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� FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
�, NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002
, ELEVATION CERTIFICATE
���//S�p �rrl �� OI O � Im ortant: Read the �nstructions on pages 1 -7.
SECTION A-PROPER:TY OWNER INFORMATION �t�i':I��,��n���r���i�y�)�,�' ,,
BUILDING OWNER'S NAME • . �pp�i���� �� � :% ��� �
JMC. �� Ni-ri�s , �,�� ��:
, ��, � � ;���' n, ;
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BUILDING STREET ADDRE S(Inc�uding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. �ZC�tljpany(�A,��tu�rpi��"'„ 3���
c/ / `>Ati,l A G� .STi'�� ...T —' l�0��7'tf Tp l.�l�R--- �`
ZIPkCODE % , y
'�.L�K t�t//�T �d�� �3�
PROPER DESCf21P ION(Lot and Biock Numb�rs,Tax Parcel Number,Legal Description,etc.)
�.o-r :1. , ��n.i,��ua � �,a��..E Cc..�u� �1�.pi�����nJ �.� l 2.� ,�,5 13���--
BUI ING US�Res dential,Non-res�3ci nUa�i,Addition,Ac�essory,etc. Use a Comments area,if necessary.)
�E.at���'"TT%4.c._.�-
LATITUDE/LONGITUDE(OP710NAL) HORIZONTAL DATUM: SOURCE: �_�GPS(Type):
( ##°-##'-!1#.�!#" or #t#.#�#�##°) �_�NAD 1927 �_�NAD 1983 ��USGS Qu�d Map �_�Other. _
SECTION B-FLOOD INSURA�CE RATE MAP(FIRM)INFORMATION
61.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME B3.STATE ��
Cc.�Ar��.wa'r�r�. 1250�1 cv Pi�.�.�...��,
64.MAP AND PANEL B5.SUFFIX B6.FIRM INDEX B7.FIRM PANEL B8.FLOOD 69.BASE FLOOD ELEVAT�ON(S)
NUMBER DATE EFFECTIVE/REVISED DA7E ZONE(S) (Zone AO,use depth of flooding)
a D a�►g ��q a � i R i � E i i �
610.Indicate the source of the Base Flood Elevation(BFE)data or ase ood depth entered in B9. '
�—�FI.>Profile ��FIRM �_�Community Determined �_�Other(Describe): _ ____ _
611.Indicate the elevation datum used for#he BFE in B9:��NGVD 1929 ���NAVD 1988 �__�Other(Describe): ______
B12.is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ���Yes �__�No
Designation Date:____�_ _
SECTtON C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on: �__�Construction Drawings* �_�Building Under Construction' ��Finished Construction
''A new Elevation Certificate will be required when construction of the building is comptete.
C2.Building Diagram Number�(Select the building diagram most similar to the building for which this certificate is being completed-see
pages 6 and 7. If no diagram accurately represents the building;provide a sketch or photograph.)
C3. Elevations–Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO
Complete Items C3.a-i below according to the building diagram speci�ed in Item C2.State the datum used.If the datum is different from
the datum used for the BFE in Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion
calculation. Use the space provided or the Comments area of Section D or Section G,as appropriate,to document the datum conversion.
Datum�l�V� t�'L� Conversion/Comments___
Elevation reference mark used� ��_Does the elevation reference mark used appear on the FIRM? �__�Yes ���No
❑ a)Top of bottom floor(including basement or enclosure) 7 .�ft.�rnj-m -
❑ b)Top of next higher floor �_,,Q�ft.��
❑ c)Bottom of lowest hori2ontal structural member(V zones only) __�.[�Q _.�ft.�- w �
❑ d)Attached garage(top of slab) , _ft.(m) � � �y ��
❑ e)Lowest elevation of machinery and/or equipment W m �.--"""
servicing the building(Describe in a Comments area.) ft.(m) � � �
❑ �Lowest adjacent(finished)grade(LAG) �.�ft.(m) z' �
❑ g)Highest adjacent(finished)grade(HAG) ` �_.�ft.(m) �y O
❑ h)No,of permanent openings(flood vents)within 1 ft.above adjacent grade_ � � �� �q'�
❑ i)Total area o f a l l p e r m a n e n t o p e n i n g s(fl o o d v e n t s)i n C 3.h__Q_s q.i n.(s q.c m) J �
SECTION D-SURVEYOit,ENGII�EER,OR ARCHITECT CERTIFICATION
This certific�tion is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
I certify fhat the Information in�ections A,B,and C on this certifrcafe represents my best efforts to interpret the dafa available. .
