118 WINDWARD IS _ ___ _ __ _ ___ _
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ELEVATION CERTiFICATE o.M.B.r�. 30��-oon
FEDERAL EMERGENCY MANAGEMENT AGENCY
�P�r���y 3�, ��
NATIONAL FLO00 INSURANCE PROGRAM
ATTENTION:Ute of tttls cettificete does not provide a waiver of the tlood insurance purchase requiremen�This form is used only to pro-
Mformatbn neceesary to enaure complia�ce with applicable community floodplain menagemeM ordinances,to determine
th Insurance promium rete,and/or to support a raquest for a Letter of Map A men dme r i t or Revision (LOMA or LOMR).You aro not
b respond to thb colleation of i�ormation unlesa a valid OMB control number is displayed in the upper right comer of thfs fortn.
Instructions to�completing this fortn esn be tound on the following pages.
SECTION A PROPEATY INFORMATION FoR iNSUFVwce coMPr�nv use
gUi�01f�K3 01NNEA'S NANAE / POLICY NUMBER
C�IQ>��5 /(/Q �
$TqEET AOORES$(Indudinq Apt•.UMt,Suits andlot 8 .Number) R P.O.ROUTE ANO BOX NUM9ER COMPANY NAIC NUMBER
� � L7�I
OTFIER OE3CRIPTION(�ot anA Blodc Numben.�,�o� � 9 U h �.� �. �s(a,�� Fs�9
Cm STATE �� ZIP COOE
G�flt rwa�i '
SECTION 8 FLOOD INSURANCE RATE MAP(FlRM)INFORMATION
provids ths fotloMring hom the proper FIRM (See instructions):
�,�AMUNrry NUMBER 2.PANEL NUMBER 3.SUFFIX 4.OATE OF FIRM INDEX S.FIRM 20NE 8.�f�o���T�)
! �D oDOB 1� 08-19- 9 � � � /�•o
7.Ir�fcats the elevatfon datum system used on the FIRM for Base Flood Elevations(BFE): �NGVO'29 ❑Other(describe on bacic)
8.Fcr 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 oommunity's BFE:l_I_�__UJ.U feet NGVD (or other FIRM datum-see Section B, Item 7).
SECTiON C BUILDING Ei.EVATION INFORMATION
1 slnq the Elevatlon Certlflcate Instructions,indicate the diagram number from the diagram
bes the subJect buildi�g's reference Ievel__�__ .
. FIRM Zones A1-A30,AE,AH,and A(with BFE). The top of the reference level floor fro t e e e ^
p(I I I ID�I.{�ieet NGVD(or other FIRM datum-see Section 8:Item 7). �� � 4 ��
(b). F1RM Zones Vt-V30,VE,and V(with BFE). The bonom of the lowest horizontal structu I be e e�e Iev
the selxted dlagram,is at an elevation of I�Lw.0 feet NGVD(or other FIRM d tum Section B ltem 7 .
(c). F1RM Zone A(without BFE). The floor used as the reference level from the selected di ���C������ �S
below❑ (check one) the hlghest grade adjacent to the building.
(d). FlRM 2one AO. The floor used as the reference tevel from the seleGted diagram is ��.0(eet above❑ or below[� (check
one)the hlghest grade adJacent to the building. If no tlood depth number is available,is the building's lowest floor(reference
leval)elevated I�accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown
3. IndlGats the elevatlon datum system used in determining the above reference level elevations:� NGVD'29 C'J Other(describe
under Commer�ts on Page 2). (NOTE: ll the elevation datum used in measuring the elevations is dilferent than that used on
Me F/AM (see SeCtlon B, Item 7j, then convert the elevations to the datum system used on the FIRM and show the converslon
equaHon under Comments on Page 2.)
4. ElevntlOn reterenCe mark used appears on F1RM: L� Yes �No (See Instructions on Page 4)
5,The re}erence Ievel elevation is based on: � actual construction ❑ construction drawings
(NOTE: Use ol Construcflon drawings is only valid il the building does not yet have the re/erence level lloor in place, in which
caas thls osrtlHcate wfll only be valid/or the building durrng the course of construction. A post-construcfion Elevation Certilicate
,
wl/l bs roqulred orrce construction!s complete.)
6.The elsvatlon of the lowest grade immediately adjacent to the building is:L�.111�l.l.� feet NGVO (or other FIRM datum-see
Sectlon 8,Item�.
SECTION D COMMUNITY INFORMATION
+ if the oommuntty official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
�not the"lowest floor"as defined in the community's floadplain management ordinance, the elevation of the building's"lowest
floor'aa deHned by the ordinance is: �..J.0 teet NGVD(or other FIRM datum-see Section B, Item 7).
2. Date o1 the start of construction or substantial improvement
FEMA Fortn 81-31, AUO 9A REPIACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR COPlT1NUAT10N
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SECTION E CERTiFiCAT10N
This certification is to be signed by a land surveyor,engineer,or architect who is authorized by state or local law to certify etevation
iMormabon when the elevation information for Zones A1—A30,AE,AH,A(with BFE),V1—V30,VE,and V(with BFE)is required.
Community o�icials who are authorized by local law or ordinance to provide floodplain managemen�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�
owner's represerttative may also sign the certification.
Reterence level diagrams 6.7 and 8-Distinguishing Features—It the certifier is unable to certify to breakaway/non-breakaway wall,
endosure size,IoCation of senricing equipment,area use,walt openings,or unfinished area Feature(s),then list the Feature(s)not
Indtxlsd I�the Certification under Comments below. The diagram number,Section C,Item 1,must still be entered.
I�that the inlormation in Sections B and C on this certilicate represents my best ellorts to interpret the data availab/e.
�unds�sMnd thaf any fa/se statement may be punishable by�ine or imprisonment under 18 U.S. Code, Section 1001.
CERTI E AME LICENSE N MeER�or An�x Seal)
' COM NY NAME
�woRESS U � ��m Q
C� TATE / 1P
� L �
SK3NATURE . � Q ' DATE PHONE 7 Z� ��
�O. D .
Copl�s should�mede'af thl�Certtilcate tor:1)community oHlclal,2)Insurance age�Ucompany,and 3)bulldln�owner.
, . ,�
COMMENTS: '
� .
� �T„ ON PILES.
SIAB BASEMENT P1ER3,ON COIUMNS
A y A
A V
ZONES ZONES 20NES ZONES 20NES
QEFEAENCE •
pf�EAENCE �E lEVfl 11EfE�ENGE
l[rEl s1000 IE�EI
i ElEV�iqr�
.m,. �,
6ASE - ..,:.. �. MSE
RO00 . .:`��.: �OJACENt :' " REiEi1EMCE R�p
EIEVAfqN REFEAENCE �p,��ENT GA�pE � ; IEVEI EtEV��qN
lEVEI Ga�OE ':i"
�AOJACENT'�
:.:. n.(� �_.��.�� '. 6N�OE �:
The dlagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones.
Elevations for all A Zones should be measu�ed at the toa of the reference level floor.
,
Elevations for all V 2ones should be measured at the bottom of the lowest horizontal structural member.
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