749 ISLAND WAY .... �.
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' � ! FED6RAL GM[RG[NCY MANAGGMENT /1Gf_NCY
� O.M.�. No. 30�7-0017
�PR O � ZQO�. ' NATIOIJAL FL�OD INSURl1NCE PR�GRl1M [x�ires Jt�ly 3�, 2002
�. � ...�' ELEVl1TION CERTf�IC�1TC
� PIANNING&[7EV��.�3�ME(YT�VCS �,��portant: Read Ihe inslruclioris on ���ges 1 - 7. �
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S[CTION/1-f'f20PERTY OWNER INfORM/�TiON ;F;ii�.�i�sU:rincg;�oirijiaiiy:Use=:;:��::
oui iric ow►iEn�s NnM �:iroi�c:'y:ciiiii��et::::;�:��::::€";};;:"� ::
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' bUIIDING STREET hDURE S(Includlnp Apl.,Unll,Suite,ancl/or OIJ�. Mo.)OR f'.O.ROUTE�NU�OX NO. ;(;�otiij�aiiy;N/.11C;.t�liiiri6er;;;?.'•�;:;;��;%�
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cir � srnir_ zm couc
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PROf' fiT OESCRif'TION(l I and Olock Numbers,Tex f'arccl Nun�b � I Dcscrl�itlon, Ic.)
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DUIIDING U (e.g.,Res�denlial, on-res�de�Ilal,hdclilfon,Accessory, le. Use Coiii�nenls secilon If necessa�y.)
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ll1TIrUDEiIONGIrUOE(OPTION�L) IIORIZONTnI. OnTUM: SOURCE: �__�GPS(Type):___
( aa'.pr'.ra.aa• or aa.axaaa'> �,ntnp isz� L�NnD 1083 L_�USGS Ouad Map �_j oii�e�: -
SECTION D -FLOOD INSUR/1NGE R/1TE M/1P (fiRM) INfORMATiON
01 t•I IP C TNIiY tJn E d COMMUNITY NUMUER D2.COU Y N/�ME 03. S�TE�
W l2S�g ��E
04, n nN0 f'AtJEI O5.SUFFIX 06.FI(1M INUEX B7.FIRM PAtJ[L oa. r�.000 C19. DnSE fLOOD ELEV�T10�1(5
NUMBER • nT EFf CTIVE REvISED OATF ZONE S
D � S 8� r9 � I 2 - (Zone lI ushe_d�eplh of flooding)
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�10. InJicale Ihe source of lhe Oase Flood Elevalion(6F[)dala or b�se flood deplh enlered in 09.
(J FIS Prolile �FIRM L�Communfly Delertnined L�Olher(Descrlbe):
811. InJfcale Ihe elevaUon datum used for the BFE In 89: �NGVO tfl29 ��N/\Vp 1900 �� Olher(Describe):
012. Is il�e buliding localed In a Coaslal 8arrter Resources Syslem(CBRS)�rea or O(herwlse Prolecled/�rea (OPA)7 �_� Yes � No
pesig��llon Dale'
SECTION C -�UILDING ELEVATION INI"ORM�T�ION(SURV[Y RGQUIR[C))
� Ct. Duilding elevc�l�ons are based on: ��Conslruclion Drawings' L�Oullding Under Conslrvr.lion' ��ffnlshed Conslrucllon
'/�new[levation Cerlilicale will be required when conslruclion of lhe buliding is corYiplele-
C2. Building Oiagram Number�_(Selecl lhe builJing diagram most simllar to Ihe buliding Ior which Ihis ceilificale Is be(ng compleled- se
pages 6 anJ 7. If no diagram accuralety represenls Ilie bullding, provide a skelcl�or�,liolograpl,.)
C3. Elevalions-Zones/11-A30,AE, Ahl,A(willi p�E),VE, V1-V30, V(wiil� BFE), /1R, /�R/!1, /1R//1E, /1R//�1•/�30,!�(2/!�I I,!�R/AO
Complele Items C3a-I below according lo Ilie bullding diagram speclfied in Ilem C2. Slale Ihe dalurn used. if(he dalum is dif(erenl from
ihe Jalum used�or lhe BFE In Secilon 8, converi Ihe ctatum lo Ihel used(or U�e BFE. Show field measuremenls and dalum conversion
calculailon, Use Ihe space provided or lhe Commenls area of SecUon�or SecUon G, as approprla(e, lo docuinent lhe dalum converslon
Dalum,��,� Converslon/Commenis
ElevaUon reference mark used_CLW R.Br�4 Ooes Ihe elevaUon reference mark used eppear on Ilie FIRM7 LJ Yes (�J Nc
� e)Top of boliom Ooor(Including Uesemenl or enclosure) �11.(m)
O b)Top of next hlgher floor.�_' ` n.(m) �
O c)Bollom o/lowesl horizonlal slruclural member(V zones oniy) A fl.(m) $� ��
❑ d)Alleched garage(lop of clab) • .�Qn.(m) �v �
O e)lowesl elevaUon oI macfifnery and/or eq�ipment '� " �s �'1 .{� 3 �i�
� servlctng Ihe bullding ;' . ;I S �,(m� � ? l �7��
O Q�owesl ed)aceni grade(LAG) .Z R.(m) z.�`� / lf Z7�Q�
O g)f-Ilghest adJacenl grade (HAGj (� . n_��i� �
� h)No. of permanenl openings(Ilood venls)wilhin 1 R. above aclJacen grade �
O I)Tolat area o(all perrnanent openfngs(Ilood venls)In C31i_��sq.tn. (sq. cm)
SECTION D-SURVEYOR, ENOINEER,OR/iRCI11TECT CCRTfFIC/ITION
l li(s cerlifical(on Is lo be signed anil sealeJ by a land surveyor, englne�r, or archpecl aulhoiized by law lo ceriify elevalion IntormaUon.
I ce�fify/hal fhe lnforrtra(ion!n Secfions A, p, and C on fhls cerfificafe represen(s m}�besl efforfs fo lnlerpre(Ilie data oveil�Gle.
!vndersland f/ia(an /a/se sialemenl ma be unishable b fine orlmprisonm'en(under f0 U.S. Code, Secfion 1001.
CERTIFIER'S NAME UCENSE NUMOE(i �� ��
TITIE COMPnNY NnM[ � � --. �
' AD�RESS N CITY S�i TE_J�Zi COOE
• SIGNATURE DATE ! Z � TEI�I'lIO�IE 2-1
FEMA Fortn 8_1-31,AUG 99�� , ,., ., . .,. SEE REVERSE SIDE FOR CONTINUATION REPLIICES /1�l PREVIOUS EDITIONS
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