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U.S.DEPARTMENT OF HOMELANO SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Federal Emergency Management Agency Expires March 31, 2012
National Flood Insurance Program Important: Read the instructions on pages 1-9.
� SECTION A-PROPERTY IN�ORMATION ���t I�sir�'i��M1��r���i� U����,
A1. Buiiding Owner's Name ,I� Iib NuH'fb�W ''� � ,+a
�( � ��L--�� � Z��� �j ,i��l+ �� �t.�i��� l�wa`���SsFt�i r� k E��'3�a,i F
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bidg.No.)or P.O.Route and Box No. OC7th(f�liy NAI�NUIfiB�P �� �4 �
S D - l7 1 E. � „� �
� ��� r�Z k t Sl��i tl�d'� 1 :
�1� ( 1 ..r.�r.7i I 1 :�t:. r'�..,.FPI ..! 1 ,,
City CL����A��n ������ State (-�� ZIPCode ���,��
��. r_.
A3. Prope�rt,y Description(Lot and Block Numbers,Tax Parcel N mber,Le al Description,etc.)
�l !-�4 , '3�G�L Z, UNIT /�t o� 13� ��DE Su DIViSIo�S No, �-
A4. Building Use(e.g.,Residentiai,Non-Residential,Additlon,Accessory,etc,) ������N�l�r,-
A5. Latitude/Longitude:Lat. 27° �B� �1O), �`� Long. Z.° � " Horizonlal batum: []NAD 1927 NAD 1983
A6. Attach at least 2 photograph�A'buliding�lf the'Cerliflcale is being used to obtaln flood fnsurance. , ,
A7. Building Diagram Number�_ .
A8. For a building with a crawispace or enclosure(s): A9. For a bullding with an attached garage:
a) Squere footage of crawlspace or enclosure(s) ��� sq k a) Square footage of aflached gerage 574 sq ft
b) No.of permanent flood openings in the crawlspace or b) No.of permanent flood openings in the attache arage
enclosure(s)within 1.0 foot above adJacent grecJe within 1.0 foot above adJacent grade
c) Totai net area of flood openings in AB.b sq in c) Tofal net area of flood openings in A9.b � sq in
d) Engineered tlood openings? �Yes �No d) Engiiieered flood openings? [�]Yes [� No
SECTION B-FLOQD INSURANC�RA1'E MAP(FIRM)INFO�tMA710N
B1.NFiP Community Name&Communily Number B2.County Name B3.State
GLE,/�.RW/�T�lz / 125og1P I'r,.fC��/�,S �- �
B4.Map/Panel Number B5.SuNx 86.FIRM Index B7.FIRM Panel 88.Flood B9.Base Flood Elevation(s)(Zone
�2 I C� G O � O�„ (s Dete ENective/Revised Date Zone(s) AO,use base flood depih)
3 8_ 18_09 �-o�_,�� ,�E �1.
610. Indicate the source of the Base Flood Elevation(BF�)data or base flood depth entered in Item B9.
❑FIS Profile �RM Community Determined �Other(Describe)
B11. Indicate elevalion datum used for BFE in Item B9: ❑ NGVD 1929 [�]NAVD 19f18 ❑Other(Describe)
812. Is the building located in a Coastal Barrier Resouroes 5yslem(CBRS)area or Othervvise Protected Area(OPA)? � Yes No
Desiqnalion bate_ �CBRS [�OPA
I. SECTION C -BUILDING EI.EVATiON INFORMATIOIV(SURVEY F2EQUIRED)
; C1, Building elevations are based on: ❑Cqnstructfon Drawings" ❑ Building Under Gonsiructfon" Finished Consttuction
''A new Elevatlon Certificate wiil be required when constructfon of the bullding is complele.
; C2. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,Vi-V30,V(with BF�),AR,ARlA,ARIAE,AF2/A1-A30,ARIAH,AR/A0. Complete It m�2.� --`.-./
below according to the building dia ram specitied(n Item A7. Use 1he s�me datum as the 6FE. -7 [,...
