57 IRIS ST ���'� � ��� ' ' ' � � ''?'f ELEVATION CERTIFICATE O.M.B.No3067-0077
� a � �„�, ,�.�.��.e� ,o;�' � . Exp�resMay31, 1993
�������-� �� ' ERAL EMERGENCY MANAGEMENT AGENCY
,,� � ���� NATIONAL FLOOD INSURANCE PROGRAM
AlT NTION:��e�f�is certifiicate does t provide a waiver of the flood insurance purchase requirement. This form is used only to
v de elex��tQ i r ��to ensure compliance with applicable community floodplain management ordinances,to
te mir{at��h����� r te,and/or to support a request for a Letter of Map Amendment or Revision(LOMA or LOMR}.
CITY� c r completing this form can be found on the following pages.
'' SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE
BU LDING OWNER'S NAME . POLICY NUMBER
�
STREET ADDRESS(Including Apt.,Unit,Suite and/or Bldg.Number)OR P.O.RO'JTE AND BOX NUMBER COMPANY NAIC NUMBER
-� �
OT,jER DESCRIPTION(Lot and Block Numbere,etc.)
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��Ty � � S�ATE �T� ZIP CODE
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SECTION B FLOOD INSURANCE RATE MAP(FIRM)INFORMATIOt�
Provide the following from the proper FIRM (8ee Instructions):
1.COMMFINITY NUMBER 2.PANEL NUMBER 3.SUFFIX 4.DATE OF FIRM INDEX 5.FIRM ZONE 6.BASE�LOOD ELEVATION
(in AO Zones,use depth)
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7. Indicate the elevation datum s�slem used on the FIRM for Base Flood Elevations(BFE): � GVD'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 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
). FIRM Zones Ai-A30,AE,AH,and A(with BFE). The top of the reference level floor from the selected diagram is at an elevation
of ' � � �.'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 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 from the selected diagram is - ' �.!�feet above� or
betow:_ (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 ._feet above� or below L�(check
one)the highest grade adjacent to the building. If no flood depth number is available, is tha building's lowest floor(reference
level)elevated in accordance with the community's floodplain management ordinance? _ Yes _ No ` Unknown
3. Ic�dicate the elevation datum system used in determining the above reference level elevations:— NGVD'29 ^� Other(describe
under Comments on Page 2). (NOTE: lf the elevation datum used in measuring fhe elevations is different ihan that used on
the FlRM �see Section 8, ltem 7J, then convert the elevations io the datum system used on the FIRM and show ihe 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 yet have!he reference leve!floor in place,in which
case this certificate will only be valid for the building during the course of construction. A post-construcfion Elevation Certificafe
wil!be required once construction is complete.)
6.The elevation of the lowest grade immediately adjacent to the buifding is:' �.�'feet NGVD(or other FIRM datum-see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
�If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
;s 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: � ��� (J.L! 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�MAY 90 REPLACES All PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION
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 are authorized by Iocal law or ordinance to provide floodplain 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 level 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.
I certify that the information in Sections B and C on this certificate represents my besi efforts to interpret the data avai/able.
!undersiand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 100 i.
RTIFIER'S NAME ``, ��e1��oN 0 � ENSE NUMBER(or Affix Seal)
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TITLE ,�::�" "0•e��i COMPANY NAME
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ADDRESS y �,� ,,�,� � ��+ CITY � � STATE � ZIP
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SIGNAT E • ` .y � . ,C3 ° � DATE PHONE
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Copies sho�id�}�d,�•O�•tY�`�grts te for: 1)community official,2)insurance agenUcompany,and 3)building owner.
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COMMENTS: '
•
� ON WITH ON PILES,
SLAB BASEMENT PIERS,OR COLUMNS
A V A A V
20NES ZONES ZONES 20NE5 ZONES
REFEFENCE
flEFEHENCE .�E LEVEI PEfERENCE
LEVE: fIOOD LEVE:
ELEVATION
♦
BASE ::."r;'�!:l'� ' BASE
..�:.%�'';:�`: AOJACENT�:�. REFERENCE F1000
� `��G . ELEVA710N
�:EVATIOt. GPAOE IEVEL
REFERENCE qp,�ACENT -
LEVE: GRADE
�'.:�ADJACENT�;�
�..��.. i!1 . . �_:�.�.�.::.:, GHADE� �.
IT{!K
The diagrams abov�e 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 floor. •
Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member.
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