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� ELEVATIAN CERTtFiCATE °•'"•g•T''°• 3°6r-o°n
, FEDERAL EMERGEN�Y MANAGEMENY AGENCY E"P���'���Y`�. ��
� NATIONAL FLOOD IivSURANCE PROGpAM
. ATT5NT10N:Uss ot this coniRcats doas not provida a wslwr ol th�tla.�d i�curance purchus requlnm�n�.Yhia lorm ts ussd onh/to pra
vide�iwatlon lntormallon n�c�ssary to�ntur�comp{i�nce with sppl'�cab{e communhy poodplaln mar�a9�ment ordnances,to dntermine
9he propa�insurencs premium rals,andlor to aupport a request ior a Leaer o;Map/'.mendmsnt or Rsv+aion(LOAAA or LOMR).You are not
requltsd to fespond to thla cotlection of inlormation unless a ve�d�MB conhot r,umber(s d:played in the upper right ccmer ot this form,
Instructlon�tor comptettng thi�torm can be tam�on the iollowin9 paQes.
SECTION A PAOP�R'i'Y IN�bRMATiON Fa+*�svawc��o�*�►+�us�
9u1101N0 OWNEft'S NAM! rOUCr uttuefa
STA[[j�(yklYdrq Ap�,(�d{,Sulq ridlor dldp.NumMr)OR/.O.ROIJTE ANO EOX NV1.(oER CO��NY NAIC INMOEII
,:�;:���.Sit�G�e t{�� �.''���E.� _
.:.� -
oYkE11 oESC11N�Ti0N(t.e and iloa rwman,�ee.)
31 d�, (a l,,,r�i c�-- �y i
CRy�— STA�TE`� ZiP CODE `
C� tQS't��'�'LLZ r'G.GIi 1 �
5EC170N p Ft.00D INSUAANCE RATE MAP(FlAM)INFOAMAYION �
Provid�the followtn9 trom the proper FIRM(See in�Wcdora)t
�.cou�u�arv Nu�.+ein :.r,we��eEa a.sur�x �.oa�oF Flw+woex e.n�w zoa� c,r►sF n000 etev.noM
��o zo�...�,.a.an�
1 '"�c17 00►8 ''D A • 9 � ICJ
7.Indlcsto thA elavatlon dsNm systvm us�d on thv�IRM t�r Base Flood Elevndons(BFE): !�NaVO'29 ❑Other(describe on badc)
s.Fo�2one�A o�V,where no BFE Is provided on the FIRM,and the cc�munity ha�establishsd a BF'E tor tt,is kwilding site,indicate
th�Community: 9FE:�_LJ..�.�..1 teet N(3V0(er other FIRM datum-soe 3scGon 8,Item 7),
SECTION C 6UILDINa ELEYA710N 1NFORMATION
1.Usirq the Elevatio�CoRiScate InsaucUons,indtcale tho diaflram number trom the daprama found on Pa9es 5 aM 6 that bsst
. deacrtt»:t�e:ubjec� bund�n�'s referonce I�vel...�. .
2(a).FIRM Zona At-,A,�310,AE,AH,and A(with EiFE7. The t�p o�the refersnce fevel Noor trom the sefected dagrsm fs at an elev�tion
ol:i.�,..!L��.LL!(oot NC3VD(or other FIRM datum-aee Sectlon 8,Item 7j.
�b).F1RM Zont:Vt•V30,VE,and V(vrith BFE�. Ths hottom of ths lowest horizonlal:huctural�rembet ol the relerence kvei trors�
, the sNect�d dta9ram,is at an etevatian oI�J,(J te�t NGVD(or othor FIAM datum-sse Seaion B,ftem 7�.
(c),F1RM Zont A(wfthout S��). 7he 800r vud as the relerence level from ths selecteE da��am la �1!.:�teet tbove;� o�
batow C (check o��) the hl9hast�rade�acent to the buildng.
