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18380 NE 30 AVEPROCESS # FOLIO # C.O.R. FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Read the instructions on panes 1 - 7. O.M.B. No 3067 -0077 Expires July 31, 2002 ended by MDC -DERM- OCT. 1999 SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number BUILDING STREET A,DD SS / induding ApL, Unit ite, andlor Bldg. No.) OR P.O. ROUTE AND BOX NO. I Company NAIC Number / b T n Y �C CITY STATE ZIP CODE LATFfUDFA DNGITLIDE (OPTIONAL) Z HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): (t l° - ' - ## t#X or St .ffr j ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map 0 Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1_ VFIP COMMUNITY NAME & COMMUNITY NUNS 62. C01MIY NAME CO 83. -r TE 64. MAP AND PANEL B5, SUFFIX 66. FIRM INDEX B7. FIRM PANEL B8. FLOOD 89. BASE FLOOD Fj FVATION (S) ,NUMBER �- DATE 1 - EFFECTIVEIREVISED DATE ZONE S) (Zone ,use depth otfiooding) . X l2oZ.5c ©or?�J -OS- - 20- 3 /M © B 10. Indicate the source of "se Flood Elevation ($FE) data or base food depth entered in B9. El FIS Profile ErFIRM [I Community Deb 'red [] Other (DPsc:n"be): 1311. Indicate the elevation datum used for the BFE m B9: GVD 1929 r] NAVD 1988 [j Daher (Descdbe): B12. Is the budding located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? D Yes ❑ No Designation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevation n s are based on: L] Construction Drawings' Building Under Conshuction' finished Constriction "A new Elevation Cam will be required when construction of the building is complete. C2. Building Diagram Ilrunb7(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 Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (wlh BFE), AR, ARIA, ARIAS, ARIA1 -A30, ARIAH, ARIAO Complete Items C3a4 below according to the building diagram specified in hem 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 caicuta �" n�) Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Daiumt yvrl Cvrrversionl Elev on reference rruadr usedCMrr�b� the elevation reference mark used appear on the FIRM? )] Yes 0 No &'a) Top of bottom floor (including basement or enclosure) �''�'' �QL�ft.(m) 0 b) Top of next higher floor ��n . ft.(m) 0 c) Bottom of lowest hor"tmrital structural member (V zones only) _ fL(m) 9 Y 0 d) Attached garage (top of slab) f�� (m) E 0 e) Lowest elevation of machinery andfor equipment servicing the building /� } tL(m) E . l 0 i) Lowest adjacent grade (LAG) i f fL(m) C 0 g) Highest adjacent grade (HAG) Cl h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade `1 e 0 i) Total area of all permanent openings (flood vents) in C3h _sq. hr. (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 punishable byfine orimprisonment under 18 U.S. Code, Section 1001. A SURVEYORS U 7-223 FEMA Form 81 -31, AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS IMPORTANT: In these spaces, copy the corresponding information from Section A. I For Insurance Company Use: CITY CODE SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CON] INUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. 1_1 Check here if attachments SECTION E - 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 fora 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 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 I I IL(m) IJJin.(cm) U above or 1J 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 1_I_I ft.(m) IJ_Iin.(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 floodplain management ordinance? 1J Yes Ll No '1_1 Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) GERI RICA I JUN 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 Check here if attachments SECTION G - COMMUNITY The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. 1J 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. 1_1 A community official completed Section E for a building located in Zone A (without a FEMA- issued or community- issued BFE) or Zone AO. G3,1 I The following information (Items G4 -G9) is provided for community floodplain management purposes. G7. This permit has been issued for: 1_1 New Construction 1J Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: _ fL(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