18455 NE 30 AVE (2)FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
O.M.B. No. 3067 -0077
Expires July 31, 2002
Important: Read the instructions on pages 1 - 7. P - Xfv;tl, �#= nl— 1332
SECTION A - PROPERTY OWNER INFORMATION I For Insurance Company Use:
BUILDING / TR E ADDRESS (Inc din Apt., Unit, Suite, and /or Bldg. No.) OR P.O. ROUTE AND BOX NO. I Company NAIC Number
nu � I
�f' 3 D quc
CITY �,_ _ - STATE /^/ / ZIP CODE
LATITUDEILONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: 1_I GPS (Type):
( ##° - ##' - ##.#ir or ##.#tt#W) L_I NAD 1927 L1 NAD 1983 1_1 USGS Quad Map LI Other:
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
NI
9NFIP COMMUNITY NAME COMMUTY NUMBER
B2. COUNTY NAME
B3. STATE
/�i
/ii CG2 pro aci- OG3�
�Jr 9/rr /'- Oact�
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B4. MAP AND PANEL
B5. SUFFIX
B6. FIRM INDEX
67. FIRM PANEL
B8. FLOOD
B9. BASE FLOOD ELEVATION(S)
NUMBER
C oo�1
T
DATE
7-17- '71-
EFFECTIVE/REVISED DATE
� -a -Fs4
ZONES)
.19 E
(Zone AO, use depth of Flooding)
Pa
BID. Indicate the source of the B se Flood Elevation (BFE) data or base flood depth entered in B9.
1_1 FIS Profile IRM 1J Community Determined I Other (Describe):
B11. Indicate the elevation datum used for the BFE in B9: Ie1-NGVD 1929 1J NAVD 1988 L1 Other (Describe):
B12. Is the building located in a Coastal-Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? IJ Yes 1,J.N6
Designation Date:
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: 1_1Construction Drawings' (JBuilding Under Construction' 1,,nfFinished Construction
`A new Elevation Certificate yfill Pe required when construction of the building is complete.
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 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
calculation. Use space provided or the Comments area of Section D or Section G, as appropriate, to docu e t the datum conversion.
D ConversioN,C�omme is
Ele ion ref re th nce mark used U /1 Does the elevation reference mark used appear on the IR ? L1 Yes Li No
ff a) Top of bottom floor (including baseme t or enclosure) 7T —1 ft.(m) v
El b) Top of next higher floor Gi _ ft.(m)
❑ c1 Bottom of lowest horizontal structural member (V zones only) n 61 _ ft.(m) 19
d) Attached garage (top of slab) f 7 ft.(m) E s V
❑ e) Lowest elevation of machinery and /or equipment
/servicing the building n /� _ _ ft.(m) S - rrrTTT \
Ci� owest adjacent grade (LAG) f "/ ft.(m) Z.-
Ci g) Highest adjacent grade (HAG)
• h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade n Aa
• i) Total area of all permanent openings (flood vents) in C3h 44 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 Vater*nt may be punishable by fine orimprisonment under 18 U.S. Code, Section 1001
CERTJFJEIt'Si LICENSE NUMBER
TITLE sv�.v O r COMPANY NAME CE!-TA
ADDRESS CITY
SIGNA RE DATE (J 0/ TELEPHONE ?C)LT- -.09 69
FEMA Fnrm AUa ei ir_ oo 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 STATE ZIP CODE Company NAIC Number.
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.
1_I 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 LL-1 ft -(m) LLlin.(cm) Ll above or Ll 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 _1-1 ft.(m) I— l— lin.(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? U Yes Ll 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 hen:.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
L1 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. 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. "A community official zompleted 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 -Gg) is provided for community floodplain management purposes.
G4. PERMIT NUMBFR - G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE /OCCUPANCY
ISSUED
G7. This permit has been issued for: Ll New Construction Ll 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 attachments
FEMA Form 81 -31, AUG 99 REPLACES ALL PREVIOUS EDITIONS