HomeMy WebLinkAboutElevation Certificate
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)>,/.. '... . .... '.FEo"ERAL EM"ERCiENCYMANAGEMENT AGENCY . O.M.B. No..3067-00n'.
/Ji".... .' ~A~lqNf-L ~LOOD INSU~ANCE PROGRAM r,EXPires July 31, 2002 . .
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'. .~ING01NNER'~~~: ;SEF' ~SE~O; ~. PROPERTY OWNER INFORMATION _ -EO< 1""",oe:O,m",, ~''''''''.''"I
BUILDING STREET ADDRESS (Including Apt.. U~it, Suite, and~dg. No.) OR P.O. ROUTE AND ~OX NO. .
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CITY ~ ;'. '::" ....., . ..... '..: .... '.. . .... ,... '. STATE
PROPER+1~~~~lPTION~~~OCk Number~, T~X Parcal N~mbar.Legal D~scriptlon, e~..l .
. .', L'"\\;.~...' \e; ",ql., LO\-r~\~"::t:'5.\~~ '~c~.J-r".,,_\.,; h'\'\ ",~.,l:__
BUILDING U~E (~,~.~eS)d~nt ~on.re~ideritlal.. Addllion. Acces.~ory' etc... \.;s~ Comments sect(onif necessay')
ZIP CODE
SS"?:l'12.
LA TITUDE/LONGITU[)E (OPTIONAL) . .
( ##0. ##'. -it#.##" Or ##.#####0)'
.. 't..,'
. HORIZONTAL DATUM:
. LI NAD 19271__I,NAD.1983
,;" .
SOURCE: I_I GPS (Type):
. LI USGS Quad Map I_I Other:
.. SECTION 8 - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
I al~FIPCOMMUNITYNAME&COMMUNITYNUM8ER' I B2.C.OUNTY.. NAME~ ^ _.\\ "1 B3. STATE rf\. ....\
. ~"R ~ on... Lr:\ ~ 2. 0'-\ ~ 2- . .::.J~ i"i\' \ . \.~
64. MAP AND PANEL . 85. SUFFIXB6. FIRM INDEX 87. FIRM PANEL B8. FLOOD 89. 8ASE FLOOD ELEVATION(S)
. . . .....NUMBER ': .:' G': .,' '. ": ~ATE '.EfFECTIVE/REVISED DATE . ZONE(S) (Zone AO. use depth of flooding)
. 0003. .... . ".' '. . . No~. \9, \C\c\I )( . c'\oC; ,'3
810./ndlcate the. sour.ce.of.the Base Flood Elev~.. '. .(8F~) .data or~ase flood depth entered i~ 89. .
.' ,1_1 FIS Profile <.,I_IFIRM . .... 'IJ6"CommunltyDe~mlned ': "_I.Other (Describe):.
. 81 (IndiCat~the elevatl~ndatuin used for the BFE in B9: I..k(NGVD 1929. I_I NAVD1988 I_I Other (Describe): /"
. 812.,ls the building located in a,Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OP A)? I_I Yes lJ::(No
Designation Date:
.,;. SECTION C. BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) .;"
. CAJifding elevations are based on: LIConstructlon Drawings.' 1_IBuilding Under ConstructIon. I~inished Construction
~ new Elevation Certificate will be required when construction of the building is complete.
C2. 8uilding 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.)
C3. Elevations-Zones A1-A30, AE,AH. A (with BFE), VE, V1-V30, V (with BFE),AR, ARIA. AR/AE, AR/A1-A30. AR/AH. AR/AO
Complete Items C3a-i below according to. the bulldi.ng diagram specified in Item C2. State the datum used. If the datum is different from
the datum used forthe BFE in Section B,convertthe datum to that used for the BFE. Show field measurements and datum conversion
calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion.
. Datum 'Conversion/Comments .
Elevation reference mark used Does the elevation reference mark used appear on the FIRI'vl? I_I Yes I_I No
. 9. a) Top of bottom noor (including basement or enclosure) '-\ ~ P, . ~ ft.(m) ~
. Cl b) Top of next higher floor qU. 0 ft.(m) ~
., <J
. Q c) Bottom oflowe. st horizontal structural member (V zones only) . _ ft.(m) :l r;
00
o d) Attached garage (top of slab) . _ ft.(m) ~ "g
Cl e) Lowest elevation of machinery and/or equipment ~_ :.
