Transcript
FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM
O.M.B. No. 3067-0077 Expires December 31,2005
ELEVATION CERTIFICATE Important: Read the instructions on pages 1 • 7. SECTION A· PROPERTY OWNER INFORMATION BUILDING OWNER'S NAME£
For Insurance Company Use: Policy Number
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BUILDING STREET ADDRESS (Including Apt., Unrr, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
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Company NAIC Number
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PRQPE~TY OESCRIPTION,0-ot ~nd Block Numbe~a~ Parcel Nu?Jber, Legal Description, etc:)
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BUILDING USE (eJJf, Resid ntial, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.) /:("('I'
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LATITUDE/LONGITUDE(OPTIO
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HORIZONTAL DATUM: 0NAD1927 0NAD1983
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SOURCE: 0 GPS(Type): ____ _ OUSGSQuadMap
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Other: ____ _
SECTION B • FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNl1Y NAME & COMt.Nl1Y NUMBl;R '
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BS. SUFFIX
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I B2. COUN1Y NAME
B6. FIRM INDEX DATE
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Ht1il"V"'-f Bl. FIRM PANEL EFFECTIVE/REVISED DATE
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B9. BASE FLOOD ELEVATION(S) (Zone AO, use depth of fkxxling)
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B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered 1n B9. D FIS Profile FIRM D ~munity Determined D Other (Describe): B11.lndicatethe elevation da~ used for the BFE in B9: GVD 1929 D NAVO 1988 D Other (Des>ribe): B12. Is the building located in a Coastal Barner Resources ystem (CBRS) area or Otherwise Protected Area (OPA)? D Yes No Designation Date
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SECTION C·BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building EJevations are based on: D Construction Drawings' D Building Under Construction' !}(Finished Construction 'A new Elevation Certificate w,lll.be required when ccnstruction of the building is ccmplete. . l Building Diagram Number _Cf_ (Select the building diagram most similar to the building for which this certificate is being ccmpleled -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, ARIA, ARIAE, ARIA1-A30, ARIAH, ARIAO Complete Items C3,-aj below according to the building diagram specified in Item C2. State the datum used. If the datum is differentfrom the datum used for the BFE in Section 8, 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 D or Section G, as appropriate, to document the datum conversion. Datum NGVD29 Conversion/Comments NONE Elevation reference mark used )'/ 4 0 Does the elevation reference mark used appear on the FIRM? 0 a)Topofbottomfloor(indudingbasementorendosure) j_fe_. _Q__tt.(m) 0 b)Topofnexthigherfloor Tfr. fi.(m) 0 c) Bottom of lowest horizontal structural member (Vzones only) tt.(m) 0 d)Attachedgarage(topofslab) Ji_. _ft_tt.(m) 0 e) Lowest elevation of machinery and/or equipment servicing the building (Describe in a Comments area) ...f!__tt (m) 0 DLowest adjacent (finished) grade (LAG) jf,_. Q_tt.(m) 0 g) Highest adjacent (finished) grade (HAG) )£..... -'1.__fi.(m) 0 h) No. of permanent openings (flood vents) within 1fl. above adjacent grade 0 i) Total area of all permanent openings (flood vents) in C3.h ..1Z£sq. in. (sq. cm)
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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 cerlify that the informafion in 3ections A, B, and f( " ii> cerlificate represents my best elforls to interpret the dafa available. 11 i· or im risonment under 18 U.S. Code, Section 1001. I understand fhat any false stat.ement ma . }~ CERTIFIER'S NAME LICENSE NUMBER W.B. Huntley Ill 8809 TITLE COMPANY NAME Huntley and Associates, Inc. STATE CITY s.c. Surfside Beach DATE TELEPHONE 1-843-238-ll745 0 -03 FEMA Form 81-31, January 2003
See reverse side for continuation.
ZIP CODE 29575 JOB#
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Replaces all previous editions
IMPORTANT: In these spaces, copy the corresponding information from Section A BUILDING STREET ADDRESSi(lnduding Apt, Unrr, Surre"andlorBldg. No.) OR P.O. ROUTE AND BOX NO.
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For Insurance Company Use:
Policy Number
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Company-NAIC Number
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SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Cerlificate frn (1) community official, (2) insurance agenVcompany, and (3) building owner. COMMENTS ~~~~~~~~~
D 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 Certfficate is intended for use as supporting infonnatron 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 loor (induding basement or endosure) of the building is _ ft.(m) _in.(cm) D above or D below (check one) the highest adjac,ent grade. (Use natural grade, if available). E3. For Building Diagrams 6-8 with openings (see page 7), the next hrgherlooror elevated loor (elevation b) of the building is _ ft.(m) _in.(cm) above the highest adjacent grade. Complete items C3.h and C3.i on front of form E4. The top of the plafonn of machinery and/or equipment servicing the building rs _ ft.(m) _in.(cm) D above or D below (check one) the highest adjacent grade. (Use natural grade, if available). E5. For Zone AO only: If no ftood depth number is available, is the top of the bottom ftoor elevated in acx:ordance with the community's floodplain management ordinance? 0 Yes D No D Unknown. The local official must cerlify this infonnation in Section G.
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owners authorized representative who completes Sections A, B, C (Items C3.h and C3.i only), and E for Zone A (without a FEMA-issued or communityissued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are correct to the best ofmy knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS
CITY
STATE
SIGNATURE
DATE
TELEPHONE
ZIP CODE
COMMENTS
D 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, 8, C (or E), and G of this Elevation Cerlicate. Complete the applicable item(s) and sign ooow. G1 . D The intormat'1on ·1n Section C was taken from other documentation that has been signed and embossed by a licensed suNeyor, engineer, or architect who is authorized by state or local law to certify elevation information. {Indicate the source and date of the elevation data in the Comments area below.) G2. DA community official mmpleted Section E for a building located in Zone A (without a FEMA-issued or mmmunityjssued BFE) or Zone AO. G3. D The following infonnation (Items G4-G9) is provided for community loodplain management purposes.
G4. PERMIT NUMBER
G5. DATE PERMIT ISSUED
G6. DATE CERTIFICATE OF COMPLll\NCE/OCCUPANCY ISSUED
G7. This permit has been issued for: 0 New Construction D Substantial Improvement GS. Elevation of as-built lowest ffoor (including basement) of the building is: G9. BFE or (in Zone AO) depth of flooding at the building site is:
_._ft.(m) _._ft.(m)
LOCAL OFFICIAL'S NAME
TITLE
COMMUNITY NAME
TELEPHONE
SIGNATURE
DATE
Datum: Datum:
COMMENTS JOB#
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FEMA Form 81-31, January 2003
Replaces all previous editions