(�.FIRM zone A0. The floor used as the referance tevel f�om the aefected da9ra�Is l_L.1.Li teet above J cr bebw�(chdck
on�)the hl�host gradv adjacent to the bu�dinp. 11 no Nood depth number Is ava�lable,Is Iha bu(ldinp's bwcst Noor(reterence
Nwn Navat�d{n aaordana wtth ths oommun;ry's Ibodplaln management ordinanceZ �,] Ya � No C Unknwvn
3,1ndiCite the etevadan datum aystem used in determintng 1he above relerance level etevallons�NGVO'29 C Other(desaibe
und�r Comments on PagQ?). (NOT'F.: !1 the olvvallon datum used Jn me�surinp the elevavons!s drf/want than that used on
the FIAM (see Sectivn B,ltem 7J,then t+vnvsrt !he elevallons to the deNm�ys�em ueed on the FIRM and ahow ths eonverslon
oqwdon urxlsr Con+m�n�s an PaDs 2.) �/
a.Elwadon r���nnc,muk usad appevs on FIRM: ❑ Yes.tiJ No (See Inswctions on Pafle 4)
S.7h�nf�rt�u level etevaUon Is based on:�ctual conEtruclion ❑ co�atrtxUnn dnwings
(tlOTB: Us�ol constructbvr dra�WnQs!s on/y vrlid N tAe Dupolnp does not yet havs ths�e/ersncs/eve/Iloa U place,!n whkh
cas�,this CeNt�eaPe w,71 only be va1Jd lor the bu�7dinp during the courss o(consbvcdon. A post-construction Elev�(ion CeR;,9caro
w!R br rtqulied on.:e constructlan!s compleb.)
B.7h��levatlon ol the iowest flrada Immedlatety adjacent to the building Is:Ll�l��.� teet NGVD(nr other FIRM datum•aee
SacHon B,ltem 7).
SECTION p COMMUNtTY INFORMATION
1.11 the c",mmunity oN'+dal ra=ponabl�for veriyinq buiiding elevations apeci6es that ths roteronce leve'.Indcatsd(n Sectbn C,ltem 1
: Is not ���s derned ln the c0+�mun�tya doodplaJn manaflament ordlnance,tha alevatlen oI Ure<,buildicroa'lowes .;
'��y�� ,�da��i� th�o►dfnatse�is: L._(_L.ILL).0 toot NGVD(ot othrr F1AAA,datum-6eA S9Cti0n B,Itlrt1�. � � �
• 2.Dfte of the start of corulructbn ac wbatandai improvemtnt .
FEMA Form at-31,MAR 97 RFPIJuCE5/111 PRfv4olJ5 Ea11oc�ls SFE AEVfRSE S+oE foR CvPmM1�T1oN
• , .�s,
_ _ _
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' . SEC710N E GERTIFlCATiON
� 'tl�is caiLlk�Uon Is to be sipned by a land surveyor,enpineer,or architect who Ia Autf�orited by state or�car taw to certlfy e�svaGon
intotmatlon whon tha elevation informallon for Zones A1-A30,AE,AH,A(with 8FE),Vt-V30,VE,and V(witn BFE)1�required.•
Communlry oMctals who aro authorizsd by bcat law or o►dinsnce to provide Ooodplatn mana9ement Inlormation.rr�ay alco sign the
eartiBcation. 1�thv casa o!Zon�s AO�nd A(wiNout a FEMA or cemmunity issued 8FE),n bu�lding oMldal,a prop6rty owner,or an
ownM's representaliv�may also sign the ceRificaBon.
Relennu level deprams 6,7 and 8•Distinpuishing Featuros-If the cortifier Is unable to certity to breakaway/non•breakaway watt,
•nclosun size,IocaGon ot aervictnp equlpment,area use,wall open(nps,ar unfnlstied uea Reature(:),then Gst the Feature(s)not
tncludQd in th�ceNfication under�omments below. 7he diagram number,SecGon C,ltem 1,mLSt sti11 La entered.
1 unty rner w�lnlormadoR In Sectlorts B and C on thls certi6ute�epnsents my best eNarts to lnterprst the data avaAabts.
1 underslu►d that�ury lalso stat�ment may bQ punishaWe by�'ne o�impri�onmenf undsi 18 U.S.Cods,SecAOn 1001.'
