2901 NW 185 STFEDERAL
EMERGE
CY MANAGEMENT AGENCY O.M.B. No. 3067 -0077
NAT
NAL FLO
INSURANCE PROGRAM Expires December 31. 2005
E
VATI
CERTIFICATE
Imo
Road t
inatruct;oaa off pages 1 - 7.
SECT;
A - PROP
TY OWNER INFORMATION
For Insurance Company Use:
BU LOING wNERB NAME
W. BASE FLOOD ELEVATIONS)
NUMBER D
Pdlcy Number
CI42 eY Gpfe Avefv4vY'
"52Z 7
ISED DATE Z
BUILDING STREET ADDRESa Ind ing Apt., Unit. S
. endra Bldg.
) QR P. OUTE ANO BOX NO.
Company NAIC Number
gol
f V
CITY
AV
STATE 21P CO E
L . 3 O
PROPERTY DESCRIPTIO (Lot and Block Number*,
I Parcel Nu
, Legal Description, etc.)
8UILOINJi USE (e.g., Residential. No—dentlal, AAdiiii
Accessary,
tic. Use a Comments area, it necasin ry.)
u I i wnrwiva 1 v
( tie° -W - Ailiow a ae.efGSM °) �J I
'19ay SOURCE: LJ GPS (Type):
LI USGS Quad Map L.J Ocher
SECTION B - FWOD INSURANCE RATE MAP (FIRM) INFORMATION
B1, NFIP C
of
UNITY NAME 6 COMMUNITY NUMB 8
82. C N
NTY N ME 8
83STAr o
o
F .
84. MAP AND PANEL 1
1 85. SUFFIX 8
88. FIR "
7, FIRM PANEL 8
88. FLOOD W
W. BASE FLOOD ELEVATIONS)
NUMBER D
DA I
"52Z 7
ISED DATE Z
ZONES) (
(Zone AO, use depth of flooding)
13 ��
810. Indicate the source of the Base Flood Elevatil prq data base flood depth entered in 89.
I_J FIS Profile U FIRM U C munity Date fined (J Other (Describe):
011. Indicate Ire elevation datum used for the BF B9: L_I NC ID 1929 IJ NAVO 1988 IJ Other (Describe):
B 12. Is the building located In a Coastal Barrier Re urces Syste (CBRS) area or Otherwise Protected Area (OPA)? IJ Yes CJ No
Designation Dale:
SECTION C - BUI NO ELEVA ION INFORMATION (SURVEY REQUIRED)
Ct. Building elevations are based on: �IConstru Drawings IJBuilding Under Construction' (Finished ConsWcdon
'A new Elevation Certificate will be required n construct of the building is complete.
C2. Building Diagram Number (Select the ing diagram rust similar to iris building for which this certificate is being completed - see
pages 8 and 7. If no diagram . accurately repre la the build g, provide a sketch o' photograph.)
C3. Elevations - Zones AI-A313, AE, AH, A (with B ). VE. VI-V2 , V (with BRIE), AR, AR)A, AWAE, AR/A1 -A30, AFVAH, Ai
Complete Items C3.a -i below according to the ilding diagra spedlied in Item C2. State the datum used. If the datum is different from
the datum used for the BFE in Section B. pan the datum i that used for the BFE. Show field measurements and datum conversion
calculation. Use the space provided or the C ants area Section, O or Section G. as appropriate, to document the datum rnnvarsion.
Datum Conversion /Comments
Elevation reference mark used Doe the elevation reference mark used appear on the FIRM? LI Yes J No
❑ a) Top of bottom floor (Including basement it
_ R ft. (m) 0
O b) Top of next higher floor 4 (m)
O c) Bottom of lowest horizontal structural ma i3er (V zones ly)
• d) Attached garage (lop of stab) nn'' 1
irL W� KQ��I�CJV�
• e) Lowest elevation of machinery andlor eQ pm m
() c ent � 1
servicing the building (Describe in a Com mants area.) A— fl.(m) a Q , r
• 0 Lowest adjacent (finishod) grade (LAG) R.(m) `� Ll `7
• g) Highest adjacent (finishad) grade (HAG) ft. (M) A (L
• h) No. of permanent openings (flood veres) thin 1 R. a adjacent grade 4' 03
• i) Total area of all permanerd openings ( vents) M G3. sq. in. (sc . tx71) rf /k
SECTION D - Su, EN NEER OR ARCHITECT CERTIFICATION
This cartrrcation Is to be signed and sealed by a 1* surveyor. a ginear, or architect authorized by law to certty eievation information,
l certify that the information In Sections A, B, and on this ceft to ne resents my best efforts to interpret the date available.
