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14 LEEWARD ISLAND � � � �� a ii_/J� (� � i U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB N0. 660-0008 Federal Emergency Management Agency Expires March 31, 2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION For Insurance Company Use: A1. Building OyrnePs Name � � PoliCy Num�er � � A2. Building Stree Address(inGuding Apt.,Unit,Suite,and/or Bidg.No.)or P.O.Route and Box No. Company NAIC Numbe� ��:, �v,�Cl/L �1..��,� � City (,,, ��,'n State -�--y� ZIPCode o,� zf�- `t-t-- �✓v� �,�7� � A3. Property Description(Lot an�Block Numbers,Tax Parcel NumberCLega�scription,��.) � �l � � l.n A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) �� A5. Latitude/Longitude:Lat. Long. Horizontal Datum: AD 1927 NAD 1983 A6. Attach at least 2 photograp o�e building if the CeRificate is being used to obtain flood insurance. A7. Building Diagram Number�,��I A8. For a buiiding with a crawlspace or enGosure(s): A9. For a buiiding with an attached garage: 2 '�"''� a) Square footage of crawispace or enclosure(s) �sq ft a) 5quare footage of attached garage ,/� sq ft b) No.of permanent flood openings in the crawlspace or b) No.of permanent flood openings in the attached g rage enclosure(s)within 1.0 foot above adjacent grade [�'Q within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b � sq in c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? �Yes j�No d) Engineered flood openings? �Yes � /� � SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name 8�Community Number 62.Coun 63.State - �1�! �'� ��.�� -- 64.Map/Panel Number 65.Suffix B6.FIRM Indeu 67.FIRM Panel B8.Flood 69.Base Flood Elevation(S)(Z ate Effe ive/Re sed Date Zone AO,use b flood d th) ��,;�> c�/i�� `3 0� �' � - /� ` d i 1.d �`� 610. Indicate the source of the Base Flood Elevatio (BFE)data or base od de entered in Item Br-i �/> ❑FIS Profile ❑FIRM Community Dete ' ed Other(Describe) c��/��% ��C"�il c c.-n� B11. Indicate elevation datum used for BFE in Item B9: NGVD 1929 ❑NAVD 1988 ❑Other(Describe) _ 612. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? � Yes o Designation Date �CBRS �OPA SECTION UILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: Construction Drawings' ❑ Building Under Construction' ❑ Finished Construction *A new Elevation Certificate e required when c truction of the building is complete. C2. Elevations-Zones A1-A3 `A AH,A(with BFE,VE 1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO. Complete Items C2.a-h below according to the ilding diagram specified em A7 Use the same datum as the BFE. Benchmark Utilized � L.�� Vertical Datum � Conversion/Comments ' � C�heck the measurement dn. (:� I j i i! `'� �� a) Top of bottom floor(inGuding basement,crawlspace,or enclosure floor)�.�LJ feet �meters( e�t,b i�onl � ' � i i L'� , :XZ�_,...__,i b) To p of the next hi gher floor .!� ❑feet meters( e o co onl y) c) Bottom of the lowest horizontal structural member(V Zones only) .�0 feet ❑meters( e 1,rri 7 �0�� d) Attached garage(top of slab) .�[.�feet ❑meters( o n�fi)- � / e) Lowest elevation of machinery or equipment servicing the building .�feet �meters( erto R iyj-°•-- (Describe type of equipment and location in Comments) f P��'�-, :.�J;��'�9Eid'f DEPT fl Lowest adjacent(finished)grade next to building(LAG) � . ` feet ❑meters( � �' -y��_..�_:"��V'JAT�R g) Highest adjacent(finished)grade next to building(HAG) �.��feet �meters(PueRo Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs,including ✓`� ,�Q feet �meters(Puerto Rico only) structural support SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information. 1 certify that the information on this Certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishab/e by fine or impnsonment under 18 U.S. Code, Section 1001. • o �Ch e if mment are provided on back of form. Were latitude and longitude in Section A pr vided by a � � ' � `�� „ �� ` �� licensed land surveyor? ❑Yes �No C-'� ` `, ��'- , /- Certifie s N �, se Numb r - <<r �-_? � ' - '� 'G _ � � � �_, r '„ ; Title Company Name � � �� ./F � v Address City State ZIP d � ��% ♦' �� /'' ,�� '_ 'c' �� na e D t /� Tele n ?�� p �� p� �� % • ��•. � FEMA Form 81-31, Mar 09 See everse side for co inuation. ' Replaces a��i�evioG`s editions ��1�'�r�t' y��.��. !(Jl� ��,dt,Y� ��i