Loading...
18410 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. ELEVATION CERTIFICATE r I 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 BUILDINGS ETADD S lnduding Apt., Un9, Suite, andlor Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number CITY STATE ZIP CODE p LATITUDE (LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: [I GPS (Type): -1##' - 41#19r or ##A##9n ❑ NAD 1927 0 NAD 19B3 0 USGS Quad Map, ❑ Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. PAP COMMUNITY NAME & COMMUNITY NUMB 82 COUISIY NAME 83.5 TE B4. MAP AND PANEL NUMBER C 2025 -c oil B5. SUFFIX B6. FIRM INDEX DATE 3 -D 9, 87. FIRM PANEL EFFECTIVEIREVISED DATE BB. FLOOD ZONE S) f3� 89. BASE FLOOD ELEVATION(S) (Zone A�q, use depth of flooding) d . 810. Indicate the source of the se Flood Elevation ($FE) data or base iio6d depth entered in B9. E7 FIS Profi{e ffFIRM © Community Dettpwied [I Other (Descdbe): B11. Indicate the elevation datum used for the BFE in 139: FTkGVD 1929 EI NAVD 1988 E3 Other (Descnbe): . 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes E] No Designation Date . SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings' Betiding Under COMI]R cticin' &frushed Construction 'A new Elevation Cerffic4qwifl be required when construction of the building is complete. C2. Budding Diagram Numbed (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. if no diagram accurately represents the building, provide a sketch or photograph.) C3_ Elevations - Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, ARIA, ARIAE, AR/Al -A30, ARIAH, ARIAO Complete Items C3a 4 below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Straw field measurements and datum conversion calcuia �.pnf�j nUse the space provided or the � Comments area of Section D or Section G, as appropriate, to document the datum conversion- Datum tVVrl Convessuzon�r� Et" -on reference mark used the elevation reference mark used appear on the FIRM? D jNo. @'a) Top of bottom floor [uu9udmg basement or enclosure) f fL(m) ❑ b) Top of next higher floor. _il(m) Q1 0 c) Bottom of lowest horimntal structural member (V zones only) ❑ d Attached E ° garage (fop of slab) f� (m) E E3 e) Lowest elevation of machinery andfor equipment m m servicm the brnldin " " "fL m 0 f) Lowest adjacent grade (LAG) t ? ft(m) z 0 g) Highest adjacent grade (HAG) � 0 h) No of permanent openings (flood vents) within 1$ above adjacent grade 0 1) Total area of all pemtanent openings (flood vents) in Cab _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 cerfrfy that the information in Sections A, B, and C on ibis certificate represents my best efforts to interpret the data available. 1 understand that anv false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. SURVEYORS TITLE _ -- _. C6MPANY�T3205 5 W 137TH AVE S, 7 225 ,5C,� -i7eyr ,--) lu�euu_ r1 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: BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and /or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number CITY ZIP SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. COMMENTS 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 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_J fL(m) LL)in.(cm) L1 above or v 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 I I_i fL(m) J_Uin.(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? 1_1 Yes Li 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 COMMENTS )J 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, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. J_J 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_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. 1-1 The following information (Items G4 -G9) is provided for community floodplain management purposes. G7. This permit has been issued for: L1 New Construction "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: _ fit(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE Check here if attachments FEMA Form 81 -31, AUG 99 REPLACES ALL PREVIOUS EDITIONS