18390 NE 30 AVEPROCESS # FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067 -0077
FOLIO # NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002
C.O.R. /a, �' ELEVATION CERTIFICATE
Important Read the instructions on pages 1 -7. Amended by MDC -DERM- OCT, 1999
SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use:
BUILDING OWNER'S NAME Policy Number
1
BUILDING STREET ADDRESS Qncluding ApL, Unil, S ' andlor Bldg. No.) OR P.O. ROUTE AND BOX NO Company NAIC Number
CITY STATE ZIP CODE
Numbers, Tax
etc.)
LATITUDEWNGrf UDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (type):
( IMF° -t f? - ##.#r or #ftJH f W) 0 HAD 1927 )] HAD 1983 ❑ USGS Quad Map ❑ Other.
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. jdFIP COMMUNITY NAME & COMMUNITY NUMB
B2. COUNTY NAME
63. S TE
B4. MAP AND PANEL
65. SUFFIX BB. FIRM INDEX
B7. FIRM PANEL
B8. FLOOD
B9. BASE FLOOD ELEVATION(S)
NUMBER
12OZ�c o0
DATE
3-D�
EFFECTIVFJREVISED DATE
- 20 - '3
ZON S)
Lf
(Zone , use depth of flooding)
X
BID. Indicate the source of lh3-Elase flood Elevation ($FE) data or base tiood depth erriered in B9.
❑ FIS Profile FIRM ❑ Community Detgpwted ❑ Other (Describe):
B11. indicate the elevation datum used for the BFE in B9: GVD 1929 ❑ NAVD 1988 ❑ Other (Describe):
Bit. 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: El Cons "auction Drawings* ❑ Buildng Under Consimr. &on' tnished Construction
*A new Elevation Certificatewill be required when construction of the building is complete.
C2. Building Diagram NumeE fJ (Select the buldng diagram most similar to the building for which this certificate is being completed - see
Pages 6 and 7. If no diagram accurately represents the "ding, provide a sketch or photograph.)
C3. Elevations — Zones Al -A30, AE, AH, A (with BFE), VE, Vi -V30, V (with BFE), AR, ARIA, AR/AE, AR/AI -A30, ARIAH, ARIAO
Complete Items C3a4 below according to the building diagram specified in Item C2. State the datum used. fi 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
calculainUse the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion.
DattmttKVr/ Crnrversiow ��y���99
E" 'on reference mark used t� the elevation reference mark used appear on the FIRM? ❑ Yes *Wict-
11
E a) Top of bottom floor (mduding basement or enclosure) f Gzfr jm) m
❑ b) Top of next higher floor �. _fL(m)
c) Bottom of lowest horizontal structural member (V zones only). ft. {m❑ d) Attached garage (top of stab) E j
• e) Lowest elevation of machinery and/or equipment W. ih
servicing the building 6n ft.(m)
• f) Lowest adjacent grade (LAG) i t _20 fL(m) m v 7
O g) Highest adjacent grade (NAG) fZ�fi {m) l n�
• h) No. of permanent openings (flood vents) within 1 ft. above adj cent grade J(0
• i) Total area of all pemm tent openings (flood vents) in C3h _sq- Jn. (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 ttris certificate represents my best efforts to interpret the data available.
! understand that any false statement inay be punishable fi ne orun risonment under 18 U. S. Code, Section 1001.
CER(IflER'S NAME G/7� P� ff h� LICENSE NU
( C Ti TA SURVEYORS INC
TITLE 1�� ff����� vv C ANY, ME 32O 7TH AVL- S '-,---225
-- F'"0eyn Z,--) MIAMI F1
_0 /un,m
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. _ For Insurance Company Use:
VNl
OR ARCHITECT
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenticompany, and (3) building owner.
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 for 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 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 U —i ft.(m) L_Uin.(cm) L_i above or iJ 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
L_L_i ft.(m) UJin.(an) 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
floodolain management ordinance? I I Yes I 1 No '1 1 Unknown. The local official must certify this information in Section G.
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owners 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 attach)
INFORMATION
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.
G1.1 I 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. 1J The following information (Items G4 -G9) is provided for community floodplain management purposes.
G7. This permit has been issued for: Li New Construction LJ 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: —fL(m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
Check here
FEMA Form 81 -31. AUG 99 REPLACES ALL PREVIOUS EDITIONS