The URL can be used to link to this page

Home My WebLink AboutSDP201100025 Legacy Document 2012-06-28 (4)u.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION GEIKI II-1(:A I E Federal Emergency Management Agency National Flood Insurance Program Important: Read the instructions on pages 1 -9. UMtS NO. "I bbU -0006 Expires March 31, 2012 SECTION A - PROPERTY INFORMATION For Insurance Company Use: Al. Building Owner's Name- Number .W n9 RnHdinn street Address fincludino AoL. Unit. guile. and/or Bldo. Dlo.l or P.O. Route and Box No. Company NAIC Number city State ZIP Cade •'" i' A3. Property Description Lot and BI ck Numbers, Tax Parcel Number, Le al Description, etc.) e ,e 17717W!4' - G �� /286 7 �, 63 7 ✓iowFJ A4. Building Use (e.g., Residential, Non- Residential, Addition, Accessory, etc.) w L A5. Latitude /Longitude: Lat. Long. Horizontal Datum: ❑ NAD 1927 YNAID 1983 A6. Attach at least 2 photograph of the building if the Certificate is being used to obtain flood insurance. AT Building Diagram Number A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: +� a) Square footage of crawlspace or enclosure(s) sq ft a) Square footage of attached garage sq It b) No. of permanent flood openings in the crawlspace or b) No. of permanent flood openings in the attached garage enclosure(s) within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b —j sq in d) Engineered flood openings? [:]Yes ❑ No _ d) Engineered flgod openings? ❑ Yes ❑ No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 1 F P mmu ity Name 8 Co r y��vNuumber �� 62. County Nayp '/ B3. State � pany Address jf? (1 City i l�► SYta�te✓ t► # B4. Map /Panel Number B5. Suffix B6. FIRM Index Da a FE,e.4 2-66 B7. FIRM Panel Effective /Revised Date B8. Flood Z n (s) B9. Base Flood Elevation(s) (Zone AO, use be ood de ) 7 B10. Indicate the source of the ase Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile ffFIRIM CRISmmunity Determined ❑ Other (Describe) B11. Indicate elevation datum used for BFE in Item Bg: ❑ NGVD 1929 FE1 NAVD 1988 ❑ Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes o Designation Date / / ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings` TrBuilding Under >nnst� phon' ❑ ,N ished Construction, j `A new Elevation Certificate will be required when construction of the building is complete. A T SG% f.11V ,,O / J Or�,M C2. Elevations - Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, ARIA, AR/AE, AR/A1 -A30, ARIAH, AR/AO. Complete Items C2.a -h below according to the building diagram specified in Item AT Use the same datum as the BFE. Benchmark Utilized Vertical Datum Conversion/Comments a) b) C) d) e) g) h) Check the measurement used. Top of bottom floor (including basement, crawlspace, or enclosure floor) feet meters (Puerto Rico only) Top of the next higher flow A feet meters (Puerto Rico only) Bottom of the lowest horizontal structural member (V Zones only) _❑ feet ❑ meters (Puerto Rico only) Attached garage (top of slab) _❑ feet ❑ meters (Puerto Rico only) Lowest elevation of machinery or equipment servicing the building _❑ feet ❑ meters (Puerto Rico only) (Describe type of equipment and location in Comments) Lowest adjacent (finished) grade next to building (LAG) feat Highest adjacent (finished) grade next to building (HAG) -1717 /2L� �►-I feet Lowest adjacent grade at lowest elevation of deck or stairs, including - u•"L�' °et structural support ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) 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 on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a licensed land surveyor? ❑Yes ❑ No ATTACHMENT D Certifier's Nam W rt_ V License Number Title r I V � pany Address jf? (1 City i l�► SYta�te✓ t► # ZIP Cod .Jr7 t97� Y2(J f✓ $igbature . <;,^ Date �f! P Tele ho -/t p �l! � —t1 FEMA Form 81 -31, Mar 09 See reverse side for continuation.