HomeMy WebLinkAbout2004, 02-25 Elevation CertificateNATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
Important Read the instructions on pages 1.7.
SECTION A - PROPERTY OWNER INFORMATION
BUILDING OWNERS NAME
'60,eGe A/ 40/7 /
V. w1. D. IVO. sup /-UU!
Expires December 31, 2005
For Insurance Company Use
Potcy Neer.;
BUILDING STREET ADDRESS (Including Apt, Ural, Sude, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
7 .5d4/EL.G EY Z --A4
CITY STATE
5Pae. Ai t64 L Y u/A
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc..)
407- .5 45' / S/ EG.L 'y [.A 3 QD
BUILDING USE (e.g., Residential, Non-residential, Addihon, Accessory, etc. Use a Comments area, if necessary.)
eSIpanVT/Az_
Company NAIC Number
ZIP CODE
9903 7
LATITUDE/LONGITUDE (OPTIONAL)
(##°-#!i'-##.#AR' or alma')
HORIZONTAL DATUM:
❑ NAD 1927 ❑ NAD 1983
SOURCE ❑ GPS (Type): -
0 USGS Quad Map
❑ Other.
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFP Oa/AUNTY NAME &COMMUNITY NUMBER
132 COUNTY NAME
5.00,4 it/E
B3. STATE
Z.4.441
B4. MAP AND PANE
B7. FRM PANEL
89. BASE FLOOD ELEVATION(S)
NUIvBER
B5. SUFFIX
B6. FIRM NEX DATE
88. FLOOD ZONE(S)
(Zone AO, use depth of f ocfrg)
DATE
53o/7V-03/y
5
,44,4y /71 /9b'8
A
2027 00
o r u. w C u swcka; U uhe toss rr000 rnevamn t3ftt) Data or base nocxi tieplh entered to 89.
0 FIS Profile D FIRM MCommunity Determined ❑ Other (Descit:le):
B11. Indicate the elevation datum used fortthe BFE k B941NGVD 1929 0 NAVD 1986 0 Other (Describe):
B12. Is the building located in a Coastal Barrier Resourqs System (CBRS) area or Otherwise Protea Area (OPA)? 0 Yes ❑ No Designation Date
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Bilking elevations are based on: 0 Construction Drawings* 0 Buddng Under Construction* 21 Finished Construdlon
`A new Elevafan Certificate we be required when construction of the buidng is fie.
C2. Building Diagram Number_ (Select the building ragman most sinter to the building for which this certificate is being completed -see pages 6 and 7. If no diagram
hely rePresents the Wig, Provide a sketch or photograpk) Z7/ A 12'44 /YJ 40 3
C3. flevatons - Zones A1 -A30, AE, AH, A (with BFE), VE, V1 -V30, V (wan BFE), AR, AR/A, AR/AE, ARIA1-A30, AR/AH, AR/A0
Complete Items C3. -a -i below according to the txuil:ling diagran spe 'Vied in Item C2. State the datum used. if the datum is different from the datum used for the BFE in
Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments aea of
Section D or Section G, as appropriate, to docurner t the datum conversion. -
Dattsn
Bevation reference mak used RM /boss the elevation rum mak used appear on the FIRM? Yes ❑ No
o a) Top of bottom floor (inducing basement orendosure) 203 z . fft(m)
o b) Top of next higher floor 20 y/ . aft(m)
o c) Bottom of lowest horizontal structural merrier (V zones only) _. _it.(m)
o d) Aftadted g (top ofd) 20 y 0. Lft(m)
o e) Laciest elevation of machinery and/or equipment
servicing the buidng (Describe in a Comments area) 20 33" d ft(m)
o f) Lowest adaoent (finished) grade (LAG) 203/ 2_ft(m)
o g) Highest adjacent (finished) grade (HAG) 20..9 . Lft(m)
o h) No. of permanent openings (Hood vends) within 1 ft. above adjacent grade .(/oic'
o ) Total area of ail perrnahent aperrngs (flood vends) s C3.h sq. in. (sq. an)
SECTION p- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
/certify that the information in Sections A, B, and C on This certificate represents my best efforts to interpret the data available.
1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIERS NAME UCENSE NUMBER
7'47 /27 00/26
TM.E
7GUA.1 2
ADDRESS / L/ Z R W. %%7 4l/7 S7 ;�c' ;Oo�ric STATE
SIGNATURE
X809/
COMPANY NAME
,2747 /72 co e A.ssac/ 972 PS
ZIP CODE
7? 2°3--
DATE
°SDATE TELEPHONE
2/26*/ S0S- 3z -/2a,/
9 -722v -
FEMA Form 81-31, January 2003
See reverse side for continuation. Replaces all previous editions