Benchmark Utilized ��T Q CLI=>41ZW/'t7�(Z 'n2- Vertical Datum �•65/ ��v���$ � �
ConversionlComments C) UL�I-1.�h�(-G� �TUM. ` 4--
Check the measurement used. � � �c�
a) Top of bottom floor(includfng basement,crawlspace,or enclosure floor)�,� �' feet �meters(Puerto Rico only) ,)� �,, ��--�z
b) Top of ihe next higher floor //� U feet meters(Puerto Rico only) �r! �v ;_�
c) f3oltom of the lowest horizontal structural member(V Zones only) N/ ��feet ❑meters(Puerto Rico oniy) �i� �.,�
d) Attached garage(top of slab) -�.-(�- feet ❑meters(Puerto Rico onlY) .r-'a � '�
-?RI !°+�S
e) Lowest elevation of machinery or equipment servidng the building ���F,,�[�et [�meters(Puerto F21co only) �� �.�
(4escribe type of equipment and location in Comments) `�
t� Lowest adJacent(finished)grade next to buildhig(LAG) �. �v �eet �meters(Puerto Rico only) m �
g) Highest adjacent(flnished)grade next to building(HAG) ��.Q�et �meters(Puerto Rico oniy) � �r�
h) Lowest adjacent grade at lowest elevalion of deck or stairs,includiny �.�[�feet meters(Puerto RICO only)
structurel su orl
SEC710N D-SURVEYOR, ENG�NEER, OR ARCHITECT CERTIFICATION � ��
This certification is to be signed and sealed by a land surveyor,engineer,'or architecl aulhorized by law to certify elevation ��`'
information. I certify that the intormation on fhis Cerfificafe represents my besf efforts to interpret the data available. `' i'`` -• � `•���,9
!understand that any false statemenf may be piuiishable by/ine or imprisonment under 18 U.S. Code, 5ection 1001. � �V 'ss�`+e "• �
�.. �Js _ ..
[V�Check here if comments are provided on back of form. Were latitude and longitude in S ction A provided by a „ �,�� ,., '�_
licensed land surveyor� [�]'�s ❑No � ° �;9 ,f' �r
Certiflers Name license Number t�. '�:;'
Larry L. Evans PLS4� 2937 `'4�
� ��. C ti
Title Company Name " -� �r a i�'
Land Survevor EvanG T.and S�,rve}�ing, Tnr. '"" '''%ryW'�`."•"° ,
Address City Slate ZIP Code v '
140Bet e
Signature Date ��_bS��Z eiephone �72�� 734-3821
�,� �
FEMA Form 81- 1, M 09 See reverse side for continuation. FZeplaces all previous editions
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IMPORTANT: In these spaces,copy the corresponding Informati.on from�ection A. �:�d�,rh§ii��`�,��bt����y,Us�, '�,�,, ,;;
���� � � u �
Bullding StPeet Address includin Apt.,Unit,5uitej and/or Bidg.No.)or P.O.Roule and Box No. (�t�lid��NU�S�9�1`,v,� a,��r'�,�' r} 'r;
9 i�/4 S�D� �K I�/"L—� , M1 �
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City t� t �rF � r '4 1 f, •,
G��/�R,.�/'�T��. �3��C,�-{ s�a�a �� �3��ae �c,n�,p,��y�NAi��N��r��r� �, ���
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$EC710N D-SURVEYOF2, ENGINEER, pR ARCHITECT C�RTIFICATION(CpNTINUEp)
Copy both sides of thi&Elevation Certificate for(1)community official,(2)insurance agenbcompany,and(3)building owner.
comments C 2.i � i I`� �1..1 f,�('"�°i�/�Il�1�..,, �/G Gnly'1, F�,.ES�C��,,. OIJ CbN��T� �a �,
5ignature (� Date b�_,05—1 Z ,�,�
L'SGheck h+ere if attachments
S�CTIOPI�- tI�pING EI.�VA7'I0N'IN�bRMATION(SURVEY IdOT REqUIf�ED)FC1R�QN�Aq AND ZONE�A(WITHQUT�FE)
���
For Z�nes AO and A(without BFE),complete Items E1-E5. If the Certificete is intended to suppqrt a LOMA or LOMR-F request,aomplete Sections A,B,
ancl C. For Items E1-E4,use natural grade,if available. Check the measurement used. In puerto Rica oNy,enter meters.
