16 SEAGRAPE CIR ,, ' 4,.� ��� �' .
' � 1(�C�� -��Z 0�� ELEVATION CERTIFICATE o.rn.e. r�. 306�-00��
FEDERAL EMERC�ENCY MANAGEMENT AGENCY Expires July 31, 1999
NATIONAL FLOOD INSURANCE PROGRAM
: ATTENTION:Use ot this certiticate does not provide a waivar ot the tlood insurance purchase requirement.This form is used only to pro-
vide etevation information necessary to ensure compliance with appiicable community 1loodplain management ordinances,to determine
the proper insurance premium rate,and/or to support a request for a Letter of Map Amendment or Revision(LOMA or LOMR).You are not.
required to respond to this collection of iniormation untess 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 INFORMATION FOR INSURANCE COMPANY USE
BUILDING OWNER'S NAME POIICY NUMBEFi
STREET AODRESS(Including Apt,Unit.Suite and/or Bldg.Number)OR P.O.ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
_j!Q c�E.l4 � e,rc.l�.
OTHER DESCRIPTIO ot and Block Numbers,etc.)
�IG�ei. � l�N�� 2�
C�-�y� STATE ZIP CODE
Clzw�a��- �-�r►a.v�
SECTION B FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
Provide the following from the proper FIRM(See Instructions): �
t.COMMUNITY NUMBER 2.PANEL NUMBER 3.SUFFIX 4.DATE OF FIRM INDEX 5.FIRM ZONE 6.BASE FLOOD ELEVATION
(in AO 2o�es,use depth)
i Zso� o� `� AJ r9 �991 14�_ �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:��_L1J.0 teet NGVD(or other FIRM datum-see 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 Z_.
2(a).FIRM Zones A1-A30,AE,AH,and A(with BFE). The tap of the reference level floor from the selected diagram is at an elevation
of`���•L�U.111 feet NGVO(or other FIRM daturrt-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 reference levet from
the selected diagram,is at an elevation oi���.0 feet NGVD{or other FIRM datum-see Section B,Item 7).
(c).FIRM Zone A(without BFE). The floor used as the reterence level irom the selected diagram is L..i�.iJ feet above tJ or
below i (check one) the highest grade adjacent to the building.
(d).F�RM Zone AO. The floor used as the reference level from the selected diagram is ��.�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 iloor(reFerence
level)elevated in accordance with the community's floodplain management ordinance? � Yes ❑ No C Unknown
3.Indicate the elevation datum system used in determining the above reterence level elevations�NGVD'29 C: Other(describe
under Comments on Page 2). (NOTE: If the e/evation datum used in measuring the elevations is different than that used on
the FIRM (see Section B,Item 7J,then converf the elevations to the datum system used on the FIRM and show the conversion
equation under Comments on Page 2.) �/
4.Elevation reference mark used appears on FIR : ❑ Yes �No (See InsVuctions on Page 4)
5.The reference level elevation is based on:.�J actual construction ❑ canstruction drawings
(NOTE: Use ol const�uction drawings is only valid if the building does not yet have the reference level floor in place,in which
case this certilicate will only be valid lor the building during the course o(construction. A post-construction Elevation Ceriilicate
wiU be�equired once construction is complete.)
6.The elevation of the lowest grade immediately adjacent to the building is:��.� feet NGVD(or oiher FIRM datum-see
Section B,Item 7).
SECTION D COMMUNITY INFORMA710N
1.If the community official responsible for veritying building elevaGons specifies that the reference level indicated in Section C, Item 1
is not the"lowest tloor"as defined in the communiry's floodplain management ordinance,the elevation of the building's"lowest
floor'as defined by the ordinance is: �l�.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 REPiACES A11 PREVIOUS EDtflONS SEE REVFRSE SIDE fOR COrfi1NUATlON
1� � 1�, .
SECTION E CERTIFICATION
' This certitication is to be signed by a land surveyor,engineer,or architect who is authorized by state or local law to certify elevation
iniormation when the elevation information for Zones A1—A30,AE,AH,A(with BFE),Vt—V30,VE,and V(with BFE)is required.
Community oKicials who are authorized by locai law or ordinance to provide fioodplain management information,may also sign the
certification. In the case of Zones AO and A(without a FEMA or community issued BFE),a buiiding official,a property owner,or an
ow�er's representative may aiso sign the certification.
Reference level diagrams 6,7 and 8-Distinguishing Features—If the certifier is unabie 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. 7he diagram number,Section C,Item 1,must still be entered.
1 certily that the information in Sections 8 and C on this certilicate represents my best efforts to interpret the data available.
1 unde�stand that any fa/se statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001.
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CERTIFIER'S NAME IICENSE NUMBER(or AHix Seal)
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':'�o��ihEi@�I �d'�,�d�of this Certificate for:1)community ofiicial,2)insurance agenUcompany,and 3)building owner.
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SIAB BASEMENT PIEAS,OR COLUMNS
A � � A V
20NE5 ZONES 20NES ZONES ZONES
AE►EAENCE qEFEAEHCE �
LEVEI
AE�EpEKE BASE IEVEL
lF•IC� iL000
EtEV�nOr+
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�;tt B�SE
.f•ti.'r'�... ..'•.�.rf•' �� ..�•j?'.', REfEPENCE f1000
lnSE • '•�•� •AOJ�CENT.0 `e: LE� 'EIEVATq�
F1000 GRADE ' '3`'
EtE'/�TpN AEiERENCE tO.IACENT ���
lEVEt GAAOE ;i
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The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones.
Elevations for all A Zones should be measured at the top of the reference level tloor.
Elevations for all V Zones should be measured at the bottom of the lawest horizontal structural member.
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