HomeMy WebLinkAboutElevation Certificate 2003Jun 20 03 12:10p McShane Construction 508 428 8508 p-4
FEOERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Elrptras July 31. 2002
ELEVATION CERTIFICATE
SECTION A- PROPERTY OWNER INFORMATION - ) For lnsurince Company Use: (
Swte, andlor Bldg. No.) OR P.O.
ail - RNJW Or ee A7*" I (—I NAO 1927 L-I NAD 1961 LI USGS OA d MW LI hints.
MAP (FIRM] INFORMATION
AAAP AND PANN
65. SUFFIX
66, FIRM INDEX B7. FIRM P
Ba. FLOOD
E FLOOD ATION( 1
NUMBER
DATE EFFECTIVFIREVISEO DATE
ZONES)
(Iona AO, use depth d Reading)
2 ivulr, )�
A
Asjg2 x1Z142
A4
n
I.n�
Ilia Indicate the So.fce at the base Flood Elevation (BFE) data or base flood depth entered in 89.
1_I FIS Profile JKI FIRM 1-1 Community Determined Other (Describe):
B 11. Indicate the etc ration datum used for the BFE in 09: IXl NGVD 1929 1_I NAVO 190E LI Other (Describe):
012. Is the building brcated in a Coastal earrier Resources System (CBRS) area or Otherwise Protected Area (OPA)7 IJ Yes X No
Designation Dale:
SECTION C -
Cl. Building eievatb is are based ore 1_1Constnretlon Drawings' 1_ ,Building Under Construction' IXIFirushed Construction
'A new Elevation Certificate will be required when construction of the building is complete.
C2. mudding Oiagran, Number —2� (Select pie 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 buRding, provide a sketch or photograph.)
C3. Elevations— Zaree All AE, AM, A (with 5FE), VE, V7-V30, V (wilh BFE), AR. ARIA. ARIAS, ARIALA30. AR/AH, AR/AO
Complete Items C3.e4 below according to the Wilding diagram specified In Item C2. State the datum used. If the datum is different from
the datum used or the BFE in Section 0, 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 0 or Section G, as appropriate, to document the datum conversion.
Datum 116111,Q__ Conversion/Commenm
Elevation reterence mark used fe M - Q-14 Pk Does the elevation reference mark used *Wotan the FIRM? I Yes I No
W a) Top of bouem poor (including basemertl or enclosure) in , n, IL(m) a
Y b) Top of nee t higher hoar _��y D.. furs) "' a
Cl c) Bosom of I nest horizontal structural member (V zones only) _ IL
O d) Attached ; erage (top of slab) _ fi W 3
n e) Lowest elevation of machinery andlar equipment SIN
servicing Ina building (Describe in a Commence area.) _ IL(m) it
It f) Lowest adjacent (finished) grade (LAG) _$ Q mm) i
g) Highest aclacent (finished) grade (HAG) 19 . IL(m)
O h) No. of pennanent openings (hood vents) within 1 fl, above adjacent grade
0 i) Total area of all permanent openings (flood vents) in C3.h sq. in. (sq. cm)
This redifiCoWn is oo be signed and Sealed by a lard surveys, engineer, or architect autfior¢ed by law to certify elevation intormadon.
I candy that the inhumation in SeU,ons A, B, and Con this certificate represents my best efforts to uitaiWet the data available.
Jun 20 03 12:10p McShane Construction 508 428 8508 P•3
Copy both sides of It is Elevation Certificate for (1) community official. (2) Insurance agere2omo2try, and (3) building owner.
OtRAEN 5
if attachments
SECTION E - St. ILOING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BEE)
For Zone AO and Zor e A (without BFE)• complete Items Et, through & If the Elevation Certificate Is intended for use as supporting
information for a LON A or LOMR•F, Section C must be completed.
Et. Building Diagram Number _ (Select the building diagram most slmllar to the building for which this cerdfipale is being completed -
see pages 6 and f If no diagram accurately represents the building, provide a sketch or photograph.)
E2. The top of the bol torn floor (Including basement or CM103Ure) of the building IS 1_Ll R(m)' I—I—Gn.(cm) I —I above or 1_1 below
(check one) the h ghest adjacent grade. (Use natural grade, if available.)
E3. For Building Olap am ; 6-0 with openings (see page 7). the next higher floor or elevated poor (elevation b) of the building is
L_LI fli L_I._(in(cm) above the highest adjacent grade. Complete Items C3A and C3.i on front of form.
E4. For Zone AO onl; If no flood depth number is available. is the top of the bottom Moor elevated in accordance with the community's
SECTION F - PROPERTY OWNER
The property owner - N owner s authorized representative who completes Sections A, B, C (items C3.h and C9.i only), and E for Zone A
(without a FEMA•ise fed or rommunity-issued BFE) or Zone AO must dgn here. The statements In Saettons A, B. C, and Ewe correctin
the best �of my Imowl sd e.
�RRbP'Ef1Nb➢P'7ER'r .`� ;`41TCibR1�EPSlES NTA V SHAM
AD 5TATF. ZIP COO
G T TE TELEPHONE
COMM�TG__
The local Official who is auttnonzed by law or ordinance to administer the community's fioodplain management dtdiname can Complete
Sections A, 8. C (or E:I, and C of this Elevation Cenifeale. Complete the applicable ilem(5) and sign below.
G 1. 1-1 The informal, in in Section C was taken From other documentation that has been signed and embossed * a licensed surveyor,
engineer, or wchitecl who is authorized by state or local law to certify elevation information. (Indicate the source and dale of the
elevation dais in the Comments was below.)
G2. 1_1 A community official completed Section E for a building located In Zone A (without a FEMA-issued or community.issued BFE) or
Zane AO.
G3.1_1 The following information (Items G449) is provided for community noodplain management purposes.
G7 T11Ls permit has t ten issued tor: 1_1 New Construction 1_1 Substantial Improvement
G8. Elevation of as-b-.ill lowest floor (including basement) of the building is: _ _ h.(m)Datum;
G9. BFE or (in Zone F 0) depth of flooding a1 the building site is: _ -_ _ fl.(m) Datum: _,_-
LOCAL OFFI ACS NaME TIM
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS '
1 Check here if attachments
FEMA Form 81-31, JI IL 00