Flood Control - Elevation Certificate - 645 E State Street - N/A - 12/9/2009
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE
OMS No. 1660.0008
Expires March 31,2012
Important: Read the instructions on pages 1-9.
SECTION A - PROPERTY INFORMATION
For Ineurance Company Use:
Policy Number
Ai. Building Owner's Name
..:;0 T '-f
A2. Building Street Address (induding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
(;,.4 e. ~
C~ State
e;AGL.t:- /.0 836t(n
A3. Property DescriPtion (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
PA!:- .1. ,:;',5,,- iZe.co....-J I'.JP :5:,-,,&,,,-:,-' t 5/":8, 7'A;< /-10. IZ~ 9 9i.~800 1<:
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) NO;../" t!ZE.5 1.:7<&,,.-, r ,.4. ('o,-r,," I ......:'.:.d
AS. LatitudelLongitude: Lat.43 0/.1. I . 40. Z' Long. IIb"~O 40.,5 Horizontal Datum: ~NAD 927 0 NAD1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number....L.d.
A8. For a building with a crawlspace or endosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or endosure(s) /J p sq It a) Square footage of attached garage ~A sq It
b) No. of permanent flood openings in the crawlspace or b) No. of permanent flood openings in the atta~arage
endosure(s) within 1.0 foot above adjacent grade ---1- within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b ~ sq in c) Total net area of flood openings in A9.b sq in
d) Engineered flood openings? 0 Yes 0 No d) Engineered flood openings? 0 Yes 0 No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Company NAlC Number
ZIP Code
B2. County Name
A A
B6. FIRM Index B7. FIRM Panel B8. Flood
Date Effective/Revised Date Zone(s)
~ ;- 0": F6 , ~ ;z, A I-I
Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
o FIS Profile 0 FIRM Community Determined 0 Other (Describe)
B11. Indicate elevation datum used for BFE in Item B9: 0 NGVD 1929 ti5J.NA VD 1988 0 Other (Describe)
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)?
Designation Date 0 CBRS DOPA
B9. Base Flood Elevation(s) (Zone
A~, use base flO,,?d .dePth.y
DYes
~NO
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: 0 Construction Drawings* 0 Building Under Construction' fgl Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations - Zones A1-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, ARIA, ARlAE, ARlA1-A30, AR/AH, AR/AO. Complete Items C2.a-h
below according to the building diagram specified in Item A 7. Use the same datum as the BFE.
Benchmark Utilized Ai/A &:X./N ~ ~ d.;vf, ,30,4- Vertical Datum /./A -"'l,~ /?~
Conversion/Comments
a)
b)
c)
d)
e)
Top of bottom floor (induding basement, crawlspace, or endosure floor)
Top of the next higher floor
Bottom of the lowest horizontal structural member ry Zones only)
Attached garage (top of slab)
Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments)
Lowest adjacent (finished) grade next to building (LAG)
Highest adjacent (finished) grade next to building (HAG)
Lowest adjacent grade at lowest elevation of deck or stairs, induding
structural support
Check the measurement used.
/- ~.: '" 4 . L ~ feet 0 meters (Puerto Rico only)
L57~ . L I&l feet 0 meters (Puerto Rico only)
AI/A. 0 feet 0 meters (Puerto Rico only)
.A/ / A , 0 feet 0 meters (Puerto Rico only)
~ ~'" ~ '....c.~ feet 0 meters (Puerto Rico only)
f)
g)
h)
zS ~ J .....L.~ feet
L.Sb4 .--L~feet
2.S~~ ...L.J&1feet
o meters (Puerto Rico only)
o meters (Puerto Rico only)
o meters (Puerto Rico only)
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. I 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 fine or imprisonment under 18 US. Code, Section 1001.
o Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a
licensed land surveyor? ~ Yes 0 No
'111.
Certifier's Name License Number
IY!;(!I../Ae(. /2. €;.ur;,el!5lZ.;~o_ pc. 5 S 7<3J ~
Title Company Name
PJZ8:S;O~iV-r ~&:raeR.lr.$01IJ GA,<JO ~~"'I~ /.uc-.
Address City State
Zl.S, ~~ ~O/~e- 10AI-(0 83704
Siggatl.lre Date Telep ne
-nrI..:A-l' -- .9 06~'. ..zoB, 8<. . 6 o~ z..
See reverse side for continuation.
ZIP Code
Replaces all previous editions
IMPORTANT: In these spaces, copy the corresponding Infonnation from Section A.
Building Street Address (induding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
e. -r-
For Insurance Company Use:
Policy Number
City
State
ZIP Code
Company NAIC Number
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenUcompany, and (3) building owner.
Comments
Signature
o Check here if attachments
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
Date
For Zones AO and A (without BFE), complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B,
and 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).
a) Top of bottom floor (induding basement, crawlspace, or endosure) is . Ofeet Dmeters Dabove or 0 below the HAG.
b) Top of bottom floor (induding basement, crawlspace, or endosure) is ==. = Deet Dmeters Dabove or o below the LAG.
E2, For Building Diagrams 6-9 with permanent flood openings provided in Sectiqn.f\ Items 8 ~/or 9 (see lli!ges 8-9 of Instructions), the next higher floor
(elevation C2.b in the diagrams) of the building is _' _ 0 feet U meters U above or U below the HAG.
E3. Attached garage (top of slab) is _' _ 0 feet 0 meters 0 above or 0 below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is _' _ 0 feet 0 meters 0 above or 0 below the HAG.
E5. Zone AO 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 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, B, and E for Zone A (without a FEMA-issued or community-issued BFE)
or Zone AO must sign here. The statements in Sections A, e, and E ani correct to the best of my knowledge.
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)
The local official who is authorized by law or ordinance to administer the community's flOodplain management ordinance can complete Sections A. B, C (or E),
and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8 and G9.
G1. 0 The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who
is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2. 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.
G3, 0 The following information (Items G4-G9) is provided for community floodplain management purposes.
G4. Permit Number
G5. Date Permit Issued
G6. Date Certificate Of Compliance/Occupancy Issued
G7. This permit has been issued for: 0 New Construction 0 Substantial Improvement
G8. Elevation of as-built lowest floor (induding basement) of the building
G9. BFE or (in Zone AO) depth of flooding at the building site
G10. Community's design flood elevation
o feet
o feet
o feet
o meters (PR)
o meters (PR)
o meters (PR)
Datum
Datum
Datum
Local Official's Name
TiUe
Community Name
Telephone
Signature
Date
Comments
FEMA Form 81-31, Mar 09
o Check here if attachments
Replaces all previous editions