I understand that any false statement may be purr' able by fine imadkonment under 1 R IL.1; rd. ,Cwd /nn rr »1
IIILE I �IAJ0 SU
ADDRESS. -�`t
SIGNATURE
FEMA Form 81.31, January 2003
_ZA_. - 9L)V-I
See reyer* side for continuation,
r TA3ANns- GNtL17---W-H
all previous editions
6Z70E017195 11 :60 p00Z/OT /E0
C
SECTION D - Su, EN NEER OR ARCHITECT CERTIFICATION
This cartrrcation Is to be signed and sealed by a 1* surveyor. a ginear, or architect authorized by law to certty eievation information,
l certify that the information In Sections A, B, and on this ceft to ne resents my best efforts to interpret the date available.
I understand that any false statement may be purr' able by fine imadkonment under 1 R IL.1; rd. ,Cwd /nn rr »1
IIILE I �IAJ0 SU
ADDRESS. -�`t
SIGNATURE
FEMA Form 81.31, January 2003
_ZA_. - 9L)V-I
See reyer* side for continuation,
r TA3ANns- GNtL17---W-H
all previous editions
6Z70E017195 11 :60 p00Z/OT /E0
C
IIILE I �IAJ0 SU
ADDRESS. -�`t
SIGNATURE
FEMA Form 81.31, January 2003
_ZA_. - 9L)V-I
See reyer* side for continuation,
r TA3ANns- GNtL17---W-H
all previous editions
6Z70E017195 11 :60 p00Z/OT /E0
C
from Section A. For Ineurance
f-{ V Alt U r a t 33ZIP CODE Company NAIL Number _ LIQ
SECTION O - SURVEY r ENGINEE OR ARCNfTECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Cartiflcals for (1 community 'al. (2) insurance agemkompany, and (3) building owner.
COMMENTS _.
- - - -- ° -- -- ••
For Zone Ap and Zone A (without BFE), complete
. "un tau
El.
veT nu I REQUIRED) FOR ZONE AO AND ZONE A (wRAOUT BFE)
information for a LOMA w LOMR -F, Section C mu
ms thro gh E5. if the Elevation Certificate Is intended for use as supporting '
be complete .
E7. Building Diagram Number (Select the
see pages fi and 7. It no diagram accurately r
ding diagr
esents the
most similar to the building for which this carbficate is being completed -
E2. The top of the bottom floor (including bosoms
or
cling, provide a sketch or photograph.)
(check one) the highest adjaeont glade. (Use
enclosure
plural grade,
the building is I_L) ft. (m) IJ_f in (dm)
available) iJ above or IJ below
E3. For Building Diagrams S-8 with openings (see
JIJ R. (m) I_ (rm) above the higher
7), then
higher floor or elevated floor (elevation b) of the bttllding is
—fin. jacont gra
E4. The top of the platform of machinery and/or eq 7pment servi
Compiete'I1ems C(3.h and C3,Yon front Of torn.
g the building is I__1__� ft, m in.
( ) (—L_J
(check one) the highystadjacem grade. (Use
rural grade,
Cm
( )JJ above or jJ below
evailabl9.)
E5. For Zono AO an If no flood depth number rs
flood lain mane ement ordinance? Yes
ilable, Is
top Ot the bottom floor elevated in accbrdance with the community's
SECTION F- PROPERAtNNCU
No
rn
nkno ,The local Oflicial must Corti this information in 8ectim G.
nw�, e
...f .,h a nr,.,n rvn
The property owner or owner's authorized repres tiva who plates SeNons A, B, C (Items C3.h and C3.) only), and E for Zone A
(without a FEMA- issued or community- issued BF or Zone AO ust sign here. The statements in So A, B, C, art' E orb correct to
the best or my e.
PROPERTY
I ne IOcal official who is authorized by law or ordina
Sections A, 8, C (or E), and G of this Elevation Cat
G1. IJ The information In Section C was taken fro:
engineer, w architect who Is authorized b)
elevation data in the Comments area bolo
G2. J A community official completed Section E I
Zone AO.
03. J The following inlamiation (Items G4-Gg) is
Ge. PERMIT NUMBER G5. GATE PEf
G7. This Permit has been issued for; I_j New C(
G8. Elevation of as -built lowest flow (including base
Gg. BFE or (In Zone AO) depth of flooding at the bu
S
Forth 81 -31, January
i• .�.,�.....n c a r,nme
CI STATE ZIP CODE
DATE TELEPHONE .
G - COMMU TTY INFORMATION (OPTIONAL) Check here if attachment'
e to adminis ir the oommunity's floodplain management ordinance can Complete
rate. Comps to the applicable item(s) and sign below.
other docurr ntation that has been signed and embossed by a licensed surveyor
Ate or iobal I w to Corby elevation information. (indicate the source and date of the
a b0ildingloi 31ad in Zone A (without a FEMA- issued or community - issued BFE) or
3vlded for Or nmunity .800 iplain management purposes.
T ISSUED G6. DATE CERTIFICATE OF COMPLUWCEioCCUPANCY
SSUFJJ
(auction L J Substanttat improvement
rM) of the b [ding It'; r. (m) Datum:
ng site is:
`R (m) Datum;�
TITLE
TELEPHONE
DATE
all previous editions