HomeMy WebLinkAboutElevation Certificate
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N CERTIFICATE
ICV MANAGEMENT AGENCY
) INSURANCE PROGRAM
the nood Insurance purchase requirement This form is used only to
11th applicable community floodplain management ordinances, to
. .'1 request for a latter of Map Amendment or Revision (LOMA or LOMA)
Instructions for completing this form ean be faund an the following pages. .
SECTION A PROPERTY INFORMATlON I FOR INSURANcE COMPANY use
VRLLEY SURVEYING CO.
447 2571
OV~
P.01
.;rUL-22-1998
13:52
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CoJDepl'B .( I '
UIIlJIVj Il\,Jjf
Phone if 44 7 --rdJ'tJ 30
i;J 4!f7 - 41z: q~
O.M.B. No 3067-0077
Elfpirr!s M;Jy] 7. 7993
POLICY NUMBER
BUILDING OWNeR'S NAME
\\/ E. N 0 V \r.lH I T ~ E. "Y
S~HEET ADDRESS (Including Apt., Unit. Suite and/or 8ldg. Number) OR P.O. ROUTE ANO BOX NUMBER
.1.L~ - WATF.J!. ~ E;. C ~ ~ "-12 A \ l
OTHeR DESCRIPTION (u.t and Block Numbers. etc.)
~..,. a~! G!>UO,1\JS ~NDR:., ~t!LJ-r( ~,urY, M N,
CITY. ' STATE
~!.~ MN
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following Irom the proper FIRM (See InstTtJctions):
COMPANY NAIC NUMBER
ZIP CODE
'(~,"1
\ . COMMUNITY NUMBER
2.. PANEL NUMBcl'\
3. SUFFIX
.. OATE OF RRM INCex
S. FIRM ZONE
'ldltlJ t:'1 i!M
6. BASE Fl.ooc E\..SVATloN
~n "0 Zanes. use deplhl
2. 71:) 4.JZ OaJZ..C 000 zc. J No t/ 'f... {'1f7 A E 'fO~. 9 ~ II-Y
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevallons (BFE): ONGVD '29 o ather (describe on back)
8. For Zones A or V, where nO BFE is provided on the FIRM. and the community has established a BFE for this building site, indicate
the community's BFE: I I I I I I.U feet NGVD (or other FIRM datum-see Section 8. Item 7)
SECTION C BUILDING ELEVATION INFORMATION
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" Using the Elevation Certificate Instructions, indicate the diagram number fram the diagrams found on Pages 5 and 6 that best
describes the subject buiJdln!;j's reference level --L- .
2(a). FIRM Zones A1-A30, AE, AH, and A (with 8FE). The top of the reference levellloor from the selected diagram is at an elevation
of I I I I I I. U feet NGVO (or other FIRM datum-see Secllon B, Item 7),
(b). FIRM Zones V1.V30, VE, and v (with BFE). The bottom of the lowest horizontal structural member of the reference level from
the selected diagram, Is al an elevation of I I I I 1 1.U teet NGVD (cr other FIRM datum-see Section B, Item 7).
(c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is W.U leet above 0 or
below 0 (check one) the highest grade adjacent to the building.
(d). FIRM Zone AO. The floor used as the reference level from the selected diagram Is I I I. U feel above 0 or below 0 (check
one) Ihe highest grade adjacent to the building. If no flood depth number is available, 15 the building's lowest lIoor (reference
level) elevated In accordance with the community's floodplain management ordinance? 0 Yes 0 No 0 Unknown
3. Indicate the eievatlon datum system used In determining the above reference level elevations: ~ NGVD '29 0 Other (describe
under Comments on Page 2). {NOTE: If ehe e/allselon datum used in measuring the elevations is different than that used on
the FIRM (see Section B, Irem 7], rhen convert the elevations 10 the datr.Jm system used on the FIRM and show Ihe conversion
equalion urtder Comments on Pa.ge 2.) .
