AHAR=PEKJ ][chm]=hFEDERAL EMERGENCY MANAGEMENT AGOICY

NATIONAL FLOOD INSURANCE PROGRAMATTENTION: Use of this care:ft does not provide a *elver of the flood ineurerne poxtnes reaffirms/rt. This form is used oray as pro-vide elevadon irdonnellon necessary to assure compliance with applicable connarty bedpan management otelnances to domino

rite. soder 20 support • request nottequired to respond to this colbctIon of information unless a valid OMB central number le * ed in Els We NM cow el be foam

knit/Wiens for completing this form can he basal on the follow* pages.

O.M.IL No. 3057-0077

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7. Indicate the elevation them system used the FIRM for Base Flood Elevations (I3FE): MINGVD 79 00ther (describe on beck)8. Wade

Os corrummk)'s BEE: U. fir) ID feet Nt3VD (or other FIRM datum-see Seethes B. bet 7).

on Pages 5 and 8 that bestdescribes the subject butkirg's reference level

2(a).

of I Lf feet04. RFDA Zones y1430, ve and V (with BFE)..The bad= mber of

The selected &mut% Is at an eievadon cd J U datum-see Section B. Item 7').

(c). dagiinis. baler 0 (onestic‘one) the tithed grade adjacent b the

AO. 0 or below 0 (checkone) the highest grade seqacent to the bolding. If no flood depth nurnber Ia aveSabfe, is the bukIng's lowest for (reference

nce? 0 Yes 1=1 No 0 Unknown3. - mes level MVO '23 0 Other (desCribe

under Comments on Page 2). (Nom I the & ahoo datum used measzeing thiMove= A s Marthe FIRM (see Sedan Item7 than convert the elevations to On the

A.

4. appears on Yes 12 No Pe Insituctioiie an Page

reference level elevation EI actual construction 0 construction draeingspare Use al :ream:don clawing, Is on veld If the bu whet

elevation of the lottet fade Immodately to efit buldng t16Id

1.

defined by the ordinance Is: l 1-1 et NGVEV tialum-see Section EL Item 7).2. Date of the start of construction or substantial Improvement

F9AA Form 81-31, MAR 97 = ECITICNS

411f? r•co'r e 1 14Q7

77.3 dagrams above Matra* the points at Vice the sieved:vs ahotid be Rimmed In A Zones and lannes.

shotid be measured al the bop of the referenze level itoor.

Sevadorts for al V Zones should be measured at the bottom of the lowest horizontal structund mernber.

This nendicatict Is tote signed by a larei engineer. or vestactiefer is ashodzedby stab a local fah to air* elevaloninternsulon when the elevation informationCommunty of/Cale *Ph ans authorized by hal lice or nrcbance to provide llosdpiali management edonnalion, may also sign the=fanatics. In to case of &nes AO and A (without a FDA or corrassity i BFE), bulldog Odd. a property corm cr en

e* representative may aho sip the naldnadon.

Reference level &warns 6,7 v ! - Dleinglishrg Feetures-N the cedars is unable to taffy to teesineerilncotratdavray wetenclosure size, location ci sentinel; equipment. wd openings, or area:Med area Featungs), thin notIncarded In the certlication =dor Comments beim The riga= camber, Section C, Item 1, mat I be wowed

SUSOMINIS $atin 1001.

CERTIRERM J=IA wash 2330*

262_00PEP ??IL=SU J=IA

cir—rL??00124 ?EPU

- r PcNr-k.] 5c 2.t1,1-5(?

Copies should be of this Carlilleme for: 1) communey oMclei, 2) Insurance agentrecomparr s, sad 3) building owner.

MP

October 1, 1997ICC Coverage effective June 1, 1997 CERT 6

•

CERTIFICATE Mew

FEDERAL EMERGENCY MANAGEMENT AGENCYNATIONAL R.000 INSURANCE PROGRAM

ATTENTION: Use of this comfit:we does not provide a waver of the flood insurance punotase re uirement. This used onprovide elevation information necessary to ensure compliance with an el:able comnaricy flocelotatn management ordinances. todetermine proper insurance premium raw. to support a reauest for a Letter of Mao Amendment or Revision (LOMA or

Instructions far completing this form cars be found on the following pages.

