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Home My WebLink AboutElevation Certificate 2016U.S. DEPARTMENT OF HOMELAND SECURITY OMB No.1660-0 Federal Emergency Management Agency 008Expiration Date: November 30, 2018 -National Flood'Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. Copy all pages of this Elevation Certificate and all attachments for (1) community official. (2) insurance aaent/comnanv anti r'Al hi i lainn minor SECTION A- PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Policy Numbe'F 'JU MARY 64RPv A2. Building Street Address (including Apt., Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No. Company NAIC Number. B 1 W-Tl. T MI ROAD city State ZIP Code Y t 6 MA ozz '&� A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) 52 s IZ5 MAP �34 RARCEL a L6C 72 L l�f, Y 14 /*It -A A4. Building,Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) K155r -AT-AL A5. Latitude/Longitude: La t h. 'j j Long. r 740, Z031-0 Z_ Horizontal Datum: n NAD 1927 NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosures)sq ft b Number of p permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b 3 (rj sq in d) Engineered flood openings? ❑ Yes VNo A9. For a building with an attached garage: NA a) Square footage of attached garage sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? n Yes ❑ No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name B3. State Y4 gA0(Jr z�01015 M 1ARL-6 CUMTY M4 B4. Map/Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel Effective/ B8. Flood Zone(s) B9. Base Flood Elevation(s) (Zone AO, use Base Z50-_� �- Revised Date food Depth) a4.k /6 j 20i'AL !4 0 1310. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 139: FIS Profile {FIRM ❑ Community Determined n Other/Source: B11. Indicate elevation datum used for BFE in Item B9: 0 NGVD 1929 j/NAVD 1988 Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Yes EfNo Designation Date: CBRS ❑ OPA FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Fxnirnfinn rh#m• Aln%mmknr Qn in i a IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number. City State ZIP Code Company NAiC Number C)Q lfl �ACAW MA d SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* dFlnished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations - Zones Al-A30, AE, AH, A (with BFE), VE, V1 V30, V (with BFE), AR, ARIA, AR/AE, AR/A1 A30, ARIAH, ARIAO: Complete items C2.a-h below according to the building diagram specked in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: c fit{ s j r Vertical Datum: AJ A VD ' 8 p indicate elevation datum urd for the elevations in items a) through h) below. ❑ NGVD 1929 YJ NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) .7 [Meet [] meters b) Top of the next higher floor In- d [feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) IVA . ❑ feet ❑ meters d) Attached garage (top of slab) ❑ feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building -2). 0 ['feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) � . t� [Zfeet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) [Zfieet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including f et ❑ meters structural support 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. / certify that the information on this Cer0cate represents my best efforts to interpret the data available. 1 understand that any false 1. statement maybe punishable by fine or imprisonment under 18 U.S. Code, Sectio7Yes Were latitude and longitude in Section A provided by a licensed land surveyor? ❑ No ❑ Check here if attachments. Certifier's Name License Number �57FFPI�&A( b. 0opt Title Company Name' Address city State ZIP Code Signature Date Telephone GPY Ali Pages of this Efevatlon Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including ludin4" of equipment and cation(, per C2(e),�iff applicable) 'lo• r wco- i hef;ltey— t ` i �bu)KC%F r�4r q�:3� 1� s1!� fS`6� r(A- �dvG�(� k)&S�A 4e_, I D_ �a R are- 4t(So 10 i Kl �Lif"s� --&-r f `��6 t rE� 0� r.( 6&3I- .)i/e Ae- 6�ehGy+ C.i{i FEMA Form 086-0-33 (7115) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Gvnir�finn n-+o. AI..r.,L.... 12A IAA O IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building StireeIt Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number. City State ZIP Code c,Yi t4 _ Y4 P 210CV q AA El ozA61f Company NAIC Number SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) ; FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1—E5. If the Certificate is intended to support a LOMA or LOMR F request, complete Sections A, B,and C. For Items E1—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, ~❑ crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above -or below the. HAG'. b) Top of bottom floor (including basement, s crawfspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 1 2 of Instructions), the next higher floor (elevation C2-b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the comrtounity's floodpiain management ordinance? ❑ Yes ❑ No ❑ 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, B, and E for Zone A (without a FEMA issued or community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 ELEVATION. CERTIFICATE OMB No. 166"008 IMPORTANT: In these spaces, copy the corresponding information from Section A. —t.n Quvn a.+uac. 1YUYGU 1WWJ Ju, Lu-10 Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. FOR INSURANCE COMPANY USE Policy Number. City_ Stale ZIP Code 1� `fir✓ -{I MA Company NAIC Number f SEC;TION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the c:ammuniV4 floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8-G10. In Puerto Rico only, enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (indicate the source and date of the elevation data in the Comments area below.) 'G2. ❑ A community officia! completed Section E for a building located in Zone A (without a FEMA-issued or c bmmunity-issued BFE) or Zone AO. G3_ ❑ The following information (items G4-G10) is provided for community fkwdplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occuparicy Issued G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) ' of the building: ❑ feet ❑ meters Datum G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum G10. Community's design flood elevation: ❑ feet ❑ meters . Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ Check here it attachments. FEMA Form 086-0-33 (7115) Replaces all previous editions. Form Page 4 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS OMB No. 1660-0008 See Instructions for item A6. - FYnirafinn rlata• Nnvamhar an 91 IMPORTANT. in these spaces, copy the corresponding information from Section A- - FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number. 5 P-V ' City State ZIP Code Company NAIC Number 00TH "kM,00i f' off ' M using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to -the instructions for Item A6. Identity all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. rtAl ! L'I Al, a Photo Two Photo Two Caption EA V p E (Af r c j FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION ,CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page OMB No. 1660-0008 Pynira4inn nmfn• k,na nn4r -2n -m4 S IMPORTANT: In these spaces, cagy the corresponding information from Section A.- -FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No. Policy Number. LEIN &AD . . City State ZIP Code Company NAIC Number AAA If submitting more photographs than will fit on the preceding page, affix the additional photographs below. identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8: Photo Two Caption L-E`F�i S 1C7-e- t/tEk.J } Z=Zj}� FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 1