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ELEVATION CERTIFICATE __. 30~?-0077 FEDERAL EMERGENCY MANAGEMENT AGENC.Y_ Expires ]u~y 31, i9~9 NATIONAL FLOOD INSURANCE PROGRAM rTENTION: Use ut this certificate does not provid· a waif, er of the flood insurance purdha,'te requirement. This form is used only to pro- ,ide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to determine proper insurance premium rate. and/or to support a request for a Letter of Map Amendment or Revision (I. OMA or LOMR}. You are not _-t,quired to respond to this collection of information unless a valid OMB control number is displayed in the upper dght comer ol this form. Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION *FOR INSU~'~CE COMP^NY USE POI. ICY NUMBER CUILDING OWNER'S NAME STREET AOORESS (lnctudlng Apl,. Unil. ~te ~or B~g. Nu~OR P.O. ROUTE AND BOX NUMBER ~ ~ O~$C~I~TION {ko~ a~d ~lock Nu~Oe~s. etc.) ;OMPANY NArC NUMBER ZIP COOE SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION _:ovide the following from the proper FIRM (See Instructions): ! 1. COMMUNITY NUMBER 2. PANEL NUMBER 3. SUFFIX [ 4. dATE OF FIRM INDEX I 5. FIRM ZONE 6. ~E ~'l. OOO ELEVATION (in AO Zo~e~. u~. ~e~t ~ ca,. the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ~NGVD '29 I'-']Other (describe on back} Ocr Zones A or V, where no BFfi ~s provided on the FIRM, and the community has established a BFE for this building site. indicate __ :~e commumty's BFE: J~.,._,& -- feet NGVD (or other FIRM datum-see Section B. Item 7). SECTION C BUILDING ELEVATION iNFORMATION _ ~Jsing the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level -'7' ' aL FIRM Zones A1 -A30, AE, AH, and A (with BFE). The top of the reference level floor from [he selected diagram is at an elevation o~ .... ~.~..~. :.~.~ feet NGVO (or other FIRM datum-see Section B, Item 7). 2, FIRM Zones V1-V30, VE. and V (wire BFE). The bottom of the lowest horizontal structural member of the reference !evel from :r'e selected diagram. :s at ar' e~evation of ~."~'_. .......... feet NGVD (or other FIRM datum-see Section 8, Item 7). :: F'.~&I Zone A (witr~out BFEJ. T~e floor used as the reference level from the selected diagram is i.,5~A.; : feet above or ueio,,v __ (check one) me highest grade adjacent to the building. ,J). FIRM Zone AC. The floor used as the reference level from the selected diagram is ~ ;,/"q .~.J feet above ~ or below -" (check one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference level) elevated in accordance with the community's floodplain management ordinance? [] Yes [] No [] Unknown . Indicate the elevation datum system used in determining the above reference level elevations; ~ NGVD '29 ~ Other (describe under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than that used on me FIRM [see Section B, Item 7]. then convert the elevations to the datum system used on the FIRM and show the conversion ~quadon under Comments on Page 2.) Elevation reference mark used appears on FIRM: ~ Yes -- No (See Instructions on Page 4) The reference level elevation is based on: _._i actual construction L_.; construction drawings [NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which case this certificate will only be valid for the building during the course of construction. A post*construction Elevation Certificate will be required once construction is complete.) The elevation of the lowest grade immediately adjacent to the building is:l I I~.l~-f'/I.L~ feet NGVD (or other FIRM datum-see Section B. Item 7). SECTION D COMMUNITY INFORMATION !! the community official responsible for verifying building elevations specifies that the reference levei indicated in Section C. Item 1 _ is not the "lowest floor" as defined in the commu0ity's floodplain management ordinance, the elevation of the bui[ding's "lowest lloor" as defined by the ordinance is: i ! t~l_~,~!.l~ feet NGVO (or other FIRM datum-see Section B, Item 7). Date of the start of construction or substantial improvement '-FEMA Form 81-31, MAR 97 REPLACES ALL PREVIOUS EDITIONs ¢ - ~ SEE RE'V~RSE SIDE FOR CONTINUATIOiq