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18375 NE 30 CTFEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067 -0077 NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 ELEVATION CERTIFICATE pp p Important: Read the instructions on pages I - 7. fCrwl t # 0/ 6 is SECTION A - PROPERTY OWNER INFORMATION I For Insurance Company Use: BUILDING STRE�TA D�DRESS�cl� ding Apt nit, Suite, and /or Bldg. No.) OR P.O. ROUTE AND BOX NO. I Company NAIC Number CITY ! /l�/J/ A �l �� (�' STAT O /p� ZIP CODE PROPERTY/ DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) BUILDING USE (e.g., ResidentialAon_resideqjja(, Addition, Accesspry, etc. Use Comments section if necessary.) LATITUDE /LONGITUDE (OPTIONAL) ( ##° - ##' - ##.##" or ##.##tMF# °) HUKICUN IAL UA I UM: SOURCE: Li GPS (Type): 1 -1 NAD 1927 (J MAD 1983 U USGS Quad Map I_I Other: SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. FIP COMMUNITY NAME & COMMUNITY NUMBER .tJrN��f'07Of cD -/Z06 62. COUNyTY NAME � r1<4fo1'4( -' JF)Di� B3. STAB co�0; B4. MAP AND PANEL B5. `SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION" NUMBER /ZOZ Jr c �8 -�' DATE I -Z ®%'3 EFFECTIVE/REVISED DATE �3 -f32- ZONES) � (Zone AO, use depth of floodir. 8.d ' B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in 89. 1J FIS Profile I_t-j'rIRM 1J Community Determined I Other (Describe): 811. Indicate the elevation datum used for the BFE in B9: 1_!J 'NGVD 1929 LI NAVD 1988 1 -1 Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? I —i Yes 1_1 No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: I- 1Construction Drawings' iJBuilding Under Construction" Finished Construction 'A new Elevation Certificate ill be required when construction of the building is complete. C2. Building Diagram IN / (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no di ram accurately represents the building, provide a sketch or photograph.) C3. Elevations -Zones Al -A30, AE, AH, A (with BFE), VE, V1430, V (with BFE), AR, AR/A, AR/AE, AR/A1 -A30, AR/AH, AR /AO Complete Items C3a -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 calculatiop. Use he space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. - Datu V t/ Conversior�(CommenIS Elevation reference mark used M9 4 Does the elevation reference mark used appear on the FIRM? 1_1 Yes 1_1 No Qn) Top of bottom floor (including basement or enclosure) �_ ft.(m) M-b-)Top of next higher floor .`� ft.(m) a ❑ c) Bottom of lowest horizontal structural member (V zones only) fL(m) o S Attached garage (top of slab) ft.(m) E ❑ e) Lowest elevation of machinery and /or equipment u m servicing the building .00ft.(m) A tB'i) Lowest adjacent grade (LAG) _ fl.(m) i a ❑ g) Highest adjacent grade (HAG) _ ft.(m) vN ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade ❑ i) Total area of all permanent openings (flood vents) in C3h sq. in. (sq. cm) 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 that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be pynishable by fine or imprisonment under 18 U.S. Code, Section 1001 CERTIFIER'S NAME a r7 n' � G "LICENSE NUMBER TITLE COMPANY ME ia2 ®9 § W ORS INC ADDRES CITY STATi iylAMI, FLZIP 6-5325 SIG UR • e DATE TELEPHONE. •FEMA Form 81 -31, AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In these spaces, copy the corresponding information from Section A. I For Insurance Company Use: I D - SURVEYOR, ENGINEER, OR Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Check here if attachments sFCTIr1N F - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO 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. El. 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.) E2. The top of the bottom floor (including basement or enclosure) of the building is IJJ fL(m) I_L.lin.(cm) LI above or LI below (check one) the highest adjacent grade. E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is _LI ft.(m) I_IJin.(cm) above the highest adjacent grade. 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 anndnlaln n,ananement ordinance? I I Yes I I No 11 Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESEN I A I Wt) ctrc r lr-! sA r rvr The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA - issued or community- issued BFE) or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE here if SECTION G -COMMUNITY INFORMATION (OPTIONAL) -tie local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete ctions A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. 1_1 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. I A community official completed Section E for a building located in Zone A (without a FEMA- issued or community- issued BFE) or Zone AO. G3. I The following information (Items G4-G9) is provided for community floodplain management purposes. G7. This permit has been issued for: IJ New Construction IJ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: _ ft.(m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: _ ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE Check here if FEMA Form 81 -31. AUG 99 REPLACES ALL PREVIOUS EDITIONS