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- C�Y�G�E Et-�C,t_.o�Ut��
- • .,, FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 '
�Q ��� - �� � �'� � ` ELEVATION CERTIFICATE
Im ortant: Read the instructions on a es 1 -7. � �� �
SECTION A-PROPERTY OWNER INFORMATION For Insurance Company,Use(:;;;�;i�.vti;
BUILDIN OWN AM 1 Policy Number , ���,;,'����d ip�y ,;
V�����. T�. � So N � r� /�- J o �-�,� s r��� _ , .����,,���Y��� t�
�BUILDIN STREET ADDRESS(Including pt.,Unil,Suite,andlor Bldg.No.)OR P.O. ROUTE AND BOX NO. Company NAIC Number , ;y;
�____� ���.�0� t SL.�I�f�.7 ' �' �,�
c�TM C LEAR.W►�TE.2 \J�AC�� �(r 3 3'� (v'� STATE ZIP CODE
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax arcel Number,Legal Description,etc.)
Lo�i' `i � -�s c�w � �STi��c-� o f= cc.��2 w�-��--�.
BUILDING UsE� e. .,Residential,Non-residential,Addition,Accessory,etc. Use Comments section if necessary.) `
r��\7Ef�Tl ►� L
LATITUDEiLON ITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: �_�GPS(Type):
� �°_��_�,�~ or ik#.il#tk##°) (_�NAD 1927 �_�NAD 1983 �_�USGS Quad Map �_�Other:
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1. NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME B3.STATE
pl 1�1 F�--
B4.MAP AND PANEL 65.SUFFIX 66.FIRM INDEX B7.FIRM PANEL B8.FLOOD 69.BASE FLOOD ELEVATION(S)
NUMBER DATE EFFECTIVE/REVISED DATE ZONE S) (Zone AO,use de�pth of flooding)
�o0-f � g- � -� � f�►� L 1•O
610. Indicate the source of the ase Flood Elevation (BFE)dala or base flood depth entered in 69.
�_� FIS Profile �_ FIRM �_� Community Determined �_� Other(Describe):
611. Indicate the elevation datum used for the BFE in 69: �"�NGVD 1929 �_� NAVD 1988 �_) Other(Describe):
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? �_�Yes �J No
signation Date:
SECTION C -BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: �__�Construction Drawings" (_�Building Under Construction' �_ inished Construction
"A new Elevation Certificate wilt be required when construction of the building is complete.
C2. Buitding Diagram Number�_(Select the building diagram most similar to the building for which this ce�tificate is being completed-see
pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
C3. Elevations—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,ARlAE,AR/A1-A30,AR/AH,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 B�E 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 Commenls area of Section D or Section G,as appropriate,to document the datum conversion.
Datum Conversion/Comments
Elev ' Does the elevation reference mark used appear on the FIRM? ���Yes �_� No
0 a) t I e or enclosure) g .�ft.(m) �
Cl b) of f�� � �� ' '� �,.,�ft.(m) � .
O c) ,'I:me ber(V zones only) R.(m) o 0
0 d) rage(top of slab) _�•��•(m) E�
❑ e) es at � i �an e ipment W;
� ��' � �
ici e mg N (/k ._ft.(m) E;, _.
❑ � .�dj S . ft.(m) z'�n
0 9) �1'M��WPMENT � . �.(m) �
❑ h) . �1�1�8Mi�flood vents)with 1 R. above adjace t grade �
❑ i) � '�1r�'rr�ali8A1�1ArT�Qs(tlood v ts)in C3h � �c sq.in. (sq.cm)
SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This ce�tification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
1 certi(y that tlie information in Sections A, B, and C on this certificate rep�sents my best efforts lo interpr�t the data available.
1 u �tand that any false statement ma be unisha6le b fine orim risonment under 18 U.S. Code, Section 1001.
C �ER'S NAME �y'► ,� �^ �� � � UCENSE NUMBER � L `�� ��� S
I ' 1 li b
TITLE ���s i t���� COMPANY NAME �L��1 p � ���LN M t�SZK��.rlc�
ADDRESS CITY G L�-a R l�Q..T C SZPTE C.�� ZIP CODE
� . ..Z �.7 R C-i� ST.. � 337CoS
SIG -J `1J\ 1 _�0 �j—OO DATE TELE ONE/,r.,,Z..1� �L l�' '"O•Z�S�U
_L\/�. S
FEMA Form 81-31,AUG 99 SEE REVERSF_SIDE FOR CONTINUATInN RFPI A�F� ai I PRFVIfII l� FIIITI(lN