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Home My WebLink AboutE-ELEVATION CERTIFICATE - 219 SOUTH LOOMIS AVENUE - OLD TOWN (3)r • gi�y .batkGea.� FEDERAL EMERGENCY MANAGEMENT AGENCY. NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 ELEVATION CERTIFICATE Expires December3l, zoos Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION For nsurance.Company Use k BUILDING OWNER'S NAME PnOcyNumber .; z „ BUILDING STR ET ADDRESS (Including Apt., Unit. Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. F ' s`" 2 0UTI4 LO0 AA IS fTe company NAILNumbervi�t CITY LC I Al STATE ZIP CODE PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, O 9 L O c-K L O D y r 7T/ A/ BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, alc. Use a Comments area; A -necessary.) ' J I t /V IATITUOE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: ( %Kf° - ##' • ##.1t#' or ##.k #'') NAD 1927 1_1 NAD 1983 SOURCE: 1_I T GPS pe): ( Y USGS Quad MapI Othell—' SECTION B - FLOOD INSURANCE RATE MAP.(FIRM) INFORMATION B1. NFIP COMMUNITY NAME 8 COMMUNITY NUMAFR o� 1 OIZT l: L-LfAJS 081 G Z L A.. E 83. STATE-- O�'14i d�NE PAN�L„ B5. S�FIX 06. FIRM INDEX 0: FIRM PANEL ` O ` O R �O DATE - 0B. FLOOD B9. OASE FLOOD ELEVATIONS) EFFECTIVE/REVISE1) DATE ZONES) OL Tow D 3_ �8 _ I tiyL 18 — L (Zone AO, use depth of flooding) B 10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered tered 89.'b� 1-1 FIS Profile 1-1 FIRM . IZI Community Determined _ 611. Indicate the elevation datum used for the BFE in 89: �_� NGVD 1929 (_( NOAVDther ( 988n1_1 Designation Date: 812. the building located in a Coastal Barrier Resources System (CBRSj area or Otherwise Protected Area (CPA)? II Yes I_XI — No D SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: I—IConstruction Drawings' I_IBi is Under Construction' I�IFinished Construction 'A new Elevation Certificate will be required when construction of the builddingg 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, VI-V30, V (with BFE), AR, ARIA, AR/AE, AR/A1-A30, AR/AH, AR/AO Complete Items C3.a-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 the space provided or the Comments area of Section D or Section G, as a Datum Conversion/Comments ppropriate, to document the datum conversion. lU (., V D / 92q Elevation reference mark used_FnRTC c.0 .. 2X-a ,Does the elevation reference mark used appear on the FIR � 0 a) Top of bottom floor (including basement or enclosure I n (:(,.,.I I Yes JXI No 0 b) Top of next higher floor ) `rL _-0ft.(m) m ®A RC/p G c) Bottom of lowest horizontal structural member Ai. —4 ( ) CI d) Attached garage (top of slab) iV zones only) _ A�. �j_ , _ flI n o X G19T N.R. Q. I 0 e) Lowest elevation of machinery and/or equipment w c ? U: servicing the building (Describe in a Comments area.) ¢ c�c} j ft m � " i VIZ 0 Lowest adjacent (finished) grade (LAG) S/b7L 8 ( ) "= ft.(m) Za 0 g) Highest adjacent (finished) grade (HAG) S Ong w m8 �# O h) No. of permanent openings (flood vents) withift.(m) n 1 ft. above adjacent grade 47 �` •`� 0 i) Total area of all permanent openings (Rood vents) in C3.h q.sq. SECTION D - 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. l certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. l understand that any false statement maybe punishable b fine or imprisonment under 1B U.S. Code, Section 1001. CERrTIFIER'S NAME - � - FENIA Form 81-31 ,January 2003 See reverse side for continuation. Replace•= ,!I previous e ailb._::: 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 a` Z .S00T LOONts $TIZE r CITY - STATE ZIP CODE CompanyNAICNumber ; ij rV K T V OL Ci S /y _ - - - 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: COMME TS TEE to elAcc QAd -At. wa/+P_.: Maier are in tkeb4JeMe�} of the on�insl Iteute The PX lStlna h e s 2 a.sd-iirCnf bid yoom -f-h.tf W4r it pa add, �io..� ha+ 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 E5. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. El. 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 1_1-1 ft. (m) j—(—j in. (cm) (—j above or j_1 below (check one) the highest adjacent grade. (Use natural grade, if available.) .. ' . 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) j_j—jin. (cm) above the highest adjacent grade. Complete Items C3.h and C3.i on front of form. E4. The top of the platform of machinery and/or equipment servicing the building is j—j—I ft. (m) I—j—j in. (cm) �_� above or (check one) the highest adjacent grade. (Use natural grade, if available.) ' E5. 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? 1 Yes 1 No j Unknown The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, 8, C (Items C3.h and C3.i only), and E for Zone A (without a FEMA-issued or community -issued BFE) or Zone AO must sign here: The statements in Sections A, 8, C, and E are correct to the best of my knowledge PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ..ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS 1-1 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. G 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 completed Section E for a building located in Zone A (without a FEMA-issued or community -issued BFE) or one AO. G3. (�he following information (Items G4-G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER GS. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY -6P 163RS� � io317 -2 -of rP 8 a 3 'XWI ISSUED '1 by G7. This permit has been issued for. j�!< New Construction 1-1 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: ft. (m) Datum: 10C, G9. BFE or (in Zone AO) depth of flooding at the building site is: Soo 3 S ft. jm) Datum: A!G V O 14� TITLE %}�(wLrnlSfr LOCAL OFFICIAL'S NAME LLrb 6 t1. /� /�S_ bt n sfl CA- �' Octp IQ,t,V,_ r COMMUNITY NAME t�lfy Dif' F� �III/tS�LO TELEPHUNt_g70_��-6700 - SIGNATURE �A , C/r � (� L. - • _ DATE COMMENTS-n t YL1 G i . iL . c Om ♦'U A., 4w_ Addi ri00,, A 1/a,Xt tarlte, Was watt -kJ T 944-4 alur litotr 40 df'Ovj h&jryorvt D c004,W&V-Js, i I Check here if attachments FEMA Form 81-31, January 2003 Replaces all previous editions