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FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.No.a0�7-0117Y
NATIONAL FLOOD INSURANCE PROGRAM Expires July 31,201r2
ELEVATION CERTIFICATE
�. important: Rsad the instructions otti s 1 -7.
SECTION A-PROPERTY OWNER INFORMATION �_ ;lj; :;tl;:iEE
i3i�:it14.•�sts°iil lii.iiiiii:::r:et..=Till:i:ii'.ieE:e
.. l.. ..........................1:::•:::a
BUILDING OWNER'S NAME ..........•....... =ii;?Ei:i::=•" 3!
t.
,Suite, or B .No.)OR P.O.ROUTE AND BOX NO. `i� % : Et=:• i:::3
BUILDING STREET ADDRESS 0 Apt, +-
LA) ST,M LP CODE A r
C
tA
PROP RTY DESCRI�,P�TION(Lot and B N Tax Psrt:e!nhsnber.Legal De:ulD etc.)
t etc. Use Comments semen If neeeesary•)
•
BUILDING US e.g. Residential,N ential,Addition.Accessory,
1' 1-�� HORIZONTAL DATUM: SOURCE U GPS(Type):
( se- r- fi . or (OPTIONAL) NAD 1927 U NAD 1983 111 USES Quad Map LJ outer.
( �'.or-e�.ti� or fRlee.tprralas') L•J ,
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B3.STATEBl.NFIP COMMUNITY NAME 3 NUMBEE I aD 4 • H 2 0 O (c.v�t A s)
B7.FIRM PANEL B8.FLOOD N.BAS FLOOD
B4.MAP AND PANEL B5.SUFFIX B6.ARM INDEX AO,use depth of&iodtt0)
NUMBER DATE EFFECTIVE/REVISED DATE Z NE 3) (Zone L
Z o ( O d g entered in B9.
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth
Li FIS Profile X4 FIRM Li Community Determined 1.-j NAVD(Describe):Li Other(Describe):
B11. Indicate the elevation datum used for the BFE in B9: NGVD 1929 U I B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA?
) u Yes A N7
r
Designation Date: _
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Finished Constntd3on
ding Under Construction'
Cl. Building elevations are based on: UConstrod Buil
ion Drawings'
•A new Elevation Certificate will be required when constriction of the building is complete.
C2. Building Diagram Number f (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 A1,A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,ARIA,AR/AE,AR/A1-A30,AR/AH,AR/AO
Complete items C3a-i below according to the building diagram
specified in�em CZ State the datum used.If the daturit Is different from
�BFE.Show field measurements datum conversion
the datum used for the BFE in Section B. convert the datum art,to document the datum conversion.
Use the space provided or the Comments area of Section D or Section G,as appropriate,
Datum Conversion/Comments ear on the FIRM? (_j Yes (,j No
El tier reference mark used Does the elevation reference mark-t?s��p
ed a)Top of bottom floor(including basement or enclosure) -L..tiff) es
❑ b).Top of next higher floor _H . R(m)
❑ c)-2ottom of lowest horizontal structural member(V zones only) L(m) g
❑ d)Attached garage(top.of slab) .
❑ e)Lowest elevation of machinery and/or equipment R(m) 1 t J 1 f
servicing the building It.(m) 11\ 7
❑ f)Lowest adjacent grade(LAG) n(m) �' I /o -2 �j-O-�/
❑ g)Highest adjacent grade(HAG)
❑ h)No. of permanent openings(flood vents)within 1 It.above adjacent rade sq - )
o i)Total area of all permanent openings(flood vents)in C3h
sq.cm
SECTION D-SURVEYOR.ENGINEER,OR ARCHITECT CERTIFICATION � �infer
or architect authorized by isw to certify
mation.
This certification is to be signed and sealed by a land surveyor, engineer, best efforts to interpret the data svarlsbte.
I certify that the information in Sections A. 8, and C on this certificate represents my
I understand that any false statement a be nishable b fine or irn risonment underis U . CodNUMBef<S�ron 1001. �1
TITLE lER'S NAME O f N 'rA.r-r- f-� COMPANY NAME UN 1 V I�2S�L-• S'UTLLlG II Rl 14
TITLE l�T'-AI"7- STATE T%L� ZIP CODE -'b?rg�C
SIGNATURE DATE JO-i -U
ADDRESS -3L7Z -Al Z-Z ;D7Z CITY y VW AL TELEPHONE' C5
�
FEMA Form 81-3 ,AUG 99
SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
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