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18675 US HWY 19 #361 ♦ �•� � ELEVATIUN CERTIFICATE OMB.Na3o�?��» ExpiresM�y37, 1993 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM "7TENTION: Use af this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to ;��vide elevation information necessary to ensure compliance with applicable community 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). Instructions for completing this form can be found on the following pages. � SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE BUILDING OWNER'S NAME POLICY NUMBER �l-a�-�� 1 c��5 n� . u � . t '� G ! STREET AODRESS ilncluaing Apt..Unit,Suite and/or Bldg.Number)OR P.O.RQUTE AND BOX NUM9ER CCMPANY NAiC NUMBER OTHER DESCRIPTION jlot and Biock Num�ers,etc.1� 1 ��,�t--'� 9� o �o � ��_ C��' STATc 21P CODE rj,�.�QfedA�R �1172tDA 3�l�Z� SECTION B FLOOa !NSURANCE RATE MAP(FIRM)INFORMATION Provide the following from the proper FIRM (See Instructions): 1.COMMUNITY NUMBER 2.PANEL NUMBER 3.SUFFIX 4.DATE OF FIRM INOEX 5.rIRM ZCNE 6.BASE FICOD ELEVATION l 25 Oq b Q��7 � �nr �9 y� �in AO Zones.use depth) 8- -� a-� �p, o p 7. Indicate the elevation datum system used on the F!RM for Base Flood Elevations (BFE);,2�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: ._feet NGVD (or other FIRM datum–see Section B. Item 7). SECTION C BUILDING ELEJATION INFORMATION 1. Using the E!evation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best <�escribes the subject building's reference level � . <<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__.g.,Z feet NGVD (or other FIRM datum–see Section B. Item 7). (b). FIRM Zones V1-V30, VE, and V(with BFE). The bottam of the lowest horizontal structural member of the reference levei from the selected diagram, is at an elevation of ._feet NGVD (or other FIRM datum–see Section B, Item 7). (c). FIRM Zone A(without BFE)..The floor used as the reference level ttom the selected diagram is .�feet above� or below_. (check one) the highest grade adjacent fo the building. (d). FIRM 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 floor(reference leveq elevated in accordance with the community's floodplain management ordinance? _ Yes _ No _ 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 different than that used on the FlRM (see Section B, Item 7J, then conveR the elevations fo the datum sysfem used on the FIRM and show the 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 o ly valid if fhe building does not yet have the reference/eve/floor in place, in w ' case this certificate will on/y be valid lor the building during the course of construction. A post-construction E/evation C will be required once construction is complete.) 6.The elevation of the lowest grade immediately adjacent to the building is:' � � ! � ,Z feet NGVD(or other ti�m se . Section B, Item 7). � 6 � SECTION D COMMUNITY lNFORMATION ,�,� �j .�'� �� :r`.. ' ff the communiry official responsible for verifying building elevations specifies that the reference I d in Q�+ tion ��rr�tP is not the"lowest floor"as defined in the community's floodplain management ordinance,the eleva ��buil�ing's."�o�y��{'✓� floor"as defined by the ordinance is: � ! � � ! I.� feet NGVD(or other FIRM datum–see Section ) `"Yr�� 2. Date of the start of construction or substantial improvement . <�a.L U C�' ' FEMA Form 81-31�MAY 90 REPLACE$ALL PREVIOUS EDITIONS SEE REVER SID ',FOR CONTINUATION i� � �� ' ��SECTION E CERTIFICATION This certification is to be signed by a land suroeyor, engineer,or architect who is a�thorized by state or local law to certity 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 are authorized by local law or ordinance to provide floodplain management information, may also sign th.� 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 certificatbn. Reference level diagrams 6, 7 and 8- Distinguishing Features—If the certifier is unable to certify to breakaway�non-breakaway wall, enctosure size, location of servicing equipment,area use,wall openings,or un!inished 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. I certify that;he information in Secfions 8 and C on this certificate represents my best efforls to interpret the data availab/e. 1 understand that any la/se statement may be punishable by fine or impr,sonment under 18 U.S. Code. Section 1001. �,w.r L. -�-��,� -c PL S� 3 7+�67 CERTIFIER'S NAME LICENSE NUMBER(or Affix Seal) ��LD6�YT s+f�N�RSTb1�e' �NGINE�i?i(�t� �:SU��ldlS rnlC TITLE COMPANY NAME 1�33 C�tF-Ta•S�v a�ve �-..ns "G' C�aaw e �i,oe,�a s :s ADDRESS CITY STATE Z�p • 12•26- 8�3- SIGNATU DATE PHONE Copies should be made ot this Ce icate for:1)community official,2)insu�ance agenUcompany,and 3)building owner. COMMENTS: —� ON 1M�TFI ON PILES, SLAB BASEMENT PIERS,OR COLUIdNS A V A A V � 20NES 20NES 20NES ZONES 20NES � REfERENCE ` REFEREHCE LEVEL REFERENLE ! LEVEI �E �ppp LEVEL ELEVATION . '?z• �.4:'.. �W_.:..a:::�c; n. �_j!1,::.,:.,*::�fti' „tl:;:tr.. �� BASE :';:::;,';`.:.`��•':.: :y:: 9ASE F1000 ''�'�'I��'��"' ADJACENT�:� s. REFERENCE FLO00 s:K: .�.. ELEVATION HEFERENCE GNADE � LEVEI EIEVATION �WJACENT ;;'..'i ,% LEVEL GRAOE '`< �,... ,:f � `}:r�};:=!Y:::.•.; �7�� ;S�'.t:::•.`::::�;��;.: e",. ,. l . . �, .;': ; '.:. � '.,� .;. ; .��: ..� . �... . , :.. . . �::.i.:'.?:..: a ' ' , . .. ,�',: .';.:.:�:i•% ..`::A0.IACENT',. � , ,. . - �..�,�1� GRADE . . +.��:�:l.:..... _..... "I�III�:�`,:�: . , � � The diagramS abpve'illustrate the points at which the elevations should be measured in A Zones and V Zones. „�. , ,� Elevatfons for all A.I;��i�;�hould be measured at the top of the reference level floor. . .; , , .- ' Efevat;ons for all V �es'should be measured at the bottom of the lowest horizontal structural member. �i. � Page 2 .�;