I understand thaf any false sfatement may be punishable by fine orimprisonment under 18 U S Code,Secfion 1001
CERTIFIER'S NAME LICENSE NUMBER
TE�F,y�J +=��v��L �s � A-�3 5
TITLE �����' �I���_�� COMPANY NAME�O�ICa4��(C-„6C�–U/2�Ut��iTT"' �G.
ADDRESS,r.. ', CI STATE ZfP CODE
G..'Cv 3�I /�l GC.p�.'/Y1�G� I r. ���INA"� �� 3.3"/S
SIGNA� r--'' DATE/� I� O TELEPHON ��7 �A� �Z�!
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. >ORTANT: In these spaces,copy the corresponding information from Section A. Forinsurance Compa�y Use �-'
d..:...,; ��:::: ........ . ,::s.v :t
JILDING STREET ADDRESS(InGuding Apt.,Unit,Suite,andlor Bldg.No.)OR P.O.ROUTE AND BOX NO. p�h�+���pbe�r
/ �-�'d.lJ �`"t/J,�t, �' ,2� - IC.1 f.C.T!-�f t,�1��►2— � .....:::: n :. ..:� r .:..:.:.. ....._�
CI� � �!TATE � ZIP CODE �pqipany tJA1C NuJnjfi�� 3 ,
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5ECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community o�cial,(2)insurance agenUcompany,and(3)building owner.
COMMENT:� �W4TiaNS RCI�.E T�L�S�.� Oh� Gt�Z/ 6-k- ���1�1�t1f�T�7�°..� ��G� ��"Yl�► m�ek5 ,
��DE_z ��, (o�'t71�a. CONG. MOnI�M�T �EL.EV= 5,(024� ana� �� D�."3�� �"''�:vS �i s�c �N
Gal.0 (��8.c,....IG. . E LL�-�/A`TI�I`J.'� .�•4-�-G'I � .
(-_� Check here if attachments
SEC710N E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BPE)
For Zone A�and Zone A(without BFE),complete Items E1.through E4. If the Elevation Certificate is intended for use as supporting
information for a LOMA or LOMR-F,Section C must be completed.
E1.Buiidin�Diagram Number (Select the building diagram most similar to the buiiding for which this certificate is being completed-
see pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.)
E2.The top of the bottom floor(including basement or enclosure)of the building is ���_�ft.(m)�_�_�in.(cm) �_�above o� �_�betow
(check one)the highest adjacent grade. (Use naturai grade,if availabie.)
E3.For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is
�—�—��t•(m)�—���in.(cm)above the highest adjacent grade. Compiete Items C3.h and C3.i on front of form.
E4.For Zone AO only. If no flood depth number is available,is the top of the bottom floor elsvated in accordance with the communiry's
floodpldin management ordinance?���Yes �_�No �__�Ur�known. The local official must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owner's authorized representative who completes Sections A,B,C(Items C3.h and C3.i only),and E for Zone A
(without a FEMA-issued or community-issued BFE)or Zone AO must sign here. The statements in Secfions A,8, C,and E are correct to
the best of�knowledge.
PROPERTY OWNER S OR OWNER'S A HORIZED REPRESENTATIVE'S NAME
ADDRESS CI7Y STATE ZIP CODE' •
SIGNATURE DATE TELEPHONE
COMMENTS
� � Check here if attachments
SEC710N G-COMMUNITY INFORMATION(OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's fioodplain management ordinance can complete
Sections A,E3,C(or E),and G of this Elevation Certificate. Complete the applicable item(s)and sign below.
G1.�__�The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor,
engineer,or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.)
G2.�_)A cammunity official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or
Zone AO.