NI�,�1 E, ��v�,�s ��� �7Z� � � �
�
CEATiKIER'S NM�E �_ n- ' LICEHSE Nt1MBEq(er AKa S�sry -
�NE�I NtAN�°�� Anda''iC.)A� ���tal�'��r�J�,Z�tEP-�.... �'L�'.
T "'—'—V' COM�ANY NAAAE � f
I ' L� v� bu�-F�c_ 3,10 1-►4�J� O� LaY�.s _ Fl. �5��a3�
�oo cm ar�� z�v
� S►3•q9C� �Z�oo
GNATWtE OATE PMONF.
Coples should b�made ot this C��tltteate lor:t}communlry atilcta�,2)Insurance spenttcompany,and 3)building own�r.
COMMENTS• �A�Aa� ��►Z E1e.�d�-ion�� 7, 4' �'
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su� uaeuort hlRS,Mt ooW�aes
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20NfS 20N!! 20►+ii 20NCt 20r�t3
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1'he dagnms above illusvats the patnta at whkh the etevatbns should bQ measured(n A Zones and V Zones.
&IwaGons lor att A Zones should be mcasured at the top of the referonce�vvel800r.
Etwations for t�V 2on�s shouid bo measured et the bottom of ths bwest hor'�zontal structurat mertlber, _, i�$, �_
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• ELEVATION CERTIFICATE O.M.B. No. 3067-OOT7
FEDERAL EMEHCaENCY MANACaEMENT ACaENCY �p�res July 31, 1999
� � NATIONAL FLOOD INSURANCE PROCRAM
ATTEN710N: Use ot this certificate does not provide a waiver ol the ilood insurance purchase requirement.This form is used only to pro-
vide elevation in[ormation necessary to ensure compliance with applicable commun'ity floodplain 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 intormation unless a valid OMB control number is displayed in the upper right corner of this form.
instructions for completing this form can be tound on the tollowing pages.
SECTION A PROPERTY INFORMA710N FOR INSURANCE COMPANY USE
BUILDING OWNER'S NAME POIICY NUMBER
�C� t�,r`..D i''1 l t�lo2
STREET ADDRESS(�ncluding Apt,Unit,Suite and/or Bidg.Number)OR P.O.ROUTE ANO BOX NUMBER COMPANY NAIC NuMeER
_� ��4C�aPE C?��rc\�
OTNER OESCfi1PTiON(LOt and Block Numbers,etc.)
31dc, (a l )��r�-- �q -
CITY STATE ZIP CODE
�'lE���-'+-�..Z FLar��
SECTION B FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
Provide the toilowing irom the proper FIRM(See Instructions):
1.COMMUNITY NUMBER 2.PANEL NUMBER 3.SUFFIX 4.DATE Of FIRM INOEX 5.FIRM 20NE 6.BASE FLOOD EIEVATION
(in AO Zones,use depth)
IZSc��'�� 0018 � A - !9 �5 1 �� to
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 buiiding site,indicate
the community's BFE:u.�._��.0 teet NGVD(or other FIRM datum—see Section B,Item 7),
SEC710N C BUILDING ELEVATION INFORMATION
1.Using the Elevation Certificate Instructions,indicate the diagram number irom the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level�— .
2(a).FIRM Zones A1-A30,AE,AH,and A(with BFE). The top of the reference level floor from the selected diagram is at an elevation
of_i.''�.L 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 reference level irom
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 floor used as the reference level from the selected diagram is Li�.:J feet above t� or
below i^_ (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 iloor(reterence
level)elevated in accordance with the community's floodplain management ordinance? ] Ye � No L Unknown
3.Indicate the elevation datum system used in determining the above reference level elevations�NGVD'29 �. Other(describe
under Comments on Page 2). (NOTE: 1/the elevation datum used in measuring fhe elevations is different than that used on
the FIRM (see Section B, lfem 7J, then convert the elevations to the datum system used on the FIRM and show fhe conversion
equation under Comments on Page 2.) �/
4.Etevation reference mark used appears on FIRM: ❑ Yes.�i:No (See InsWctions on Page 4)
5.The reference level elevation is based on:�ctual construction ❑ construction drawings
(NOTE: Use of construction drawings is anly valid if the building does not yet have the re(erence leve!f1oo�in place,in which
case this certificate will only be valid/or the building during the course o!construction. A post-construclion Elevafion Certificate
will be required once construction is complete.)
