8 SEAGRAPE CIR ... w3 ��p �- .
• . �t���j -�� a� ELEVATION CERTIFICATE o.M.a. r�. sob�-oo��
FEDERAL EMERGENCY MANACaEMENT ACaENCY Expires Jvly 31, 1999
NATIONAL FLOOD INSURANCE PROGRAM
. . ATTENTION:Use of this certificate does not provide a waivar of the flood insurance purchase requirement.This form is used only to pro-
vide elevation intormation necessary to ensure compliance with appticable commun'�ty 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
�equired to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form.
Inatructiona for completing this form can be found on the following pages. .
SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE
BUI�DING OWNER'S NAME POIICY NUMBER
STREET ADDRESS(Including Apt,Unit,Suite and/or Btdg.Number)OR P.O.ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
� 5� C�;,e.l� —
OTHER DESCRIPT (Lot and Block Numbers,etc.)
1� � 2 -
CITY STATE ZIP CODE
�l�Arulf4�� '�l o�z��1t�
� SECTION B FLOOD INSURANCE RATE MAP(F1RM)INFORMATION
Provide the following from the proper FIRM(See Instructions):
t.COMMUNITY NUMBER 2.PANEL NUMBER 3.SUFFIX 4.DATE OF FIRM INOEX 5.PIRM 20NE 6.BASE FLO00 ELEVATION
(in AO Zones,use deplh)
�z5 0�� oc�1� � �1�� . 19 ,591 AE- �o
7. Indicate the elevation dat�m 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:��_��.0 feet NGVD(or other FIRM datum—see Section B,Item 7),
SECTION C BUILDING ELEVATION INFORMATION
1.Using the Elevation Certiticate Instructions,indicate the diagram number from 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_L_�'•�2i� .0 teet 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 from
the selected diagram,is at an elevation of�.��J,U feet NGVD(or other FIRM datum—see Section B,Item 7).
(c). FIRM Zone A(without BFE). The floor used as the reterence level from the selected diagram is Li_.iJ feet above�J or
below i (check one) the highest grade adjacent to the building. .
(d). FIRM Zone AO. The tloor used as the reference level from the selected diagram is LU.L;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 communiry's floodplain management ordinance? ❑ Ye� ❑ No C 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: If the elevation datum used in measuring the elevations is diflerent than that used on
the FIRM (see Section 8,Item 7J, then convert the elevations to the datum system used on the FlRM and show fhe conversion
equation under Comments on Page 2.)
4.Elevation reference mark used appears on FIRM: ❑ Yes�No (See Instructions on Page 4)
5.The reference level elevation is based on:�actual construction ❑ construction drawings
(NOTE: Use of construction drawings is only valid if the building does not yef have the reference level 11oor in place,in which
case this certificate will only be valid/or the building during the course o/construction. A post-construction Elevation Certificate
wil!be required once construction is complete.)
6.The elevation of the lowest grade immediately adjacent to the building is:��L.� feet NGVD(or other FIRM datum-see
Section B,Item 7).
SECTION D COMMUNITY INFORMATION
1.If the community oHicial responsible ior verifying bui�ding elevations specifies that the reference level indicated in Section C,Item i
is not the'lowest floor"as defined in the communiry's floodplain management ordinance,the elevation o(the building's"lowest
floor"as defined by the ordinance is: �i�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 EDtTIONS SEE REVERSE 510E FOR COrfiINUATION
.
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 officials who a�e authorized by local law or ordinance to provide iloodplain management information,may also sign the
certification. In the case of Zones AO and A(without a FEMA or community issued BFE),a building official,a property owner,or an
owner's representative may also sign the certification.
Reference levef 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.
!certily that the information in Sections 8 and C on fhis certilicate represents my best efforts to interpret the data available.
1 understand that any lalse statement may be punishable by fine or imprisonment under f 8 U.S. Code,Section 1001.
M�,�,_�� F �tNk,�s �s� s-�zv
CERTtFI �N/�1�Q�, `''i�s ',. U ENSE NUMBER(or AHix Seaq �L�
.t���°�. > .� f�v� k` �Z (� 'cw� �o��.►sUl�;�i �1 ', =�S
u�:�E• (� ��..•.e;��, :% COMPANY NAME t
: 4��� � -� � � � S I�c� S�,k� 31 [�arv cl 0. ��s �L 35��a39
-+ STATE Z�P
� �n�ss. ,� cirv . tX�
�.;�: �..� ���. ���; 8i3�9�- 2�
,� .�t .-
�A � �- �;�.�,q DATE PHONE
,r 3 �, �
� + "; ' as`
Coples,�,c�;�i�d�'�.'made�of this Certificate tor:1)community ofticial,2)insurence agenUcompany,and 3)building owner.
COMMENTS R '� ..: �'{C�`4rA�� �L��. CI E� ° ID `�`�
�•la��.2 ���a�.� E�cJ = l2 S`l
ON WITH ON PIIES,
SLAB BASEMENT PIERS,OR COLUMNS
A V A A V
20NES ZONES 20NE5 ZONES 20NES
AEFENENCE qEFEAEMCE
REFEpkNCE�
B�SE tEVEI LEVEI
tE�£i ���
ELEV�rqr+
:;�
;i�i,;fil' :'.4t;' .;'�,u:; v:i,: .... ��• � MSE
... .. .. .�......... . ...... .•.�..
_ ..:;:::•:r,i`�' :•�,� REFC�E!,CE FLO00
8t5E �DJA�ENT.:'. `'�•t: � ELEVATqN
i1000 ..;�:�r.:.:L . GHAOE '.''iA. LEVK �
EIEVAtqN REFERENCE �O.IACENT ',�.:
tEVEI GMOE ::;z
. �ti{r� r'ir�:izr::
�;�$t'..."'_..� ';dr,'; :...� . .. . � .
1�i�F: �ii,�ii;�[�'::�:i,f�i,�ii:'} ."��::� :::::
. iiN:.+ '.:f•:.;.:r....:::........: .. i t.:.
{•. t.:i;.•. ::i�:}'..:, ':i:;::.
�1 �'y:J.��'. .�.�M1t:i�:�:i;`.i::..: .:�, •�� .
. •i ��'%i}' '.:;r;AOJACENTi.
���'t•� '•'��'�?r•.:i:=iLS�.:•:r•:.:
iiJr..� •'• • GMOE
.�;r�:'r' �f1� r';:•:�::.{":':`' "�pn:i;: .
....:.c�y,c:�.. . . .T:..:'�•: .
The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones.
Elevations tor aIl A Zones should be measured at the top of the reference level iloor.
Elevations tor alt V Zones should be measured at the bottom of the lowest horizontal structural member.
Page 2