Flood Control - Elevation Certificate - 2401 E State Street - Eagle Water Co - 4/28/2010`U.S. DEPARTMENT OF HOMELAND SECURITY EL=V , 71ON CER ti IFHCa a E DME 3�ia. 1660 0008
=ederal Emergency Management Agency `xpifes iVlarc 13 : , 2C1 r
National Flood Insurance Program important: Read the instructions on pages 1 -9.
SECTION A - PROPERTY INFORMATION For Insurance Company Use:
Al. Buildinq Owner's Name
Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No.
City
State
Company NAIC
ZIP
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
s= MOM fi' ¢! 'l
A4. Building Use (e.g., Residential, Non- Residential, Addition, Accessory, eic.) &UU[C.PAL WgV� 140U.C9 ArC, �i 4A, � �➢,
A5. Latitude/Longitude: Lat. 49-* 4 1 r5 4-1 Long. Q ICo ` i 5 ' �J Z + Horizontal Datum: ❑ NAD 1927 NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
AT Building Diagram Number
A8. For a building with a crawispace or enclosure(s): -A A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) kr sq ft a) Square footage of attached garage W J'& sq it
b) No. of permanent flood openings in the crawlspace or b) No. of permanent flood openings in the attached garage
enclosure(s) within 1.0 foot above adjacent grade 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
T Engineered flood openings? ❑Yes 'X No d) Engineered flood openings? ❑ Yes ❑ No
SECTION 8 - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
61. NF1P Community Name &Community Number 82. County Name 63. State
i La =D! -i�6
B4. Map/Panel Number 1 B6. Suffix B6. FIRM !ndex B7. FIRM Panel 88. Flood 1 39. Base Flood Elevation(sl (Zone `
Date Effective/Revised Date Zone(s) j 40, use base flood depth)
i( OOj4,0 gyoZ 4),3 -_73 .'' Z -1 S — 70-3:5 i AM Z,; : -7 9•
B10. Indicate the source of the Base Flood = levation (BFE) data or base flood depth entered in Item B9.
J FIS Profile FIRM Community Determined ill Other (Describe)
611. indicate elevation datum used for BFE in Item B9: E NGVD '1929 XNAVD 1988 ❑ Other (Describe)
B12. is the buildina located in a Coastal Barrier Resources System ;'CBP.S) area or Otherwise Protected Area (OPA)? "es NO
Designation. Date `( CBRS ❑ OPA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
CI. Building elevations are based on: ❑ Construction Drawings - _; Building Under Construction* misheG Construction
`A new Elevation Certificate 'II be required when construction of the building is complete.
C2. Elevations - Zones Al -A3 AE AH, A (with BFE), \/E, V1-V30, V (with BFE), AR, AR /A, AR/AE, AR/A1 -A30, AR /AH, AR /AC. Complete Items 02.a -h
below according to the buil diagram specified in Item AT Use the same datum as the BFE.
Bencnmarik Utilized 'Rp K �- 5"i Lfr-- PL_ S'T-_t a —,, 'Vertical Datum )V AVM
Conversion /Comments
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. l certify that the information on this Certificate represents my best efforts to interpret the data available. !
understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
❑ Check here if comments are provided on back of form.
Company Name
M
Were latitude and longitude in ction A provided by a
licensed land surveyor? longitude ❑ No
iq
ZIP,
Check the measurement used.
a) Top of bottom floor (including basement, crawlspace. or enclosure floor)
�-t. ❑ feet
❑ meters (Puerto Rico only)
b) Too of the next higher floor
❑ feet
❑ meters (,Puerto Rico only)
c) Bottom of the lowest horizontal structural member (V Zones only)
❑feet
❑meters (Puerto Rico only)
d) Attached garage (top of slab)
_❑ feet
❑ meters (Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the buildinc
'L�'i��.Lj feet
❑ meters (Puerto Rico only)
(Describe type of equipment and location in Comments)
T) Lowest adjacent (finished) grade next to building (LAG)
_. ❑ feet
(J meters (Puerto Rico only)
g) Highest adjacent (finished) grade next to building !HAG)
(❑ feet
❑ meters (Puerto Rico only)
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
❑ feet
❑ 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. l certify that the information on this Certificate represents my best efforts to interpret the data available. !
understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
❑ Check here if comments are provided on back of form.