c.CsAutaarr NumeeR 3. SUFFIXm AO Z . us* won

FORwSURANCE CCNPANv tSECT/ON A PROPERTY INFORMATION

BUILDING OWNERS NAME

R Ite.erSTREET AOORESS tirmascung Ant- Una. Sum moor Mew P.O. SOX felmilER

A vileOTHER Nunsets. Nc.3

I

POUCY Niereee

I

CC3APANv mac Jc[m_f[f

?-,,,,30-,5w_n[-; C.- •OP CODE

Provide me following from me procer FIRM (See Instrucionst:

1- M>KB;/ hog__[

3 „47. Inoicate the elevation oaturn system used on the FIRM fcr Base Flood Eievattons (8 °filer (oesolbe on8. For Zones A or V. where no EFT: is provided on me FIRM. arid the commune) has estar.tisned a EFE :nts building site. inc:c

inc community s EFS:. 1 41 feet NGVO (or outer RAM datum-see Season El. Item 7.

I CF Fiala

Using the Eevation Certificate Instructions, indicate the diagram number from the diagrams foull on Pages 5 and 6 tnat bestdescribes the subject building's reference level

2(a). FIRM Zones Al -A30. AE. AH. and A EFE. The tco of the reference level floor from the seied:ed diagram is at an efevalof 3' feet NGVO (or other FIRM daturn-see Section EL Item 7).

(b).FIRM Zones VI -V30. VE. and V (with -the selecteddiagram. is at an elevation of feet NGVD (or other FIRM datum-see Secton B. Item 7). —

(c).FIRM Zone A (without EFE). The floor used as the reference level from the selected diagram is feet abovebelow j (check one) the highest grade adjacent to the building. -

(d).FIRM Zone AO. The floor used as the reference level from the selected diagram is ._ feet above or belowone) the highest grade adjacent to the building. If no flood depth number is avaiiable, is the building's lowest floor (referencelevel) elevated in accordance with the community's floodpfain management ordinance? No

dicate the elevation datum system used in determining the above reference level elevations: Other (ciesclbe—

under Comments on Page 2). (NOTE: If the elevation datum used it measuring the elevations is different than that used onthe FIRM (see Section B. Item 77, then convert the elevations to the datum system used on the FIRM and show the conversionequation under Comments on Page 2.)

4. eevation reference mark used appears on FIRM: 11 Yes No (See Instructions on Page 4)

_ 5. The reference level elevation is based on: actual construction 0(NOTE Use of consUtrmion drawings is only valid if the building does not yet have the reference level floor in gam in whict

case this certificate will only be valid for the building during the course of =.nstruction. A post-construcion Elevation Certifimtewill be required once construction is complete.)

6. The elevation of the lowest grade immediately adjacent to the building is.. 'Section B. Item 7).

SECTION 0 COMMUNITY INFORMATION

1. community official responsible for verifying building g4avations specifies that the reference level indicated in Section C. Itemis not the lowest floor' as defined in the community's floodpiain management ordinance, the elevation of the building's lowestboor as defined by the is: feet NGVD (or other FIRM datum-see Seaton E. Item 7).

2. ate of the start of construction or substantial improvement

93

77;1

VKERAO VKJAO

N@[Oa_`la

Thiscenfficauors is to be signed by a land surveyor. engineei . orardhiteclwho aucrionz•ct by sone or local law moofy

informal:on mien tne elevation information far Vhg^l A1-A30. .AE. (wen _l[p0,p2/-p[- V (with Ewa is requtreiCommumty officals are auffionzed by local law or ordinance to provide floodiffain management infonnasan. may also sigcertification. in the case of Zones AO and A (without a FEAA co community issued EIFE). a budding aff/csai. a prewar owner,

owners representative may also sign the ceruficason.

Reference level diagrams 6.7 and 8- Distinguishing Features-it the certifier is unable to certify to breakawayinon-brealcawayenclosure size. location of servicing equiorrient. area use. wal openings. or unfinished area Feacre(s), then list the Feature(sincluded in the certification under Comments below. The diagram nismoer. Seccan C. item I. must soft be entered.

ocdn CIUQI 177 [^l o data ^.

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]ABllBA0Plc...Ad.-ex-- &p.m t rt- eer /1.2. >,

ITME CCUPANY NAME ‘,0

4 4 2z. C- -45/ci c.1 O q 1 35AGOR OP=PA

SIGNATURE

Copies should be this Certificate for :1) community offletal. 2) Insurance agent company, and 3) building over

CCMMENTS: -? ni_, l

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The diagrams above illustrate the points at which the elevations should be measured A Wji`n and V Zones.

Eevations ail A Zones should be measured at the top of the reference level floor.

Eevations for all V Zones should be measured at the bottom of L"..a lowest horizontal smictural member.

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