Laserfiche WebLink
ELEVATION CERTIFICATE OA1e'�'�°' <br />EXPIREF: JUNE OII lYYO <br />FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM <br />TMa lo�m b lo �a usM Icr: q Poa��FlpM comtrvaion only w�on t�a Uuo tl� Inlormnllon I� avalinhle' I�e huilalnp elto; nn0 t� Pro-FIRM GuliClnp� utoE minp Pm4FIRM rNef. <br />ImUvc�iom Inr complolln0 m'n lo�m cnn �a r-.�� on Ine rovone �IOo. <br />STPEETADDFE55 <br />11pI.dIUm4U w:s / IOp,B NO. pOU %NU B <br />OTHER DESCFIPTqN (Bbck �nE bi numNn., Nc.) <br />dion lor zones M�A30. <br />or fAe ownei s reprox <br />roO br loal law a ad <br />cax <br />SECTION I BUIIDING ELEVATION INFORMATION <br />Ihe <br />wAo <br />1. Using Ihe Flood Insurenco Manual or the NFIP Flood Insurance App���cation—Pah 2 Workshee6 i^dicate Ihe prooer diagrem numbar_ <br />•/ 2. FIRM Zones A7•A30, AE, AH, end A(with BFE). The lop of Iho rele:ence level floor from Ihr � ected diegram is at an <br />elevalion of leet NGVD. (or other dalum-see MS) <br />3. FIRM Zones Vt•V30, VE, and V(with BFE). The bottom ol Iha lowesl horizontal siructural member of Ihe reference ievel floor Irom <br />I�e selected diegram is at an elevalion of leet NGVD (or other datum-see M5). <br />4. FIRM Zone AO. The tloor use0 as the relorence Ievel Irom the seiected dieg�am is W feet above highesl netural graAe nezt to <br />the buitding (also enter i� Ilne 8). This vaiue must be eQual to or greater than the AO Zona Ilood depih number listed below. It no <br />Iluod deplh number is evailable, is Ihe building's lowes: tloor (or reference level) elevaled in accordance with the communiry's <br />Boodplain menagement ordinances9 �Yes ❑No ❑Unknown <br />5. Indicate the elevation dalum system used in determining the above reference level elevations: �NGVD ❑Other (describe on back) <br />6. Indicete the elevation datum system used on Ihe FIRM lor base flood elevations: ❑NGVD ❑Other (describe on back) <br />(ATTENTION: If fM elevelion Oatum useO in meesunng (he elevalions is diNeren� then tAe! use0 on fAe F:RM, fAen fhe elevatioru provide0 <br />musl De conwrted Io tM tlelum syslem used on thn FIRM.) <br />✓7. is the relerente level based on actual consiruction9 ❑ Yes ❑ No' <br />' A"No" enswer is only valid it the building tloes not have Ihe ralerence level Iloor in place. Fill in the elevaUon based on construc- <br />tion drawings and Co not complete queation N8. It "No" is checked, this cartification will be valid only for buildings In tAe course of <br />conatnx.Mion. Afler consiruqion ol Ihe reference level Iloor is completed, a poslconstructfon elevetion certifiute will be required for <br />continued flood insurance cwerage. <br />r/8. Piovids the lollowing measurements usinp ihe natural grade nezt to the buildinp (round to Ihe neareal loot). <br />a. The relerenCe level is: b. The gerage fbor (il applicable) Is: <br />wleet ❑above ❑below (check one) the highest grade. wfeel ❑above ❑belaw (check one) the hfghest gratle. <br />wfeel ❑above ❑below (check one) the lowest grade. wfeel ❑above ❑below (check one) the loweat grade. <br />SECTION 11 FLOOD INSURANCE RATE MAP INFORMATION <br />Provide the following irom the proper FIRM (see Instructions on beck-Defe of FIRM) and accompanying tneurance application: <br />535 .� 3 y � �`180 <br />=levation relerence mark usec <br />or <br />�', � �%� ��y .� <br />�ars on FIRM ❑Yes �No (See <br />SECTION III CE <br />ru surveyor, engineer, oi a•cNfact w�o <br />AE, AH, A(wiM BFE), V1-VJO, VE, ana <br />tafive can sign the cenilicalion. Cammi <br />� nlso si9� !he certilicalion. I cerlily IAn <br />un <br />side for <br />h BFE) is roquired. In t�e <br />orriciars wno are euNortz[ <br />inlormation on fhis certili[ <br />71FIE ' N�ME LI EN E NVMBER (or �Hi� �IJ <br />TITLE <br />SIQNATURE <br />�c� IM oriyIn�l topr o11M coi <br />�n! IM Ihlyd copy nt�InM Dy <br />NAME <br />FOR OPiIONAL GOMMUNI7V USE: Is Ihe releronco level also �he lowosl lloor unaer Ihe <br />❑�ES ❑NO II NO I�e elovalion ol Iho lowos: Iloor is leat NGVD. <br />vv <br />or <br />OATE PHONE <br />�yqlullon. TM wconE copy MouW a wpplhG le tM <br />communlly pnmlt otlky, II �apulroU. <br />manegemenl <br />tne <br />r[�uronw eia� noieq 593-117 (6/B7) <br />