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HomeMy WebLinkAbout34-2116-014-0430FOPROCESS LIO # FED EMERGENCY AGENCY FLOOD INSURANCE PROGRAM C.O.R. = ELEVATION CERTIFICATE Important: Read the Instructions on pages 1 - 7 SECTION A - PROPERTY OWNER INFORMATION OWNER'S NAME ' STREET ADDRESS (Including Apt., CITY 0 PA O.M.B. No. 3067-0077 Expires July 31, 2002 For•Jnsurance Company J e:; Policy Number, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 4 STATE ` ZIP CODE 330 5-14 and Block Numbers, Tax Parcel Number, Legal Description eta) BUILDING USE (e Residents residentla! ddition, Acres 1 --__-,G~ d ` - sory,.etc Use Comments section if necessary.) 2Si dri r~ ,-(~tl~-re Glovsc- LATiTUDEA-ONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): ( - - or © NAD 1827 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION BIN COMMUNITY NAME & COMMU TY NUM R 92. COUNTY NAME B3. STATE 134. MAP AND PANEL B5. SUFFIX ZB6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER DA E 5 EF A Or ,4 ISED DATE ZONE(S) (Zone AO, use depth of flooding) (9 sa G Jr N 810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. ❑ FIS Profile ❑ FIRM ❑ Community, 2?rmined ❑ Other (Describe): B11 1. Indicate the elevation datum used for the BFE in B9: Uf NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe): 1312. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ❑ No Designation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRE C1. Building elevations are based on: ❑ Construction Drawings" ❑ Building Under Construction* [ff Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Building 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 Al-A30, AE, AH, A (with BFE), VE, V1430, V (with BFE), AR, ARIA, AR/AE, ARIAl A30, ARIAH, AR/AO Complete Items C3a-i below according to the building diagram specified in item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the 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 FIRM? ❑ Yes ❑ No ❑ a)To fb p o ottom floor {including basement or enclosure) ❑ b) Top of next higher floor ~.5 ft {m} xj~(m) I CIS ❑ c) Bottom of lowest horizontal structural member (V zones only) ~v~ A ft-(m) ❑ d) Attached garage (top of slab) ❑ L -VIA fL(m) e) owest elevation of machinery and/or equipment servicing the building ❑ f L w ft-(m) B ) o est adjacent grade (LAG) 5 'L! fL(m) L( z ❑ g) Highest adjacent grade (HAG) :.z` ❑ h) Na. of permanent openings {flood vents) within 1 ft. above jacent grade ❑ 1) Total area of an permanent openings (flood vents) in C3 so. in. (sq. cm) fp, , SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certificadon is to be signed and seated by a land surveyor, engineer, or architect authorized by law to certify elevation information, I certify that a information in Sections A, B, and Con this certificate represents my best efforts to interpret the data available. /understand at an false statement ma be Punishable b fine or im risonment under 98 U. S. Code, Section 9009. CERTIFIER'S ME }AGO dGtO/USO LICENSE NUMBER Tl7LE~ %~~aC~ ~uY? off' COMPANY NAME G,eOv P -Nc. -7''pP <576W ADDRESS S? CITY i~ STATE r. ZIP CODE 3 3 SIGNATURE r DATE l TELEPHONE 3 /ate/,;~cof 305 - 3~Z -~/SS FFRAA Fnrm nii-Q4 m ir* nn aCC DM Knorr, of nr rnn nI1A e-rt►nt R rin►i nrnt AP.rn AI I nnrt a~„n rr ,r,..•sr