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i E ,g,TI J : C FiCAT E FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ATTENTION: Use of this ce~iflcate does not ~de a w~v~f the.f~uranCe purchase requkement, This form iS used only to provide elevation information necessa~ te en~ ~mp~ienc~ ~i~ ~ca~ community floodplain m~nagement otdinancas, to determine the proper insurance premium rate,~/or to Su~p~ ~ t~s~ a Le~e~ 0f Map Amendment o~ Revision {LOMA or Inctructions fo~ completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION eUILeING ©WNEE'S NAME : ' '' " STREET ADDRESS [r~¢[udins Apt. L~nit. SL~ite andJor Sidg~ Number OR P.e. ROUTE/~NO BOX NUMSER OTHER DESCRIPTION (Lei CITY , STATE .... SECTION B FLOOD iNSURANCE RATE MAP (FIRM) INFORMATION ~777~f Provide the following from the proper FIRM (See Instructions): 7, tndica, te the elevation datum system used on the FIRM for Base Flood Elevations (EFE): [~ NGVD '29 [] Other (describe on back) 8. Far Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate the community's BFE: L I I I I feet NGVD (or other FIRM datum-see Section D, Item 7). SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level ~. 2(a). 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 ~1 1~lgl~l.~ feet NGVD (or other FIRM datum-see Section B, Item 7), (b). FIRM Zones V1-V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from the selected diagram, is at an elevation 0fl ..I [ I I 1.L] fe~t NGVD (or other FIRM datum-see Section B, Item 7). (c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is I I I,Lg feet above ~ or below ~ (check one) the highes~ grade adjacent £o the building. (d). FiRM Zone AC. The floor used es the reference leve~ from the selected diagram is I ! ,J.J ~ feel 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 [evei) a!evat~d in e~'cordance with the community's floodplain management ordinance? [] Yes ~ No [] Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations' '~ NGVD '29 ~ Other (descr(be under Comments on Page 2). (NOTE: if the elevation ~tatum used in measuring the elevations is different than that used on the FIR~ [see Section B. Item 7], then convert the elevations to the datum system used on the FiRM and show the conversion equati~n under Commente 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: [] actual construct[on ~ Construction drawings (NOTE; Use of construct/on drawings is only valid if the building Hoes net yet have the referehce /eve/ floor /n p/ace,/n which case this certificate will only be va/id for the building during the course of construction. A post-conStruction Elevation Certificate will be required once construction is complete,) 6. Theelevationofthe[owestgradelmmedietelyadjacenttothebuildingis;I ! L~'//~i.~. feet NGVD (or ether FIRM detum-sse ~ection B, Item 7). SECTION D COMMUNITY INFORMATION 1. if the COmmunity official responsible for vedtyfng building e(evations specifies that the reference level indicated in Section C, {tern 1 is not the "lowast floor" as defined in the community's floodplain management ordinance, the elevation of the build/rig's "lowest floor~ as defined by the ordinance is: I I I I I !.L.J feet NGVO (or other FIRM datum-see Section [3, Item 7). 2. Date of the star[ of construction or substantial improvement FI[N~A Form I~1-31~ MAY 90 REPLACES ALI, PREVIOU~ EDITIONS SEE REVSRSE SIOE FOR CONTINUAT'ION