRM datum-see SectIon B, Item 7),
, ,
2. PANEL NUMee:R
:3, SUFFIX
o 0.0 'Z...
c..
'. DATE OF FIRM INoex
NOVo I Cj I Iqq7
~. 1'1".... ZONE
"1..:1 0 \-r~:)z...
'K.'
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevallon Cenltlcal!l Instructions, indicate the diagram number frOm the diagrams lound On ,Pages 5 afld 6 that best
describes the liubJect building's ra/erence lev81 I. ' .
. ~(a). FIR~ ~one5 A 1 ~,A30, AE, AH,' and' A (wllh 8F~1. The top 01 Ihe rerefenca levellloor from the selected diagram is at an elevallon
.., of'" ,I .--' reet NGVD (or other FIRM datum-see Sec~lon 8, lIem 7).
(b). FIRM Zones V, -Y30, VE. and V (with BFE). The bottom of the lo.....~st hori~o"'(al strucfural member 01 the reference level from
the selected diagram, 'Is al an elevatlon ~t I I I I I I.U lael NGVD (or other FIRM datum-see Secllon 8, \lem 7).
(e). FIRM.Zone A (without 8FE). The floor used as the reterence le\lel 'ro~ the sEllectec diagram is I I I.~ leet a?ove 0 or
, below'-! (check one) the highs.sl grade adjacenllo Ihe bUilding., ' tJ,
(d), FlAM Zone' AO. The floor used as the refe~ence level/rom Ih~ selected dIagram I~ I I I,U feet above 0 or below 0 (checl<
one) the hIghest grade adlacent to the building. II no flood depth'number is available, Is (he building's lowest floor (relerence
level) elevat~d In ,ac~ordance .....lth the community's floodplain management prdlna,nce7 0 Yes 0 No 0 Unknown
3. Indicate ,Ihe elevation datum system used In determining the above rele'fence level elevations: ~ NGVD '29 0 Other (describe
under Comments on Page 2). (NOTS: If the efevation datum used In mBasuring rhe efevatlons 15 different than /hat used on
the FIRM, (~Be Sect/an B, 'ftem 7], then conven the 91evallons to 1M datum syslem used on the FtRM and show the conversion
equation under Comments on Pfl98 2.) .
4. Elevation reference mark used appears on FIRM: 0 Yes ~ No (See Instrucllons on Page 4)
5. The reference' level elevalloflls based on: !:5'1 aclUal construction 0 construellon drawings
(NOTE: US8 of construct/on drawinfls Is only valfd if the buffdlng daBS not yer have' the reference It!JVBI floor In pface, in which .
case this certificate 'Nfl( only be valid for /he bulldfng during, the course or cO(lsrruc/fon. A post-cons/ruc/fon Eleva/lon Certff(cars
....((, be required once constructfon is compfe/e.),
6. The eievatlon o/the'lowest grade ImmedIately adjacent to the building Is: I I rlli.JjJ.t3J feet NGVD (or other FlAM datum-see
Section e, lIem. 7). '
SECTION 0 COMMUNITY INFORMATION,
It the ~ommunity cttlcial responsible lor vBrltying building elevallons specl/les that the reference lavellndlcated In Section C, lIem 1
Is liot the '.Iowesl/locr" as defined In the community's 1I00dplal,n management ordlnan~e, the elevation c/lhe bUilding's -lowest
1I00r" as defined, by tt'1e ordinance is: I l I I , I.U leal NGVD (or other FIRM datum-see Section B, lIem 7).
.2. Dale ot \h.~ s.tan"o/ construction ~f substanllal improvement
., HMA FOrttl 81-]1, MAT 90' ., R~PLACES ALL PREVIOUS EDITIONS SEE ReVERSE SIDE rOA CONTINUAilON
, 06/28/~9
15:04
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l4J 003/003
SECTION E CERTIFICATION
_ This certlflcallon Is to bo signed by a land su':"'eyof, engln~er, or archltBct who is authorized by state or local law to cenlly elevation'
., information .....hen the alevalJpn InformatIon for Zones A1-A30, AE, AH, A (with BFE),V1-V30,VE, and V (with BFE) Is required.
