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Flood Control - Elevation Certificate - 489 N Cobblestone Lane - N/A - 8/3/2000 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE O.M.B. No. 3067-0077 Expires July 31, 2002 Important Read the Instructions on pages 1 .7. SECTION A . PROPERTY OWNER INFORMATION SOn I~ n ~S~ OR P.O. ROUTE AND BOX NO. CITY G~. STATE 10. ZIPCODE 8~~/fo PROPERTY DESCRIPTION (lot and Numbers, Tax Parcel Number, Legal Description, etc.) BUILDING USE (e.g.. Residential, di' , Aa:.essory, etc. Use Comments section if necessary.) (';l HORIZONTAL DATUM: SOURCE: 0 GPS (Type):..... o NAD 1927 0 NAD 1983 0 USGS Quad Map 0 Other:. _ _ _ _ LATITUDElLONGITUDE (OPTIONAL) ( #If'. ##' . ##.##" or ##.###1#f) SECTION B . FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP C~MUNllY NAME & COMMUNITY NUMBER B2. COUNTY NAME A. I B3. STATE 10 {;;4 t,. 16000 rtO~ 84. MAP AND PANEL B5. SUFFIX 86. FIRM INDEX B7. FIRM PANEL B8. FLOOD NU~~ER ~ DATE EFFECTIVElREVISED DATE ZON~S) (cO q q -22-99 -22-99 AE B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. o FIS Profile ~ FIRM 0 Community Detennined 0 Other (Describe):. ..'_ B 11. Indicate the elevation datum used for the BFE in B9: l&f NGVD 1929 0 NA VD 1988 0 Other (Describe): _ _ _ . _ B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes ~ No Designation Date. . . . . 89. BASE FLOOD ELEVATION(~ (Zone AO. use depth of flooding 256 SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: 0 Construction Drawings* 0 Building Under Construction* LB1 Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number~(Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations - Zones A1-A30, AE, AH, A (with BFE), VE, V1-V30; V (with BFE), AR, ARJA. ARJAE, ARJA1-A30. ARJAH. ARJAO Complete Items C3a-i below according to the building diagram specified 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 area of Section 0 or Section G, as appropriate. to document the datum conversio Datum _ Conversion/Comments..... Elevation reference mark used _Does the elevation reference mark used appear on the FIRM? 0 Yes o a) Top of bottom floor (including basement or enclosure) ~. kft.(m) :l o b) Top of next higher floor ~. Gz...ft.(m) ~ fl .,., o c) Bottom of lowest horizontal structural member ('I zones only) . _ft.(m) ::l <<i o d) Attached garage (top of slab) . _ft.(m) ~ ~ o e) Lowest elevation of machinery and/or equipment Ji/A ~ : .8~ servicing the building . _ft.(m) E <<i Q f) Lowest adjacent grade (LAG) ~. Lft.(m) ~ ~ Q g) Highest adjacent grade (HAG) ~.12tt.(m) ~ en o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade. 10. ~ o i) Total area of al/ permanent openings (flood vents) in C3h ~q. in. (sq. em) 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 infonnation. I certify that the information in Sections A, B, "and C on this certificate represents my best efforts to interpret the data available. _ I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIAER'S NAME {)A(2I?eN /2. Ll?AV /11 LICENSE NUMBER 7?"t~ TITLE Pt?o lAi'II ~(/~~ - '()(2.. COMPANY NAME L/d./f) Sv~ '1Nu ADDRESS Z2 G. S7ATl:: CITY 6. LE . STATE ( ZIP CODE DA~~ -3 -to TELEPHONE : .In these spaces, copy the corresponding Information from Section A. TREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. For Insurance Company Use: Policy Number STATE ZIP CODE SECTION 0 . 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 o Check here if attachments SECTION E . BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1 through E4. If the Elevation Certificate is intended for use 8S supporling information for a LOMA or LOMR-F. Section C must be completed. E1. Building Diagram Number _(Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2. The top of the bottom floor (including basement or enclosure) of the building is _ ft.(m) _in.(ern) 0 above or 0 below (check one) the highest adjacent grade. E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is _ ft.(m) _in.(cm) above the highest adjacent grade. E4. For Zone AD only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? 0 Yes 0 No 0 Unknown. The local official must certify this infonnation in Section G. SECTION F. PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or community-issued BFE) or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS o Check here if attachments SECTION G . COMMUNITY INFORMATION (OPTIONAL) 'he local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete >actions A, B. C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. '1. 0 The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation infonnation. (Indicate the source and date of the elevation data in the Comments area below.) ,2. 0 A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zone AO. ;3. 0 The following lnfonnation (Items G4-G9) is provided for community floodplain management purposes. . PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED 7. This pennit has been issued for: 0 New Construction 0 Substantial Improvement 8. Elevation of as-built lowest floor (including basement) of the building is: _' _ft.(m) 9. BFE or (in Zone AO) depth of flooding at the building site is: _' _ ft.(m) .OCAL OFFICIAL'S NAME TITLE ;OMMUNllY NAME TELEPHONE ;JGNA TURE DATE Datum: Datum: ;QMMENTS .--. -.