Transcript
FEDERAL EMERGENCYMANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM
O.M.B. No. 3067-0077 Expires December 31, 2005
ELEVATION CERTIFICATE Important: Read the instructions on ages 1 -7. SECTION A-PROPERTY OWNER INFORMATION
L
BUILDING OWNER'S NAME
Bill Black BUILDING STREET ADDRESS (Including Apt., Untt, Sutte, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
214 9th Ave. South CITY
STATE
ZIP CODE
SurlSide Beach
SC
29575
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Lot 5, Block 18 North Garden Clfy Section BUILDING USE (e.g., Residential, Nor>./A,p.fl/AE, PJ>./A1-A30, AAJAfi,AAJAO CornplefB lfBms C3.-a-i belowacccrding 1o1he building dagam specified in lfBm C2. S1ate the da1um used If the dalum is clfferent1i'om the da1um used for the BFE in Section B, convert the dahrn 1o 1hat used for the BFE. Shem field rreasuremenls and datun conveision calculation. Use 1he space pl'C!lided a the Cornmenls area of Section D or Section G, asapproJJiala, 1o docLmentthe.dahrn conversion. Dahm NGVD 1929 Conveision/Cornmenls Elaiation reference marl< used--"=Does the elaiation reference mirk used
o a)Topofbot1omfloorQncludngbasernentorenclosure) o b)Topofnexthigherlloor
awear on the FIRM? D Yes 121 No
QJ!.11.SeeNote ~ft
o c) Bottom of lowest horizontal slruclural member(\/ zones on~) o d)A1!achedgar.ige{1opofsl!b) o e) LO\\llSt elaiation ofmachineiy and/or equiJ:ment sen/icing 1he buUd'ITTg (DesC11be in a Cornmenls area) o ~ LO'M9SI adjacent {finished) ~de (I.AG) o g) Highest aqacent {finished) ~de (HAG) o h) No. of permanent openings {flood venls) vithin 1ft allCNe acjacent ~de JL o OTotal area of all permanent openings (lloodvenls) in C3.h _!Lsq. in. (sq. cm)
~
"'
,,'r-""-'--:::;::::::::::::::~---, 1;
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NIA ft N/Aft
13. 7 ft See Note 11.8ft
!lift ,,,\''',
SECTION D- SURVEYOR, ENGINEER, OR ARCHllECT CERTIACATION
r;o~'•1,,,,
,/ J\.!}. . . . . . .;,'.'.\?,Z/ '··.,
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation infonnatio!f;f.,"13 .... ""· ~:;, I cerlify that the information in Sections A, 8, and C on this cerliflcate represents my best effons to interpret the data En/al/able. fo/ yr', I understan.dthat any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. i NEL;~~8';:i:~~~CKj5 ~ CERTIFIERS NAME LICENSE NUMBER ?\. No. co1033 JI-- I NEISONLHARDWICK 7215 s-<'\ li'Ji
:il' e
TITUE PROFESSIONAL ENGINEER 'DRESS • .ilO St SI T
COMPANY NAME , '*"~'"·..... NEISON L HARDWICK& ASSOCIATES ··,·lopofthepla1foon ofmachineiyancVerequi/Jnen!seMcingthebuiding is _ ft.(m)_in.(an) D alx:!ieer D below(checkone) the highestadjacentgade. (Use nalllral gade, if available). E5. For Zone AO only: Wno flood depth number is available, is the lop of the bollllm floor elevaled in accornance 1Mth the ccrnmunily's ftooS D No D Unknown. The local oflicial mus!certiftthis infonnation in Section G.
SECTIONF - PROPERTY OWNER (OR OWNER'S REPRESENTAllVE) CERllFICATION The propeey owner er O'Mler'S authorized represenlalive v.ro canpleles Sections A, B, C Qtems C3.h and C3.i only), and E for Zone A (IMthoul a FEMA-issuE>d er communilyissued BFE) er Zone AO must sign hera Thestitements in Sections A, B, C, aid E Bffl conect to the best ofmy knowledge. PROPERTY OWNERS OR OWNERS AUTHORIZED REPRESENTATNE'S NAME ADDRESS
CITY
STA1E
ZIP CODE
SIGNATURE
DA1E
1ELEPHONE
COMMENTS
D Check here if attachments SECTION G -COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law er oro;nance 1D administer the canmunily's floocPlain management ordnance can complele Sections A, B, C (er E), and G of this Elevation Cerlilicale. Complele the applical:re item(s) aoo sign below. G1 . D The infonnation io Sec!lon c - laken from other documentation that has bee:n signoo and embossed by a licensOO SUIV"fer, engineer, er architect 1Mlo is authorized by slate er local law lo certift elevation inlilimafion. Qndioate the source and dale of the elevation data in the Ccrnments aree below.) G2. D Acarm1unily oiiicial completOOSection Efor a buiding localed in Zone A (v.ithout a FEMA-issued er conmunilyissued BFE) er Zone AO. G3. D The following information Qtl:rns G4-09) is pr!Mded for conmunily flooment
_ _ft.(!n)
GB. El"1ation of as-Ouilt lowest ftocr Qnclucing basement) of the buildng is: G9. BFE er Qn Zone AO) depth offloodng atfuebuildng sile is:
_._ft.(m)
LOCAL OFFICIAL'S NAME
TITLE
COMMUNITY NAME
TELEPHONE
SIGNATURE
DA1E
Dahm: Dahm:
COMMENTS
D Check here if attachments FEMA Form 81-31, January 2003
Replaces all previous editions