G3.�__�The fotlowing information(Items�G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISS ED G6. DATE CERTIFICATE OF COMPLIANCFJOCCUPANCY
ISSUED
G7.This permit has been issued for: �_�New Construction �_�Substantial improvement
G8.Elevatiori of as-built lowest floor(including basement)of the building is: _ ___ft.(m)Datum:_v�____
G9.BFE or(sn Zone AO}depth of flooding at the building site is: _ __ft.(m)Datum:_ ___�
LOCAL OF ICIAL'S NAME TITLE
COMMUNIN NAME TELEPHONE
SIGNATURE DATE
COMMENTS
� . � � Check here if attachments
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, � FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
, NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002
ELEVATION CERTIFICATE
��V�S�D �� �� �� O � Im ortant: Read the instructions on pages 1 -7.
SECTION A-PROPERTY OWNER INFORMATION Fur;I�su�anceCor�pa�ylls�
... ..., . ��, ,. ,:> .. ......... ...__.i
BUILDING t�WNER'S NAME • • P�G.ey NUmber ' �
� �nc. c� ,��-�-��s �
. ,, � .,
BUILDING STREET ADDRE S(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Campany NAtC urri�F
/ / �>A tiI A G.� -5�� T -- l�-� 2�'tf �"D[�J��-- .: �
ci�.L��4�lit/+4TE �p R�/�4 c3�-? E
PR— OP�ERTI DESCRIP ION(Lot and Biock Num rs,Tax Parcel Number,Legai Description,etc.)
Lo7' 2 , /�A��►.�b,�c.a y �p�f-F Gc..uc3 �x1�.t�Jr��n�J P.S 1 Z.z t��5 13�'-l�-
BUI ING l SE e.g.,Residential,Non-resid�ntiai,Addition,Accessory,etc. Use a Comments area,if necessary.) '
�S� E�'T!'"/.4 c...�--
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ��GPS(Type):
( ##°_##'_####" or ##.#####°) �_�NAD 1927 �_�NAD 1983 ��USGS Qu�d Map �_�Other. _
5ECTION B-FLOOb INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2.COUNTY NAME 63.STATE ��
cc.����wa-r�r 125aq(,� P�u�.�.��s
B4.MAP AND PANEL B5.SUFFIX B6.FIRM INDEX B7.FIRM PANEL B8.FLOOD B9.BASE FLOOD ELEVATION(S)
NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of flooding)
C7 � Ac�C Ig 1�1� A I� 1 �i� ,q E I I �
610. Indicate the source of the Base Flood Elevation(BFE)data or ase ood depth entered in B9.
�_�FI;>Profile �X�FIRM �_�Community Determined �_�Other(Describe):_____ ________
611.Indicate the elevation datum used for the BFE in 69:��NGVD 1929 �__�NAVD 1988 �__�Other(Describe):_�
612.Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ���Yes �__�No
Designation Date:_______
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on: �__�Construction Drawings" �_�Building Under Construction' ��Finished Construction
*A new E_levation Certificate will be required when construction of the building is compiete.
C2.Building Diagram Number_�p(Select the building diagram most simitar to the building for which this certificate is being completed-see
pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.)
C3. Elevatioris—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO
Complete Items C3.a-i below according to the building diagram specified in Item C2.State the datum used.If the datum is different from
the datum used for the BFE in Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion
calculation. Use the space provided or the Comments area of Section D or Section G,as appropriate,to document the datum conversion.
Datum�JG�D��9 Conversion/Comments___
Elevation reference mark used_��G+A�M�?'7'�_Does the elevation reference mark used appear on the FIRM? �__�Yes (�� No
❑ a)Top of bottom floor(including basement or enc►osure) ____ 7 __.D�ft.(�nj-m "
❑ b)Top of next higher floor __ ��_.��ft.{r�-`�
❑ c)Boitom of lowest horizontal structural member(V zones only) ___1�p ___.?�ft.�}- N �
❑ d)Attached garage(top of slab) __, __ft.(m) � �� ��y ��
❑ e)Lowest elevation of machinery and/or equipment W m �,/^
servicing the building(Describe in a Comments area.) ft.(m) E „ �
❑ �Lowest adjacent(finished)grade(LAG) __, S_.�ft.(m) z' �
❑ g)Highest adjacent(finished)grade(HAGj ___��_, f.�ft.(m) � �
❑ h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade_�_ � � � �A'��
❑ i T o t��l a r e a o f a l l e r m a n e n t o e n i n s fl o o d v e n t s i n C 3.h_�_s J �
) P P 9 � )� q.i n.(s q.c m)
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
I certify thaf the fnformation in�ecfions A,8,and C on fhis certiftcate represents my best efforts to interpret the data available. .