6.The elevation oF the lowest grade immediately adjacent to the building is:�.� feet NGVD(or other FIRM datum-see
Section B,Item 7).
SECTION D COMMUNITY INFORMATION
1.It the community official responsible tor verifying building elevations specifies that the reference level indicated in Section C, Item 1
is not the"lowest floor"as defined in the community's floodplain management ordinance,the elevation of the building's"lowest
floor"as defined by the ordinance is: L�.�1.0 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 REPLA(�5 ALL PREYIOUS EDITIOtJS SEE REVERSE SIDE FOR COMINUATION
♦ I
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� SECTION E CERTIFICATION
� This certification is to be signed by a land surveyor,engineer,or architect who is authorized by state or local law to certify elevation
information when the elevation information for Zones A1-A30.AE,AH,A(with BFE),V1-V30,VE,and V(with BFE)is required.
Community officiais who are authorized by local law or ordinance to provide floodplain management information,may also sign the
ce�tification. In the case of Zones AO and A(without a FEMA or community issued BFE),a buitding official,a property owner,or an
owner's representative may also sign the certification.
Reference level diagrams 6,7 and 8-Distinguishing Features-If the ceRifier is unable to certify to breakaway/non-breakaway wall,
enclosure size,location of servicing equipment,area use,wall openings,or unfinistied area Feature(s),then list the Feature(s)not
included in the certification under Comments below. The diagram number,Section C,Item 1,must stilt be entered.
!certify that the information in Sections 8 and C on this certilicate represents my best efforts to interpret fhe data availab/e.
f understand ihat any lalse statement may be punishable by fine or imprisonment under i8 U.S. Code,Sect;on f001.
11��c1�.w�1 E, ���,�5 ��� 57Zc�
C��}j�fggq�S p1AME UCENSE NUMBER(or Affix Seaq
���,�,�.� nll���� �.,��r�c�rs �'�v��t�-,,�� Ccs�-,��stE�—s, r��.�-
:'��,�y��� . � �"!t � V� ���OMPA�NYNAME
•.� � L�� Lr��1� O� La�Le-S FL. 3�f��
t*j� `� CITY STATE _� 21P
c:j r� ��. �-1 Z- 9 y ���-99� ��
d, �• N TUP�' ,r, '�+ DATE PHONE
5 a �� r�
�...� F,8
^;. �/ . ., .. . • `.. . :
µ.,Q��,i,���ou�,�b`e made of this Cectificate tor:1)community official,2)insurance agenUcompany,and 3)building owner.
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COMMENTS: G7�4�r�Aa� ��c�►Z E�E�/r��ivN = �, � (
1�-�A�� �-�:�A�'�.1� �1 E�1��'��c9�rv = ��. C7
ON WITH ON�ILES,
SLAB SASEMEHT VIERS.OR COLUMNS
A y A A V
ZONES 20NES 20NE5 20NE5 ZONES
AEfEpENCE
tEVEI nEfERE7+GE
AEFENtKE MSE LE�/El
lEvEl ���
EIEV�T%'i/
:,'SR:
'".l 1. '.d�7��4 .1.. ti
MSE
MSE ..: . •'AW�CEM�.:°.:'Sj' NEfEnEKE � f1000
i1000 GAAOE � ";:';_ lE'/Et EIEVATqN
E�E'NT� AEiERENCE �O.WGEtiT .ri�..
lEVEI G�uOE
i I�ry���,S.t)iS.i.
..sfs:pi:�:±Y..
�,_Y'.:;: �.��'�i:(�'::';i!��.:�'
-'•" .�'�....�:�;.:.�.'::::.:..:i '.,-,"`�
.':J::�' '-T'?:'::�• ':�I�i.•:�r��•
'•�!': .;:�i�.,'i.,'i�:�":`::'ii'�' AOJACEN7::
� i' ��" �_^�5::�:.!• Gi1A0E
.. .:.'':��:•......... ....... ..
The diagrams above iltustrate 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 Iloor.
Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member.
Page 2