.Communlty officials who are 31,1thorized by lecallaw or ordinance to prollld!lllQodplaln management Informallon. may also sign the
certification. In the case: 01 Zones AO and A.(withOUI 3 FEMA Of community issued 8FE), a bullc:llng oHlcial, a property owne.r. or an
owner's representatlvs may also sign the cer1lllcatlcn.
, ,
Rs/erance lavel dlilgrBms e, 7 and 8 . Distinguishing Features-II lhe'cel1lller Is llnabls 10 certify to breakaway/non-breakaway wall,
enclosure slle, location 01 servicing equipment. area use, wall openings, or unnnished area Featufe(s), ther'1l1stthe Feature(s) not
Included In the celilllcatlon under Comments below. The diagram number, Section C, Item 1, must stili be entered,
I csrrify thaI the informer/en In Sectlems. Band Con Ihls certiflcale represents. my bBSC efforts Ie interprer the data available.
I understand rhat' any falsB sra,Ierrrent may be punIshable by fins or imprisonment under 18 U.S. Code, Secrlan 1001.
,R'1~'f\. \~ ,~~ S\'''-'~)o..J':lOl'\ \ n\ p)~ ,..~~.
CERTIFIER'S NAf.\E ' .'. \ LICENSE: NUMBE~ (or Allb S.lIl) ,
LA-Nn ,S"t:)"f\V")~' \J'"\\-e'-i ~\Jt<.'-.leu~~ Co", -PPt.
I.....r:: COMPANY NAME l [) I '
\G,LD10 (RAN\(\'V\ \R~l\ S.f.. r~\OR- LA- 11M",
~ cITY STATE
( /'.. ~/.7 I '\c I t;1,lq~. (l,p\ 7) 4 ~'l --z.S-,(""l
SIGNATURE ,~$# .4-;/ ~., --... ,I '""I CATE -- . PHON!;
TITLE
-c; 1)'372>
ZIP
ADDRESS
COpIB$ s/"lould be' ~ade of this Cenlflcate rcm 1) community official, 2) Insurance agenllcompol'W, and 3) building owner,
COMMENTS:
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0..",,0 \-:'~
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CLbo-.J€..
-.(2:.\-o0(1.... , '; s
B,~.E.
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~ ~'-' r...~10 ~
9' 09 - e
e ~~~i'?e& :~...:S.-'\9
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\ ~ ~A- t." k."c.,\-'- <3 N
'::I~"~e. e..\~~Cl~ON @.. l 'S~
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c 4- j)~clL ')
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D,lSEIlIEiIfT
.~ "5~~ ~...ol"f-f?~~~f) +,\-e,,':"~.J
~~"S"E.D' G. RP-ce... 0-20
0tC PIL..iS,
PlEAS, OR COI.UMHS
IAl'!AEi'c:Eh m-
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tlEV....TION
fl~ 1
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V
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-f/. ~ ,,~~
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11m!), I \\;t~\:~1::{i!;~i'~"j~i~,:;~ l/ ?~:,.',,:::~:(\::~~t!'I~;f.
~7.'i\~.I..: l..J;:';:~:.~"'~~"'::.:~/I.~"~~:f::/~; J '~'~/! IoGJ..ClI!P't.;,
.~:-J.'~j. R1\":r.,;'~~:8!/t::::~;;.~.~,:tI:.1 1rt.';'~I': OfUDE !:
A
ZONES
v
ZONES
A
It ZONES ,
0~~
A
'ZO~E9
11\!>l:IlVCl! I .........,.,.,.
lEin ~ o.....O!
-.
fI.~
!\..,j"'ATlOfII
The dlfigrams above Illustrate the points at .,.,hlch the elevations ShOLlld.be measured In A Zones and V Zonas.
'" . ,
Elevations ror all A Zones shculd'be m9aSurad atlhe top or the reference 19velltoor.
Elavallol1s ~r all V Z0l18S should be measur9d' atlhe bonom of lhe lowest horizontal structural member.
e
Pagll 2