I understand fhat anyfalse statementmaybe punishable byfine orimprisonment under 18 U.S.Code Section 1001.
CERTIFIER'S NAME.-r--E��Y� ��,��� LICENSE NUMBER L� � 4���
TITLE �v���/ �`������� COMPANY NAME�O�/�����Ul�� �G_
�" I
ADDRESS�. CI STATE ZIP CODE
��,3� McGor�m�� ��• '�I�nl�-�2., �l 3.�'/�'`�
SIGNA��E��� ...----� DATE�� '� TELEPHON .y ,,,r � ,��y
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• IM ORTANT: In these spaces,copy the corresponding information from Section A. Forinsurance�ompany Use
::: ::�. ..::s �'
' BUILDING STREET ADDRESS(including Apt.,U�it,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Policy NUi"1�ber
// �'A��(I �'V1,�1, �7'�2� — l�.I /�.T'f-f (etl
CI� � �`TATE � ZIP CODE CQmpany t*IAIC Number
L-�'t..r �
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community o�cial,(2)insurance agent/company,and(3)building owner.
COMMENT:� ��/4'raNS l��E 13��E.� �N c.i-r�! 6-� C��RuJ�r�. gE�c1� ��'nc� 11'1A�2�5 :
"DE-z ��, (o`�L71�, GON.G, MdnI�M�T �EI..EV,= 5,Cv24� anc� �� D�.^3�� �"'�SS �� �I�C iN
�ID (�)4 c..r k_ . �t...��/ATI p I�J� .5�� 4�—�''I � .
�__� Check here if attachments
SECTI�N E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zone A�and Zone A(without BFE),complete Items E1.through E4. If the Elevation Certificate is intended for use as supporting
information far a LOMA or LOMR-F,Section C must be completed.
E1.Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed–
see pa�es 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.)
E2.The top of the bottom floor(including basement or enclosure)of the building is I--I—I ft•�m)I—I--Iin.(cm) �__�above or �_�below
{check ane)the highest adjacent grade. (Use natural grade,if available.)
E3.For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is
�—�—��t•(m)�--�--�in.(cm)above the highest adjacent grade. Complete Items C3.h and C3.i on front of form.
E4.For Zone AO only. If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's
floodplriin management ordinance?�_�Yes �_�No �__�Unknown. The local official must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owner's authorized representative who completes Sections A,B,C(Items C3.h and C3.i only),and E for Zone A
(without a f=EMA-issued or community-issued BFE)or Zone AO must sign here. The stafements in Secfions A,B, C,and E are correct ta
the best of my knowledge.
PROPERN OWNER'S OR OWNER'S AUTHORI2ED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE •
SIGNATURE: DATE TELEPHONE
COMMENTS
�__� Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Sections A,E3,C(or E),and G of this Elevation Certificate. Complete the applicable item(s)and sign below.
G1.�__�The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor,
engineer,or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.)
G2. �_�A cammunity official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or
Zone AO.
G3.�__�The following information(Items G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY
ISSUED
G7.This permit has been issued for: �_�New Construction �_�Substantial Improvement
G8. Elevation of as-built lowest floor(including basement)of the building is: _ _ ___ft.(m)Datum:V�_______
G9. BFE or('sn Zone AO)depth of flooding at the building site is: _ ___ft.(m)Datum:___�_`_,
LOCAL OFFICIAL'S NAME TITLE
COMMUNITV NAME TELEPHONE
SIGNATURE DATE
COMMENTS
. I � Check here if attachments
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