865 BRUCE AVE ',�S{"1,�...f ri -- . �j��c-�=iw •�f..��.T�'.+.a3�__i -y-.-� +�'���� ���.,��� � . sY-�=..�..��•^. �,�,f�i_
1�,f�..� . x.. .� "-s"-,�+ew�. _.a�'r�,r�,at'Q.A�# �, �.; .T�VL",�_� ,.-J"a t .- . .�' =.-.. �3'S',.'S �r��..���LL
.z-r`.+--�-. ���,._--!+--'��+ .�..w.�:�'v.ti+� � �� - r ,�-�-..r+•' _..r:.w.. �-+:.-++r.�•�.�'��_
-- .� � � � ��.M.e. �
� ��_=----_ .�-�.� _.�_. . _�._.__. =�E1.EVATION .CERTIF�CATE .�.�_--=:y. �;mM Y�,'-;�
. - --- ----- • • -�EDEAAI E�IAEAGENCY AAANAGEMENT AGENCY ------- -- " � --
- : � _ . : . NATIONAL F�OOD iN5URANCE PROGRAM _ _��-
ATTENTION:Use of this c�rtificate daes not provide a waiver of the tlood insurance purc�ase requiremarrt. This form is used only to -
� provide eievation inbrmation necessary to ensure complianca with applicable community floodptain management ordinances,to . �- �-_
determine the praper i�surance premium rate,andlor ta suppoK a request tor a Letter of Map Amendment or Revision(IOMA or LOMR),
instructlons(ar campleting this torm pn be found on the foilawing pages.
SECTION A PROPEfiTY INFOAMATiON �uasuw►n�ca coMa�wv use
BUII,DING ONJNER'S NAhtE '� � POUGY NU118ER
e /� �
STAE�AOORESS' aac.Unrt.Suas anaor Numnx�OA P.O.HOUTE AND BOX NUMBEa COA�tPArrr wuC.ritMBER
�5 C��
OTHER DESC IPT70Iy,(lot antl 8 umoen�etc.; �� /� A
J Z rr� J
CTY 11 r�� ��� �TC ZIP CCDE
l� � y l.i
SECTION 8 FIOOD INSURANCc AATE MAP{FlRM) INFI�RMATION
Provide the following from the proper F1RM (Sae Instructions):
7.COMMUNlTY NUMBER 2°ANEL VUMBE� 3.SUFFIX 4.OATE Of FlRM INDEX 5.=1fiM ZCVE o.2ASE=IOOD ELEVATION
�11f AO ZAnBS.U58 tl8pt111
� �S�`i� �� _ � 8 �� � �4� !/• �
7. Indicate the elevation datum system used on the FiRM for Base Rood E?evations IBFEj: �NGVD'29 _Other(describe on back)
8. For Zones A or V,where no BFc;s orovided on the F1RM,and the community has establisned a BF� 'or;his building site. indicate
the community's BFc: ._feet NGVD (or other FiRM datum-see Section B. Item �.
SE�T10N C BUILDING Ei.F/ATION INFaRMAT10N
1. Using the E!evation Certificate Instruc:ions, indicate the diagram number from the diagrams`ound on Pages 5 and 6 that besi
• describes the subjeci building's reference level .
2(a). F1RM Zones A1-A30,AE.AH,and A(with BFc). The top of the reference level floor`rom the selec;ed diagram is at an elevation
of' ! •' � .�feet NGVD(or other FiRM datum-see Secdon B,Item�. �
(b). F1RM Zones V1-V30,VE,and V{with BFtj. The bottom of the lowest horizontal structural member of the reference level from �
• the selecied diagram,is ai an elevation of� ` � � � �.J feet NGVD(or other FIFIM datum-see Section B, Item�.
