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ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM / ............ COX NUMBE~' STATS ZIP c(~DE This form is to be corn e ed by a and survoyor~ engineer or arch lac who s au hor zed by stale law to ~ertity elevation Information when the elevation I Iir~formation for :,ones ~-A$O, AE~ AH~ A(w h RFE).-VI.V30, VE~ and V(with BFE) iS required In the ease of zone AC, the building official, the property Iowner, or the owner's repre.~entafive should complete the information in Section I and may e so comp eta the certifi~atlon Community efhoials who are [authorized by local law or ordinance to provide floodplain management information may also complete this form SECTION I BUILDING ELEVATION INFORMATION Using Ihe Flood Insurance Manual or the NFIP Flood Insurance Applicalion--Part 2 Worksheet, indicate the proper diagram number FIRM Zones Al-A30,, AL, AH, and A (with BFE), The top of the reference level floor from the selected diagram is al an elevatioe of ~'~;;>, ~ __feet NGVD (or other datum-cee #5) FIRM Zones VI-V30, VE, and V (with BFE) The bottom of the lowest horizonlal structural member of the reference level floor from the selected diagram is at an elevation of ....... feet NGVD (or other datum-see #5), FIRM Zone AC 'i'he floor used as the reference level from the selected diagram is I I Ileal above highest nalural grade next to the building (also enter in line 8) This value must be equal to or greater than the AC Zone flood depth number listed below If no flood depth number is available, is the buildings lowest floor (or reference level) elevated in accordance with the communily"s floodplain management ordinances? [-~Yes L']No []Unknown Indicate the elevation datum system used in determining the above reference level elevations:: [~NGVD [~ Other (describe on back) Indicate the elevation datum system used on the FIRM for base flood elevations:: []NGVD []Other (describe on back) (ATTENTION If the elevation datum used in measuring the elevations is different than that used on the FIRM, then the elovation$ provided must be converted to the datum systen~ used on the FIRM ) IS the reference level based on actual construction? []Yes ' A "No' answer is only valid if the building does not have the reference level floor in place Fill in the elevation based on construc- tion drawings and do not complete queslion //8, If 'No" is checked~ this ceddicafion will be valid only for buildlegs in the course of construction After construction of the reference level floor is completed~ a post-construction elevation certificate will be required for continued flood insurance coverage Provide the fallowlng measurements using the natural grade next to the building (round fo the nearest foot),, a The reference level is:: b. The garage floor (if applicable) is- I_,J.~feeI [~above E]below (check one) the highest grade I I Ifeet E~above []below (check one) Ihe h~gnest grade [J-~fee[ []above []below (check one) the Iowes~ grade. ULJfeet []above []below (check one) the lowest grade. SECTION ii FLOOD INSURANCE RATE MAP INFORMATION Provide the following from the proper FIRM (see Instructions on back-Date of FIRM) and accompanying insurance application: lin A0 Zone,, use depth) ELEVATION ~ESTABLISHED FOR ZONE Elevation reference rnark used appears on FIRM [,~ [~]No (See reverse side for details) SECTION III CERTIFICATION Th~s certd~cation ~S Jo ~ signed by a land sur~eyor, engineer, or architect who I$ author£z~d by siai~'"iaw to c~rfify elevation info~maOon when the ~ elevation information for zooes A t-A30, AL, AH. A(with BFE), Vi.V30 VE, end V(wlth BFE) is required In the case of zone AO, the Duilding official, the property owner,, or the owner $ ropresentative can sign tl~e certification, Community offictals who ere authorized Dy local law or ordinance to provide tho data ava aO e nders a d ha any false $ atement ma~ be punishable by flne,,,~r imprisonment under 18 US Code, Section lOOt ZIP S-P2-_?Pr9o