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Home My WebLink About34-2112-003-0960ev e-f 30 -,1 -r?6 O.M.B. NO. 3067-0077 ELEVATION CERTIFICATE /-A Expires May 31, 1996 FEDERAL EMERGENCY MANAGEMENT AGENCY ~p~ NATIONAL FLOOD INSURANCE PROGRAM ~g ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. his form is used only to provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR). Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE BUILDING OWN PS NAME / POLICY NUMBER T ` M nom/ are :~~W .4 STREET ADDRESS-( cluding Apt., Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER w ej=;u - 17V45 OTHER DESCRIPTION (Lot and Block Numbers, etc.) CITY STATE ZIP CODE SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION ;.~~':.•t= t ii' Provide the following from the proper FIRM (See Instructions): 1. COMMUNITY NUMBER 2. PANEL NUMBER 3. SUFFIX 4. DATE OF FIRM INDEX 5. FIRM ZONE 6. BiSE'~' C~ D.EL a'7 Ot`w P 4,, A,0 gees, use deli) g 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): NGVD '29 ❑ Othex (d scrjbe on b 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; Rndicde the community's BFE: feet NGVD (or other FIRM datum-see Section B, Item 7) ~{Jg=a~ SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, indicate he diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level 21 FIRM Zones Al-A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation of . ❑ feet. NGVD (or other FIRM datum-see Section B, Item 7). I (b). FIRM Zones V1 430, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from the selected diagram, is at an elevation of feet NGVD (or other FIRM datum-see Section B, Item 7). i (c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is I. ❑ feet above ❑ or I below ❑ (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 ~ 1. ❑ feet above ❑ or below ❑ (check one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown i 3. Indicate the elevation datum system used in determining the above reference level elevations:7i(NGVD '29 ❑ Other (describe under Comments on Page 2). (NOTE. If the elevation datum used in measuring the elevations is different than,'that used on the FIRM [see Section B, Item 71, then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) j 4. Elevation reference mark used appears on I M: Yes El No (See Instructions on Page 4) 5. The reference level elevation is based on: actual construction ❑ construction drawings l (NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which case this certificate will only be valid for the building during the course of construction. A post-construction Elevation Certificate will be required once construction is complete.) !!I11 of the lowest ' grade immediately adjacent to the building is: feet NGVD (or other FIRMI1 datum-see 6. The elevation o 11 Section B, Item 7). T! SECTION D COMMUNITY INFORMATION 1. If the community official responsible for verifying building elevations specifies that the reference level indicated In Section C It elm 1 is not the lowest floor as defined in the community's floodplain management ordinance, the elevation of the buildings lowest floor' 'as defined by the ordinance is: J. ❑ feet NGVD (or other FIRM datum-see Section B, Item 7). 2. Date of the start of construction or substantial improvement FEMA Form 81-31, MAY 93 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE' FOR CON11NUAl ION SECTION E CERTIFICATION This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation information when the elevation information for Zones Al-A30, AE, AH, A (with BFE),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 AO and A (without a FEMA or community issued BFE), a building official, a property owner, or an owner's representative may also sign the certification. Reference level diagrams 6, 7 and 8 - 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 list the Feature(s) not included in the certification under Comments below. The diagram number, Section C, Item 1, must still be entered. l certify that the information in Sections B 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. TITLE :iNATLL4 COII)(IU~ E NUMBER (or Affix Seal) l ) / Certificate for: 1) community official, 2) insurance agent/company, and 3) building owner. t, ON WITH ON PILES, SLAB BASEMENT PIERS, OR COLUMNS A V A A V ZONES ZONES ZONES ZONES ZONES REFERENCE REFERENCE BASE LEVEL I REFERENCE LEVEL FLOOD LEVEL ELEVATION ::=1 BASE BASE REFERENCE FLOOD ADJACENT FLOOD GRADE LEVEL ELEVATION REFERENCE ADJACENT ELEVATION LEVEL GRADE : ADJACENT::. . . . GRADE The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones. Elevations for all A Zones should be measured at the top of the reference level floor. Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member. Page 2 MI' 41, .ii m. m pl i e~. .I