4. Elevation reference mark used appears on FIRM: 0 Yes ~ No (See Instructions on Page 4)
5. The relerence level elevation Is based on: ~ actual construction 0 construction drawings :
(NOTE: Use of construction draw;rtgs Is only valid (f the building does not yel have the reference /evel floor in place, in which
case this certificate will only be valid for the building du~;ng the course of construction. A pose-construction clevation Certificare
will be required once construction Is completB.)
6. The elevation of the lowest grade Immediately adjacantto Ihe building Is: I 1<1l1.lQJ . ~ leet NGVD (Qr olher FIRM datum-see
Section e, Item 7).
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1. II the almmunlty official responsible lor verifyIng building elevations specifies that the reference lavellndicated In Section C, Item'
is not the "lowest floor" as delined in the community's floodplain management ordinance, Ihe elevation of the building's "lowest
floor" as dE3t1ned by the'ordinance is: I I l'fIOltJ.ffl fa at NGVD (or other FIRM datum-see Sectlon 8, Item 7).
2. Date of the stan of construction or substantIal improvement ~ l'f I c; GI .~ . .
SECTION 0 COMMUNITY INFORMATION
SEE REVERse SIDE f=OR CONTINUATION
FEMA Form 81-31, MAY 90
REPLACES ALL PREVIOUS EDITIONS
JUL-22-1998 13:54
VRLLEY SURVEYING CO.
612 447 2571
P.01
SECTION E CERTIFICATION
'.
This certification Is to be signed by a land surveyor, engineer, or architect who is authorized by state or loes/law to certify elevation
information when the elevation Information for Zones A1-A30, AE, AH, A (with 8FE),V1-V30,VE, and V (with BFE) is required.
Community officials who are authorized by local law or ordinance to provide floodplain management Information, may also sIgn the
certification. In the case of Zones AD and A (without a FEMA or community issued BFE), a building otficial~ a property owner, or an
owner's representative may also sign the certification.
Reference level diagrams 6, 7 and B . Distinguishing Features-If the certifier is unable to certify to breakaway/non-breakaway wall,
enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then listlhe Feature(s) not
included in. the c~rtification under Comments below. 'The diagram number, Section C, Item 1, must still be entered.
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I certify that the information In Sections Band C on this certificate represents my tJest effons to Interpret the data available.
I understand that any false statement may be punishable by fine or impr(sonmenr under 18 U.S. Code, Seer/on 1001.
ce~FleA'S NAME LICENSE NUMBeR (or AIlI" Seal)
/'cOlf./J4,ld .4. C:;WI4.u$~,J mAl. .# /I!J/~
TITLe COMPANY NAME
_L4~ S U l3ul!E. y"e.... Ye... II c. '< S Cle.Ue:"'" I vV"'i eo. I R A-,
ADDRESS CITY' STATE ZlP
/66 70 ~,e,q,u~ r~"1 PI2./..." WIG/!!- MAY. 5>37Z
Sl~~~ ~^'.. 7_Cl~_q~ 6/Z.o~lf~J-Z57D
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Copies should be made 01 this Certificate for: 1) community afflclal, 2) insurance agentJcompany. and 3) buildIng owner.
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COMMENTS: rtuE Au,ld/~~ /c, A- /'JtJI! 1-~t"D ~~~ ",/oot.</ U'~
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,I..- -n.:-p ~ T'''- f'':'.s:t.! GQ~f" ~L. e,y/'// h.e qT tllEt.-. 9/1,,30
~.e p/U,P,-.-fz.:, /~ ~r ~~e4' S~~~.c /)~,o"-r---"'=7 I hK r I~ ~.I~e/
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ON
SLAB
WITH
lIA"MEp(T
ON PI~ES.
PIERS, OR <<=OLUIolINS
A v
ZONES ZONES
1'1.00lI
!.LEVATlOH
A v
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ZONES ~ONES
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Gl\ll0E . '. LE'ta. \
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The. diagrams abOve illustrate the points al whIch the elevations should be measured in A Zones and V Zones.
Elevations for all A Zones should be measured atlhe top of the reference level floor.
Elevations for all V Zones should be measured at the bottom of the lowest horIzontal structural member.
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