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ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PJ~OGRAM .... ~rATE ZiP COOE ~nformafion for zones A f.A$O, AE, AH,, A(wilh BFq),, vr-Vse, VE= ~nd V(wite BFE) is required In lhe csse of zone AO= the Dui/ding official= the properly I~l~th~rized Dy local law or ordinance to provide flCodplain management information may also complete this form SECTION I BUILDING ELEVATION INFORMATION 1 Using the Flood Insurance Manual or the NFIP Flood Insurance Application--Part 2 Worksheet= indicate the proper diagram number ~' FIRM Zones A~,I-A30 A~,, AH= and A (with BFE), The top of the reference level floor from the selected diagram is at an elevation of~.~__~ '~ feet NGVD (or other datum-see #5) 3 FIRM Zones V1-V30, VE, and V (with BFE) The bottom of the lowest horizontal structural member of the reference level floor from the selected diagrSrn is at an elevaIion of ...... feet NGVD (or other datum-see #5) 4 FIRM Zone AU The floor used as the reference level from the selected diagram is I I Ifeet above highest natural grade next to the building (also enter in line 8) This value must be equal to or greater than the AU Zone flood depth number listed below If no flood depth numbe~ is available,, is the building's lowest floor (or reference level) elevated in accordance with the community's floodplain rrlanagement ordinances? []Yes []No ["'lUnknown 5,, Indicate the elevation datum system used in determining the above reference level elevations:: ~NGVD [] Other (describe on back) 6, Indicate the elevation dalum syslem used on the FIRM for base flood elevations: L~lNGVD []Other (deacribe on back) (ATTENTION It tee elevation delum used Itt measudng the e/ovations i$ different than that used on the FIRM,. then the elevations provided must ee converted to the datunl system used on tee I~IRM ) 7 IS tho reference level based on actual construction? [] Yea ..~No* * A 'No' answer is only valid if the building does not have the reference level floor in piece. Fill in the elevation based on construc- tion drawings and do not complete question #8 If "No' is checked, this certification will be valid only for buildings in the course of construction. After cooslrucfion of fha reference level floor is completed, a post-consfroc~on eleYal~on certificate will be required for continued flood insurance coverage 8 Provide the following measurements using the natural grade next to the building (round to the ~aarest foot). a The reference level is:: b The garage floor (if applicable) is:; I [ Ileal []above []below (check one) the highest grade I ] I feet []above []below (check one) the highest grade,, l_J.~leel ~above []below (check o~te) the lowest grade [ [ Ifeet []above r~below (check one) the lowest grade, SECTION II FLOOD INSURANCE RATE MAP INFORMATION Provide the foflowing from the proper FIRM (see Instructions on back-Date of FIRM) and accompaeylng insurance application:: Elevation reference mark used appears on FIRM []Yes ~.No (See reverse side for details) SECTION III CERTIFICATION This cerhfic~Iior) [$ Jo be signed by a lan~ sutYeyor, engineer, or arceil~t who is au'ii,oozed by stele law to '~rtify elevation i~fort~ion Whe~ the elowt~on mformet~en for zones A 1.A30, AE= AH, A(wJth BFE), V1-V30, VE, and V(with BFE) is ~equ~red In the case of zone AU. the bufld~ng official, the property Owner or tho owner's representative can sign the ~eHihcation ~mmunay officials who are aufhoriz~ by I~al law or ordinance to ptowde I I SIGNATURE DATE FHON~