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��� FEDERAL EMERGENCY MANAGEMENT'AGENCY O.M.B.No.30d7.0077
" - NATIONAL FLOOD INSURANCE PROGRAM Expires July 31,2002
-: ELEVATION CERTIFICATE
s* important: Read the instructions of pages 1 -7.
SECTION A-PROPERTY OWNER INFORMATION €iFpC er-colP!!Nr• `illi;'
�. !�er...sr .............r.......
BUILDING OWNERS NAME ::s:::..:r.Ititllied Ki33iaeiiFiiEEr::••.•• • : r
BUILDING STREET ADDR S Including Apt. O,Suite and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. ::Ccmpeny
I C�O Rai ST TE ";3
ZIP CODE
.cm( �i4�f f 1� �3 ,¢Gt� �D iz d i4 3 30 O•4- _
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
BUILDING USF"t.g.,RrciO^nt►.i P°"n-r dentist.Addition�e�itc��Comments section II necessary.)
,��� €NA HORIZONTAL DATUM: SOURCE: i Li GPS(Type): r
LATiTU /'-i NGITor oposse) NAD 1927 L NAD 1983 L_1 USGS QuadMap u --
( 14r'-A4K'- .a or slr.ala ') Li
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION '
BI.NFIP COMMUNITY NAME&COMMUNITY NUMBER 82 83.STATE
COUNTY NAME ��
ege 1 2 0 0 4 7,.?RO
B4.MAP AND PANEL 135.SUFFIX B6.FIRM INDEX 87.FIRM PANEL Be.FLOOD Be.BASE �depth of flooding))
NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) REL 0 3
(201(CO'7jO°t I 'uGI, 1' , �9ci�-- V E
110. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered In B9.
t1 PIS Profile 0 FIRM L Community Determined L Other(Describe):
111. Indicate the elevation datum used for the BFE in B9:12S,(NGVD 1929 Li NAVD 1988 Li Other(Describe):
112. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? Li Yes lj No
Designation Date:
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
Buildin
:1. Building elevations are based on: LJConatruetion Drawings' {.,_{ g Under Construction' LlFinished Construction
'A new Elevation Certificate will be required when construction of the budding is complete.
:2. 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.)
:3. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,ARIA,AR/AE,ARIA1-A30,AR/AH,AR/AO
Complete Items C3a-i below according to the building diagram specified in item C2 State the datum used. If the deturtl 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 appropriate,to document the datum conversion.
Datum ConversioNComments r on the FIRM? Yes LJ No
Elevation reference mark used Does the elevation reference mark used appear
O a)Top of bottom floor(including basement or enclosure) fL
❑ b)•Top of next higher floor fl'( ll
❑ c ottom of lowest horizontal structural member(V zones only) _s.ft.(m) r h .
❑ d)Attached garage(top,of slab) � �.L(m) 1 i /
O e)Lowest elevation of machinery and/or equipment • 4 -7 6
servicing the building (1(m)
CI f)Lowest adjacent grade(LAG) . -1•(m) j 1- 4/ -O�. S.
O g)Highest adjacent grade(HAG) ' �{rl •
5_ft.(m)
❑ h)No. of permanent openings(flood vents)within 1 ft.above adjacent grade ' * ,
CI i)Total area of all permanent openings(flood vents)in C3h -�� sq. (sq.cm)
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 eievattoh information.
I certify that the information in Sections A, 8, and C on this certificate represents my best efforts to interpret the data avariable.
I understand that any false statement jrray be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAME O f4'NJ -7T1Z:AG LICENSE NUMBER -a-87!
•
TITLE v ( L. /='/1.7'7-- COMPANY NAME UN I / Ia I:kt_- 5'U1TLJEY/R!(4
CITY jaay ATM At STATE �L_ ZIP CODE •y 3
ADDRESS '��Z -/V 1D{Z.I�+E17Z SIGNATURE
DATE 1 _ /. -L.fl - TELEPHONE 6 .7 3 4, O 4 z-=EMA Form 81-3 ,AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS