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Flood Control - Elevation Certificate - 160 E Grove Lane - Lakemoor Sub 3 - 11/29/2014E Lf.- Ml I Ll I US. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660 -0008 FEDERAL EMERGENCY MANAGEMENT AGENCY EXpi-ation Date: July 31, 2015 Nar,cml FlamJ lms=rc FmgWn 157FORTANT: Follow the instruc' r, -is nn pages 1 -9 SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY USE A1• Building Ownert Nam L +-1AKMFTT rn " 1 � � Policy Number: A2. Build ng Stree: Addrass (I -,Lludin Apt., Unit, S. ilc, and/a► Bldg. o.) or F0. Route and Box No. Company NAIL Number: Ea - city IFft ILZ State { A�O ZIP Code 6 A3. Property 0escr) Lion (Lot and Block Numb rs, Tax Parcel Number, Legal Description, etc. 1, fS �1:r7 � Jr � S t u t5L� n.1 t � � - A4. Building Use (e.g., Residential, Nan Residential Addition, Accessory, etc. 7. I t A5. Latitude /Longltude: Lat. 4- 2p,4r3 ff "•3 rf — Long. ) f a f rD $ ��_ Horizon ;al Datum. ❑ NA01927 MNAD 1983 AG. Attach at (east 2 photographs oft a building If the Certificatt: Is being used to obtain flood insurance. A7. Building Diagram Number AS. For a bu tiding with a c►awlspace or enclosure(s): A9. For a building wlth an attached garage: a) Square footage of crawlspace or enclosure(s) _7 S sq ft a) Square footage of attached garage sq ft b) Number of permanent flood openings In the crawlspa_e b) Number of permanent flood openings in the attached garage or encioswe(s) Whin 1.0 foot above adjacent grade _ within 1.0 foot above adjacent grade _ LID c) Total net area of flood openings in A8.4 db.96� - sq in c) Total net area of flood openings In A9.b e:;? sq in d) Engineered flood openings? ❑ Yes ,2!PNo d) Engineered flood openings? ❑ Yes ❑ No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFiP Commun ty Name & Commuuni y Number C-Try bT UA&Ix i b coo3 B2. County Name A0A a) Top of bottom floor (Including basement, cra+vlspace, or enclosure floor) it 83. State UDAtNo 84. Map /Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel Effective/ Revised Date B8. Flood Zones) 189. Base Flood Elevations) (Zone AO, use base flood depth; ❑ meters d) Attached garage (top of slab) QY6 . �5 feB 19 � X03 � I ?�v3 AiE � 2 (vo. — BID. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 89: F!S Profile pnRM ❑ Community Determined ❑ Other /Source: Bi Indicate eievatfon datum used for BFE In item B9: ❑ NGVD 1929 J9 NAVD 1988 ❑ Other /Source: BI 2.Is the budding located in a Coastal Barrier Resources System (CBRS) area or Ottienvise Protected Area (OPA)? []Yes 1@ No Designation Date: / / ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Co- istructlon Drawings* ❑ Building Under Construction' girinished Construction "A new Elevation Certificetr will be required when construction of the building is complete C2. Elevations - Zones Al -A30, AE, AH, A (with BFE), VE, Vl -V30, V (wilh BFE], AR, AR /A, AR /AE, AR /Al -A30, AR /AH, AR /A(3 Complete Items C2.a -h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: TIP-MW "B E� to - — Vertical Datum. . k • s UD Indicate elevation datum used for the elevations In Items a) through h) below. ❑ NGVD 1929 )QNAVD 1988 ❑ Other /Source: Datum used for building elevations must be the same as that used for the EIFEL Check the measurement used. a) Top of bottom floor (Including basement, cra+vlspace, or enclosure floor) it ,feet ❑ meters b) Top of the next higher floor . —I ® feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) ❑ feet ❑ meters d) Attached garage (top of slab) QY6 . �5 I$fect ❑ meters e) Lowest elevation of machinery or equipment servicing* the'bullMng 3 . Z e fee: ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) . '. : (,afoot ❑ meters M) lowest adjacent grade at lowest elevation of deck or stairs, including ❑ feet ❑ meters structural support SECTION D - 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. f certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by One or Imprisonment under 18 U.S. Code, Section 1001. JR Check here if comments are provided on back of form. ❑ Check here if attachments. Signature Were latitude and longitude in Section A provided by a licensed land surveyor? (fifes ❑ No !) 1&6 !f " ills If j .w rFOF IDS � liy IV?� FEMA Fomt 086-0.33 (Ravlscd 7/12) Sea reverse side for continuation. Replaces all previous editions_ ELEVATION CERTIFICATE, page 2 IMPORTANT: In these spaces, copy the corresponding Information from Section A. FOR INSURANCE COMPANY USE Building treet Address (including Apt.. Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. Fcllcy Nurriter: . o R ve LANE' ci t, .FA& stet L.C� ZIP code $3 b (` Company N vC Number: L SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments A f /t 131 W r C.c LL A, l i A- _ .. _ --F _ Signature Date SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AD and A (without 8FE), complete Items EI-E5. If the Certificate Is Intended to support a LOMA or LOMB -F request, complete Sections A, Band C. For Items E1-E4, use natural grade, If available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation Information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). e) Top of bottom focr (including basement, crawispace, or enclosure) Is []feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom f ocr (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E_2. For Building Diagrams 6-9 with permanent flood openings provided In Section A Items 8 and /or 9 (see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building Is ❑ feet []meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) Is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and /or equipment servicing the building Is []feet ❑ meters ❑ above ar ❑ below the HAG. E5. Zone AO only. If no flood depth number is available, Is Cite top of the bottom floor elevated in accordance with the community's fioadpiain ianagement ordnance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, 8, and E for Zone A (without a FEMA- Issued or cammunity- Issued SFE) or Zone AO must sign here. The statements in Sections A. B, and E are correct to the best of my knowledge. Properly Omer or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here If attachments. SECTION 0 -- COMMUNITY INFORMATION (OPTIONAL) The local official who Is authorized by law or ordinance to administer the cormunitys noodplain Manag0rient ordinance can complete Sections A, 6, C (or E), and G of this Elevation Certificate. Complete the applicable Item(s) and sign below. Check the measurement used in Items G8 -GIO. In Puerto Rico only, enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and seated by a licensed surveyor, engineer, or architect who is authorized by law to cerrfy elevation Information. (indicate the source and date of the elevat on data in the Comments area below.) G2. ❑ A community official completed Section E for a building located :n Zone A (without a FEMA-Issued or community- issued BFe) or Zone AD. G3. ❑ The following Information (Items G4 -1310) is provided for community floodplaln management purposes. G4. Permit Number G5. Date Permit Issued 136. Date Certificate Df Compliance /Occupancy issued 137. This permit has been issued far ❑ New Construction ❑ Substantial Improvement 68. Elevation of as-bui t lowest floor (including basement) of the building: 0 feet ❑ meters Datum 69. BFE or (in Zone AO) depth of Eloading at the building s tw ❑ feet ❑ meters Datum G16.Community's design flood elevation- _ ❑feet ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments FEMA Form OR&O33 (ReviSed 7 112) ❑ Check here if attachments. Replaces all previous editions. ELEVATION CERTIFICATE, page 3 BUILDING PHOTOGRAPHS See lnstructio:is for Item A6. IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, acid /or Bldg. No.) or PO. Route and Box No. Policy Number. City — e _ State ZIP Cade _ _ _ I Company NAIL Number If using the Elevation Certificate to obtain NFIP flood Insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View "; and, if required, "Right Side View- and "Left Side View.` When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as Indicated In Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. F PST -T-vu-'Ad— r=5 U h j) T'R*j Ua-N i FEMA Form 086-493 lRevised 7/121 Replaces all previous editions. ELEVATION CERTIFICATE, page 4 BUILDING PHOTOGRAPHS Continuation Page IMPORTANT: In these spaces, eopy the corresponding information from Section A. FOR INSURANCE COMPANY USE Dutding Strict Addreati tir,chimriL Ap6„ Ureit, Su-ir, Lvw /pr Bldg. No.) o, FQ P._w[ ., aT,..3 r!ox No. Potfcy[�fumbev. City State zi Cade CompOW NAIC Ivrrrrbrr �- `t1 If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs w;th: date taken; 'Front View' and 'Rear View': and, if required, `Right Side View' and "Left Side View." When applicable. photographs must show the foundation with representative examples of the flood openings or vents, as indicated In Section A8. rl"_ f4 � � r r f �fj j7 C N., O% per•' Z 9 50 vTtt YA" l-7b KI ti& F f�ST FEMA Form 086[}33 (Revised 7/12) Replaces all previous editions.