E1. Provide elevatinn informatlon for the following and check ihe appropriate baxes to show whether the elevatfon is above or below the highegt adJacent
grade(HAG)and the lowest adjacent grade(LAG).
a)Top of bottom floor(including basement,crawispace,or enclosure)is � ❑feet ❑meters ❑a6ove or ❑below the HAG.
b)Top of bottom 11oor(including basement,crawlspace,or enClosure)is _ Qfeet ❑meters []ahove or C]below the LAG.
E2. For Building Diegrams G9 with permanenl flood openings provided in Secti Items 8 and/or 9(see a es 8-9 of Instructlons),the next higher floor
(elevation C2.b in the diagrams)of the building is �Q feet�metrJrs �above or �below the H�1G.
E3. Attached garage(top of slab)is �feet []meiers [�ebove or [] below the MAG.
E4. Top of plalform of machinery and/or equipment servicing the building fs ��feet []meters �above or []below ihe HAG.
E5. Zone AO only: if no flood deplh number is available,is the top of ihe bottom floor elevated in accordance with the community'3 iloodplaln management
ordinance? [] Yes [] No [� Unknown. The loeal official must certify this informat(on in Sectinn d.
SECTION F-PRQW�RTY OWNER(OR OWN�R'S REPR�SENTATIVE)C�RTIFIGA710N
The property owner or own�r's authorized representafive who completes Sections A,B,and E for 2one A(wi8iout a F�MA-issued or community-Issued BFE)
or Zone AO must sign h�re, The sfatements in Sections A, 6, and E are correcf to the best of nry knowfsdge.
Property Owner's or Owner's Authorized Represenfative's Name
Address City 5tate �IP Code
5ignature bate Telephone
Comments .
� e at ns
; SECTIQN C�-COMMUNITY INFORMATION(OPTIf�NAL)
The local official who is authorized by law or ordinance to adminlster the communiry's fl�odplain management ordinance Can complete Sectipns A,B,C(or ),
and G of this Elevatfon Certificate. Complete the applicable item(s)and sign below. Check the meaeurement used in Items G8 and G9.
G1. � The information in Sectlon C was taken from other documentation Ihat has been signed and sealed by a Ilcensed surveyor,englneer,or architect who
f5 auth'orized by law to certi(y elevation informatlon. (Indicate ihe source and date of the elevation data in the Comments area be(ow.)
G2. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO.
G3. ❑ The following information Qlems GQ-G9)Is provided for community tloodplain management purposes.
' G4. Permit Nurhber G5. Date Permit Issued G6. Uate Certiilcate Of Compliance/Occupancy Issued
G7. This permfthas been fssued for. ❑ New Conslruc0on ❑SubstanUal Improvement
G8. Elevation of as-built lowest floor(including basement)of the building ❑feet ❑meters(PR) Datum
G9. 6�E or(in Zone AO}depth of flooding at the building site �feet ❑ meters(PR) Datum
G10.Community's design flood elevation ❑feet ❑meters(f'R) Datum
Local Official's Narne� Tille
Community Name Telephone
5lgnature � Qate �
Comm�nts �
�` ❑Check here if attachments
F�MA Form 81-31, Mar 09 Replaces all previous editions
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�3uilding Phptc�graph�
See Instructions for Item A6.
� I d�`IfrSUP���ce�orllp�fl�Us�� „
Building Skreet Address(including Apt., Unit, Suite,and/or Bldg. No.)or P.O. Route and Box No. �� �'y Nurnbe�� ; � y, ;
21-�-9 �� 5+�c D��► �G �;,� ; ��
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City GL-L�1 f��/v'/� 1 �=R— JL,4G�-{State L� ZIP Code �ontipany r�UV� i�„ber �, , '
�371v`� < <�� ��' �,�
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If using the Elevation Certificate to obtain NFIP flood irisurance, affix at least two buiiding photographs below according to
the instructions for Item A6. Identify all photograpl�s witli: date taken; "Front View" and "Rear View"; and, if required, "Right
Side View" and"Left Side View." If subrnitting more photographs than will fit on tl�is page, use the Continuation Page on the
reverse. ' .
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