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Home My WebLink AboutE-ELEVATION CERTIFICATE - 1006 WEST MOUNTAIN AVENUE - OLD TOWN (3)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 BUILDING OWNER'S PC c fNumber BUILDING STREET ADDRESS (Including Apt„ Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. _+,. 1 I .�', 4. a pt,r,� +: W. M O V uT,q / ^JAVEV�,v Company NAIC Number t c CITY ..AI 1 r `. FO 0 Lit- / lvf STATE ZIP CODE PROPERTY DESCRIPTION (Lot and Black Numbers, Tax Parcel Number, Legal Description, etCO o 0`Sz PARCgLL * 7 / — — U i BUILDING USE (e.g., Residential, Nonresidential, Addition. Accessary, etc. Use a Comments area, if necessarv.l RC—SIDE.VT/AL Anftr-r,—& - - + 1•�RicUNIAL DATUM: ( - #rF' • Kx.J.Y' or k#.1a###'� 1-1 NAD 1927 1-1 NAD 1983 SOURCE: I_I GPS (Type): 1-1 USGS Quad Map 1_1 Other SECTION 13, FLOOD INSURANCE RATE MAP INFORMATION - - 7-/ 1 7 —1S -03 - .,-N+n or noodmg) B10. Indicate the source of the Base Flood Elevation (BFE) data or base ood depth entered in 9. 50 17' S I —I FIS Profile I-1 FIRM I_I Community Determined 811. Indicate the elevation datum used for the BFE in 89 NGVD 1929 I —I Other (Describe): Q LD T WN W Q B 12. Is the building located in a Coastal Barrier Resources System (CBRS) area or O1-1 therwise Protected Area ( ? 1-1 Other (Describe): Designation Date:_ ( ) I_i Yes [XI No SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C 1. Building elevations are based on: I_IConstruction Drawings' _ IBuildi'A new Elevation Certificate will be required when construction of the building is comple eg Under onstructian' hilFinished Construction 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, V1-V30, V (with 8FE), AR, AR/A, 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 can calculation. Use the space provided or the Comments area of Section D or Section G. as appropriate, to document the datum conversion. Datum N6VD 1010 Conversion/Comments 4 .See COmeq-fs Elevation reference mark used -EEC- 7Hu fir- 91 Does the elevation reference mark used a p a) Top of bottom floor (including basement or enclosure) 5,017 appear on the FIRM? I —I Yes IXl No b) Top of next higher floor --------- • � fttm) Cl c) Bottom of lowest horizontal structural member (V zones only) .. G d) Attached garage (top of slab) G e) Lowest elevation of machinery and/or equipment 1V.A ft.(m) m m (°�T' servicing the building (Describe in a Comments area.) a 621 O 0 Lowest adjacent (finished) grade (LAG) �� ' Z7 ft.(m) E 2 s ex ? 5® 8 -� O g) Highest adjacent (finished) grade HAG T 17 SZ ft.(m) i c- L c. O h) No. of permanent openings (flood (HAG) within 1 ft. above adjacent grade —g_ S617ft.(m) v, r 3/ { UO O i) Total area of all permanent openings (flood vents) in C3.h !_ sq. in. (sq. cm) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION r�� This certification IS to be signed and sealed by a land surveyor, engineer, or architect authonzed by law to certify elevation information. I certify that the information in Sections A. B, and C on this certificate represents my best efforts to interpret the data available. I understand that t any false statement may be punishable by fine orimprisonment under 18 U.S. Code, Section tool. CERTIFIER'S NAME RtCNARD A iZUTyEeFOBD LICENSE NUMBER T CD Lo pleo%esslaua EAJ/I,L)FD d C COMPANY NAME w4l2T +V S ZIP cENIA Form 81-31, January 2003 See reverse side for continuation. =A r." J P.eplac-, �''I qrw1:inus e.t. S,&,Q 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 10060 w Met/N rA# iu AvE �vve CITY STATE ZIP CODE Company NAIC Number F LCI S C6 R 6. Tz 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. 4- �' sdth C�✓ten i r'i- ota 014'4= F�, (O�t a✓�-BY CJkci iii%a+-C✓ 146uY6nv 1_I Check here if attachments _ 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 �_�_� ft. (m) 1_1__1 in. (cm) 1__1 above or below (check one) the highest adjacent grade. (Use natural grade, if available.) E3. For Budding Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is j_j_j ft. (m) 1_1_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 �_�_� ft. (m) 1_1_1 in. (cm) 1_1 above or 1_1 below (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, B, 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, B, 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 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. 1__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. 1_1 A community official completed Section E for a building located in Zone A (without a FEMA-issued or community -issued BFE) or Zone AO. G3. �<The following information (Items G4-G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PER ISSUED 3 - L v -1 G6. DATE CERTIFICATE OF COMPLIANCe/UccurnnUT fj'� -pp i Os0 R� brf�1I S r ih- q-4 -r%y ISSUED G7. This permit has been issued for. j�!New Construction �_� Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: 5-o 1'7 . � ft. (m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: fro i 7 . S ft. (m) Datum: LOCAL OFFICIAL'S NAME TITLE Fio9C/ lu;n G(YYL/rr115>�1 � ____/?CifS%tG� H/�PS I��Ot n50✓t COMMUNITY NAME TELEPHONE _ f o� �-L � CO�ir,rt5 �O 70- - 700 SIGNATURE DATE _ �/�iir I - I o� �i �Jrr l y Leos COMME— NT8- Check here if attachments FEMA Form 81-31. January 2003 Replaces all previous editions