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ELEVATION CERTIFICATE o. Ms FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ~/TION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to ~de elevation information necessary fo ensure compliance with applicable community floodplain management ordinances, lo ,termlne the proper insurance premium rate, and/or to supped a request for a Letter of Map Amendment LOMA or LOMR). Instructions for completing this form can be found SECTION A PROPERTY INFORMATION SECTION B FLOOD INSURANCE RATE MAP (FIRM} INFORMATION E COMPANY USE ~MPANY NAIC NUMeER Provide the following fro~ the proper FIRM (See Instructions): 7, Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ~NGVD '29 ~ Other (describe on back) 8. For Zones A or V, where no BFE i$ provid~ on the FIRM, and the community has established a BFE for this building site, indicate the community's BFE:~ [ [_j J J.~ feet NGVD (or other FIRM datum-see Section ~, Item 7). SECTION C BUILDING ELEVATION INFORMATION 1, Using the Elevation Certificate, Instructions, indica~ the diagram number from the diagrams found on Pages 5 and 6 the best describes the subject building s reference level ~, 2la). FIRM Zones Al.A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation of ~_,.~. L~ feet NGVD (or other FIRM datum-see Section B, Item 7), lb). FIRM Zones VI.V30, VE, and V (with BFE). The bottom of the towest horizontal Structural member of the reference level from the selected diagram, is at an elevation of b~_. [_~.,,. I .~J feet NGVD (or ether FIRM datum~see Section B, Item 7). lc). FIRM Zone A (without BFE), The floor used as the reference level from the selected diagram is I I I,~J feet above [] or below [] (cheek one) the highest grade adjacent to the building, (d), FIRM Zone AC. The floor used as the reference level from the selected diagram is I I I.I [ feet above [] or below [] (check one) the highest grade adjacent to the building, If no flood depth number is available, is the building's lowest floor (reference level) elevated in accordance with the community's floodplain mane§emmet ordinance? [] Yes [] No [] Unknown 3, Indicate the elevation datum System used in determining the above reference level elevations: ~ NGVD '29 [] Other (describe under Comments on Page 2), (NOTE; If the elevation datum used in measuring the elevations is different than that used on the FIRM [see Section B, Item 7], then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) 4. Elevation reference mark used appears on FIRM: ~ Yes ~ No (See Instructions on Page 4) 5. The reference level elevation is based on: [~i1 actual construction ~'~ construciion drawings (NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which case this certificate will only be valid for the building during the course of construction. A post-construction Elevation Certificate will be required once construction ia complete.) 6, The elevation of the lowest grade immediately adjacem to the buildlng is: I I ~-~J~l. L~ feet NGVD (or other FIRM datum-see Section B, Item 7). SECTION D COMMUNITY INFORMATION 1. If the community official responelble for verifying building elevations specifies that the reference level indicated in Section C. Item 1 is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest floor" as defined by the ordinance is: I_.J r_.] .~...j, [_/feet NGVD (or other FIRM datum-see Section B, Item 7). 2. Date of the start of construction or substantial improvement Form 81,31~ MAy go REPLACES ALt. PREVIOUS E OITIOtd$ ~E REVERSE SIDE FOR CONTINUATION