(c). FIRM Zone A(without BFE}. The floor used as the reference levei from the selected diagram is �.4 feet above� or �
below❑ (chedc one) the highest grade adjacent to the building. �
. (d). FIRM Zone AO. The floor used as the reference level from the selected diagram is ��.`.�feet above r or below�(check�
one)the highest grade adjacent to 4he 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 n No ❑ Unknown �
3.Indicate the elevation datum system used in determining the aliove reference level elevations:r NGVD'29 ❑ Other(descnbe �"J
under Comments on Page 2). (NOTE.• lf the e/evation datum used in measuring the elevations is different than that used on `'
�e F1RM �see Secfion 8, ltem 7j, then converi the elevations ta the datum system used on the FIRM and show�e conversior.
equation under Commenis on Page 2.) _
4. Elevation reference mark used appears on FIRM: ❑ Yes ❑No (See Instructions on Page 4j �
5.The reference level elevation is based on:'� actual construciion ❑ construction drawings ��
(NOTE: Use of corrstructlon drawings is only valid if the bur7ding does not yef have the reference/eve/floor in place,in which .
case this certificate wr71 only be valid for the bwlding during the course of construction. A posf-consbvcL�on ElsvaGon Certihcate `"—
wi11 be required on�e construcGion is complefe.) • �-S�
6.The elevafion of the bwest grade immediately adjacent to the bulding is:� � � � .�� feei NGVD(or other FIRM datum•see �
SecUon B,Item�.
� ' '- �'" " - - � -- - SECTION D COMMUNffY 1NFORMATION - - � •� - -- � -- -----�--'""'
� _
� t.If the community offiaal responsble for verifying buld�g elevations specifies that the reterence level i�cated in Section C,Item 1
is not the'lowest flao�'as defined in the community's floodplain management ordinance,the elevation of the bu1dng's"bwest
floor"as defined by the ordnance is: �u.�.0 feet NGVD(or other FIRM datum-see Section B,ftem 7j. , .-. �
_ -2:Date of the stari of consUuction or substantial improvement.- - -,-- •- ----.�. ` _ ` ..--, -• - ------•- •--•', ,. - ._
fEMA form 81-31�MAY 90 • REPLACES ALL PREVIOUS EDITIONS . SEE REVERSE SIDE FOR CONTINUATIO�.
. . . _ - �;;,.•,,;
" '. �. _ .. . � _ �.. . � ... � ' . , _ C i - . '� '. . """." _" . c �� ��� jt� r�e,'.�l•�i{t.
SECTION E CER7IFICATION
This certification is to be signed by a land surveyor,engineer,or architect who is authorized by state or local law to certify elevat+on
information when the elevation information for Zones A1—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 cert"rfier is unable to certify to breakaway/non-breakaway wall,
enclosure size,location of servicing equipment, area use,wall openi�gs,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.
I certify that the information in Secfions B and C on this cernfrcate represents my best eHorls to interpret fhe data available.
I understand that any ialse statement may be punishab/e by fine or imprisonment under 18 U.S. Code, Section 1001.
:_ �S��3 7 �-7
CERTIFIER'S NAME LICENS NUMBER(or Affix Seal�
�. ',7�1: C1ZS� � �� ��U.�Lt.'. --rN�
TITLE COMPANY NAME
p� �, �(�. �
ADDRESS CITY_ � � ,• � �ATE ZIP
� � , J�{�'C' Y— 35 7S
SIGNATU E DATE PHON 'r �/-y ����
c�.�
Copies should be made of this Certifi ate for: 1)community official,2�insurar�ce agenUcompany,and 3) building owner.
COMMENTS:
•
� • • - ON WITH ON PILES,
SLAB BASEMENT � PIERS,OR COLUMNS
A V A A V '
ZONES ZONES ZONES ZONES 20NES
REFEREHGE
FEfERENCE �E LEVEI REFERENCE
LEVEI ���p LEVEI
ELEV�Tqr+
_ ♦
t _L'
B�Se - �, B�SE
...�.-�:.,:: �D.I�CEHT���. iIEFEHENCE F1000
FIOOD .. . . �� . ' �EyE_ EIEVATtON
EIEVATION REFERENCE ApJACENT
IEVEI GRADE -
!�Sl� -
_ 'f �
�'.:.AQIACENT�.
...;:.�.��.:-�...�.1:... ......�'�:�.��1'�`�.
GRADE �
The diagrams above illustrate the points at which the elevations should be measured in A�ones and V Zones.
Elevations for all A Zones should be measured at the top of the reference level floor.
Elevations ior all V Zones should be measured at the bottom of the lowest horizontal structu�al member. �
Page 2 •