Company Name
M
Were latitude and longitude in ction A provided by a
licensed land surveyor? longitude ❑ No
iq
ZIP,
Form 81- 31,'Mar 09 / See reverse side for continuation. - Replaces ail previous editions
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Form 81- 31,'Mar 09 / See reverse side for continuation. - Replaces ail previous editions
JRTANT: in these spaces, copy the corresponding information from Section A. � For Insurance Company Use:
ling Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.Q. Route and Box No. Policy Number
State ZIP Code Company NAIL Number
I C =0 A- i
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
% i iurRs�}�p FL-o 4 e a rz nia� —U96W )A IQ_1- bQU'dEZ NO
Check here if attachments
SE TjibN E - 13UILdMIG ELEVATION INFORMATION (SURVEY'rNOT/REQUIRED) FOR ZONE AO AND. ZONE A (WITHOUT SFE)
For Zwines AO and A (without BFE), complete Items E1 -E5. If the Certificate is intend-id to support a LOMA or LOMR -F request, complete Sections A, B,
and C. For Items Ei -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters.
Ei . 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 (including basement, crawispace, or enclosure) is Meet ❑meters 171above or ObeiowtheHAG.
b) Top of bottom floor (including oasement, crawlspace, or enclosure) is []feet ]meters ❑above or I ] below the LAG.
For Building Diagrams 6-9 with permanent flood openings provided in Secfio-�A, Items 8 and /or 9 (see apes 8-9 of Instructions), the next higher floor
(elevation C2.b in the diagrams) of the building is _ ❑ feet El meters `] above or �beiow the HAG.
E3. Attached garage (top of siab) is feet meters 77 above or a below the HAG.
E4. Top of platform of machinery and /or equipment servicing the building is _ Q feet ❑ meters ❑ above or 7 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
t
ordinance? L Yes ❑ No "I '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, B, and E are correct to the best of my know /edge.
Property Owner's or Owner's Authorized Representative's Name
Address
Signature
Comments
City
State ZIP Code
Telephone
Check here if attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized § 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. F7 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. 1 A community official completed Section E for a building located in Zone A (without a FEMA- issued or community- issued BFE) or Zone AC.
G3. i r 1
The following information (Items G4-G9) is provided for community floodplain management purposes.
I 'G4. °ermit Number G5. date Permit Issued GE. Date Certificate Of Compliance /Occupancy Issued
G7. This permit has been issued for: ❑ New Construction ❑ Substantial improvement
G8. Elevation of as -built lowest floor (including basement) of the building I_ feet ❑ meters (PR)
G9, BFE or (in Zone AO) depth of flooding at the building site ❑ feet ❑ meters (PR)
GIC. Community's design flood elevation, ❑ feet ❑ meters (PR)
Local Official's Name Title
Community Name Telephone
Signature Date
Comments
Datum
Datum
Datum
L_ Check here if attachmentz
FEMA Form 81 -31, Mar 09 Replaces all previous editions
Building Photographs
See Instructions for Item A6.
Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy- Number
24-61 r=. rrAT- = srQarmT'
State
ZIP Code
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two 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." If submitting more photographs than will fit on this page, use the Continuation Page on the
reverse.
DoE C Re ^fR
Building Photographs
Continuation Paae
Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. `eolfcy . Nuffftr
P-01 BOX
City Z State P Code
S
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all
photographs with: date taken; "Front View" and "Rear View "; and, if required, "Right Side View" and "Left Side View."
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