<lI ~
. servicing the building . . .... . _ ft.(m) ~ ~
CJ f) Lowest adjacent grade (LA.G). ' CJ \ "1. .::L. ft,(m) i.~
.,(/)
a g) Highest adjacent grade (HAG) . "1 2.l... . . Q ft.(m) g
o h) No; of permanent openings (flood vents) within 1 ft. above adjacent grade :!5
o i) Total area of all permanent openings (flood vents) in C3h sq. in. (sq, em)
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 information in Sections A, 8, and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001,
CE;;:TIFIER'S NAME '-0 \ r) f\' c:::::..~ , LICENSE NUMBER, . (', .
. 1'\ {) N (.I, rv.. 1'"'\ ....:;:) \.).:. t:>o.\N '.')I~\-l \ 0 \ c- 7..,
r. . ~l'-.H~ S,~..'\l~'C COMPANYNAME\l(,Ue' ~'-~R..\1"'\v,( c...:>.. r.~.
~ESS ~\1.Di' ~t-'1 K. \\..1\. -i'. r...,:, \ <SE' CITY f1'<.\ct>- \...".k IsTATE \11\,.\ 'I ;~CDE S'~~7,.2-
. SIGNATURE. .. . .. ~{/ /7l .... ". . ..' DATE '1_C7 _ -'"" / TELEPHONE a '" \111_'" ""1 n
. ~ d/' L..-"'\. . '.___' ."'7-~.-:: _ _ .{, l ....... '-- ~\ S L -"\'-1. C-J c..
F=MA Form 81-31, AUG99.' SEE REVERSE SIDE FOR CONTINUATION REPLA.CESALL PREVIOUS EDITIONS
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.,;~f;'ORTANT: In these spaces, copy the corres on ding Information from Section A.
: "'BUILDING STREET ADDRESS (Including Apt., Unit, Sui and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
,,'". ..' ~,.--:s:,...,0 ~ 3~eo. \d,;~ -)"S\e...., Gla.c:...\~
, CITY ,n' _ " ',Yc' L~'..', " STA'fE ZIP CODE
. t'R U'l <2.. \.:...~l-€'_ ' ffiN' tS'o-::'.
..:_ .:,.,SECTION D. SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy bothslde,s of this ElevatlonCertificat,e for (1) coniinunityofficial, (2) insurance agenVcompany, and (3) building owner.
COM~~:s.~:'tc:~t~:~;~S~~~~N~~~~~) (.AA..o. rU. L..",,_Q
~,F,;9f[1f1~yt~:ri~~~~.4roR.~nY;;~~6;~~if~S~;'i " '
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I_I Check here if attachments
SECTION E. BUILDING ELEVATION INFORrw;'lATJON (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONEA (WITHOUT BFE)
. For Zone AO and Zone A (without BFE), complete Items E1 through E4. 'If the Elevation Certiflcate Is intended for use as supporting'
" information for a LOMA or LOMR-r=, Section C must be completed. , ' ' '
, E 1. Building Diagram Number . (Select the building diagram most similarto the building for which this certificate Is being completed -
'. see pages 6 a~d 7. ,If no diagram accurately represents ihe building, provide a sketch or photograph.)
" E2.,The top of the bottom floor (including basem.entor enclosure) oUhe building is 1_1_1 ft.(m) 1_1_lin.(cm) 1_I..above 0;-1_1 below
(check one) the.hlghest adjacent grade; , .' . .
: E3.: For BulldingDlagrams6~8with' openings (see page 7), th,e next higher floor or elevated floor (elevation b) of the building is
,.;: I_LI ft.(m) L:.-'..:;..lln.(cm) above the highest adjacentgrade. ' .' ,
:~ E4.:'Fo~ZOnE!'AOOn.IY:.. If no fl.ood depth number is, available, is the top of th,e 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, 8, and E for Zone A (without a FEMA-issued or
community-issued BFE) or Zone AO must sign here.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME,
\. '-.' '.' .'
, ,
....,. ..
"
, CITY
STATE
ZIP CODE
,DATE,
TELEPHONE
COMMENTS. '
"_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
SectLOns A, B, C (or E), andG of this Elevation Certificate. Complete the applicable item(s) and sign below.
G 1. I_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
. ZoneAO. , ' .
G3. 1_lThefollowing information (Items G4-G9) is provided for community floodplain management purposes.
I G4. PERMIT NUMBER, I G5. DATE PERMITISSUED ~~U~~TE CERTIFICATE OF COMPLlANCE/OCCUPANCY
G7. This permit has been issued for: I_I New Construction I_I Substantial Improvement
Ga. 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
.' ..-MENTS '
FEMAForm 81-31, AUG 99
1___' Check here if attachments
REPLACES ALL PREVIOUS EDITiONS.