12 SEAGRAPE CIR v
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. . _ '�p��, ELEVATION CERTIFICATE o.M.s. r�. aob�-oo��
r ��'o� FEDERAL EMERGENCY MANAGEMENT ACaENCY Expires July 31, 1999
NATIONAL FLOOD INSURANCE PROGRAM
• ATTENTION: Use of this certificate does not provide a waivar oi the flood insurance purchase requirement.This form is used only to pro-
� vide elevation information necessary to ensure compliance with applicable commun'tty fioodplain management ordnances,to determine
the proper insurance premium rate,and/or to support a request for a Letter of Map Amendment or Revision(IOMA or LOMR).You are not
required to respond to this coilection of information unless a valid OMB control number is displayed in the upper right corner of this form.
instructiona tor completing this form can be found on the following pages.
SECTION A PROPERTY INFORMA710N Foa iNSUaaNCe coManrvY use
BUILDING OWNER'S NAME POLICY NUMBER
STREET AOORESS(Inctuding ApL,Unit,Suite and/or Bldg.Number)OR P.O.ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
�2 �l4 ,�4 f. �'1rC``L —
OTHER DESCRIP71 N(lot and Block Numbers,etc.)
1'3� � . t �n3 C�' �
���, S7ATE ` ZIP COOE
��� ����a�� '!="k�r�d�
SECTION 8 FLOOD INSURANCE RATE MAP(FlRM)INFORMATION
Provide the toltowing from the proper FIRM(See instructions): -�
1.COMMUNITY NUMBEfl 2.PANEI NUMBER 3.SUFFIX 4.DATE OF FIRM INOEX 5.FIRM 20NE 6.Bn AO 2a�s�,use dept ON
i2sp97 eo1�3 � A �9 r9� ��. ►o
7.Indicate the elevation datum system used on the FIRM for Base Flood Elevations(BFE): �NGVD'29 ❑Other(describe on back)
8.For Zones A or V,where no BFE is provided on the FIRM,and the community has established a BFE for this building site,indicate
the community's BFE:��iJ.0 feet NGVD(or other FIRM datum�ee Section B,Item 7),
SECTION C BUiLDING ELEVATION INFORMATION
1.Using the Elevation Certificate instructions,indicate the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level 7
2(a).FIRM Zones A1-A30,AE,AH,and A(with BFE). The t�p of the reference level floor from the selected diagram is at an etevation
of:�`'•�I`•.iJ feet NGVD(or other FIRM datum-see Section B,item 7).
(b).FIRM Zones V1-V30,VE,and V(with BFE). The bottom of the lowest horizontal structural member of the reterence levei from
the selected diagram,is at an elevation of���.0 feet NGVD(or other FIRM datum-see Section B,Item 7).
(c).FIRM Zone A(without BFE). The tloor used as the reterence level from the selected diagram is L't-s'.�feet above� or
below� (check one) the highest grade adjacent to the building. .
(d).FIRM Zone AO. The floor used as the reference level from the selected diagram is LU.�feet above� or below�(check
one}the highest grade adjacent to the 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 J No [ Unknown
3.Indicate the elevation datum system used in determining the above reference level elevations:�NGVD'29 C: Other(describe
under Comments on Page 2). (NOTE: //the elevation datum used in measuring the efevations is different than that used on
fhe FIAM (see Section B,1lem 7j,then converi !he elevations to the datum system used on the FIRM and show the conversion
equation unde�Comments on Page 2.) �-�
4.Elevation reference mark used appears on FIRM: ❑ Yes LSyVo (See InsVuctions on Page 4)
5.The reference level elevation is based on�actual construction ❑ construction drawings
(NOTE: Use ol construction drawings is only valid if the building does not yet have the relerence leve!floor in place,in which
case this certi/icate will only be valid/or!he building during the course of construction. A post-construction Elevation Certificate
will be required once construction is comple[e.)
6.7he elevation of the lowest grade immediately adjacent to the building is:���.V feet NGVD(or other FIRM datum-see
Section B,Item 7).
SECTION D COMMUNITY INFORMATION
1.If the community official responsible tor verifying building elevations specities that the reference level indcated in Section C, Item 1
is not the"lowest itoor"as detined in the community's floodplain management ordinance,the elevation of the building's"lowest
floor"as defined by the ordinance is: �L..J.0 feet NGVD(or other FIRM datum-see Section B,Item 7).
2.Date of the start of construction or substantial improvement •
FEMA Form 81-31,MAR 97 REPLACES ALL PREV10U5 EOfT10NS SEE REVERSE SIDE FOR CONTINUATION
• , • �
SECTION E CERTIFICA710N
' This certification is to be signed by a land surveyor,engineer,or architect who is authorized by state or local law to certify elevation
intormation when the elevation information for Zones A1-A30,AE,AH,A(with BFE),V1-V30,VE,and V(with BFE)is required.
Community otficials 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 communiry issued BFE),a building official,a property owner,or an
owner's representative may also sign the certification.
Reference levei diagrams 6,7 and 8-Distinguishing Features-If the certifier is unable to certify to breakaway/non-breakaway wall,
enclosure size,location of servicing equipment,area use,wall openings,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.
1 certify that the information in Sections B and C on this certi6cate represents my best efforts to interpret the data available.
1 understand that any fafse statement may be pun;shable by�ne or imprisonment under 18 U.S. Code,Section i001.
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Cop�'i��.s?�+or�ld be.made oi this Certificate for:1)community official,2)insurance agenUcompany,and 3)building owner.
COMMENTS: G7 �/� � � I��11�►���� ' I � ,
������ a��,��Z EIEJ�;o�_ ,3. ��
ON WRH ON PILES,
SLAB BASEMEHT PIEHS,Oii COLUMNS
A � � A V
ZONES 20NES 20NES 20NES ZONES
REFEAENCE REiEAENCE
B�SE IEVEt LEVEI
AE�Ept/+CE �
�Evf� i1000 ,
TEIEVATqN
;:��: 1
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r°�.:..:
- :..:: .... M�SE
- :.:.;.;.�.�:`��: :�:»iT iL000
B�SE ..:�:;.�.�:':-= •AOJACENT•:� �i'�:. REPEAENCE � ' EIEVATION
it000 GAADE ' ';:;ir'. IEVK
E�E'/+•� REfEi1ENCE �O,IACEhi .:
LEVE� G�uOE :?�
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The diagrams above illustrate the points at which the e�evations should be measured in A Zones and V Zones.
Elevations for all A 2ones should be measured at the top ot the reference level floor.
Elevations tor all V Zones should be measured at the bottom ot the lowest horizontal structural member.
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