Laserfiche WebLink
Sr/2UCVV/<'FS "~ !3E ~t<1CED ,N ~ F-~oaDPcA.,~ CD_.2r0l~;sF FEEL <br />GOrtJ/EYJR SUf'Ae,2T ,Sr~'I>vOS ~~ S~ ANDS w, r• HAVE il/Q DrSCE,C'N, QC.E <br />SECTION E • BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFEI <br />F« Zone AO and Zme A (vntltoN BFE), wmplete ItertS E 1 Nrough E4 If Ute Elevawn CerOficate s mended fa use as supporting Infonnatan fa a LOM4 a LOMR~F, <br />Section C must ce competed <br />E7 BuA0n9 Dragrarn Number(SeleUttie buildng dsg2rn most sunuarbthe buiUmg fcr wff~ch this cerUfiratesbeuu1 tx~leted-see pages6and7 1(rod~agram aawately <br />represents Vte tuumng, pnmde a sketch a pholog2ph J S' ~E SK(~ jzEf ) ~' RFrflc'~2f <br />E2 The tap d the botlom boor pnduding basement or enclosure) of me W ibng 5 _ h (m) _in (an) ^ above a ^ bebw (chuck one) Ute hghesl adjacent grade (Use <br />natural grade, lr available) ~/~ <br />E3 Fa Buibirg Diagrams rr0 wtth openings (see page 7), me ned hgher Poor a elevated floor (elevaWn b) of the Wibug is _ ft (m) _in (cm) above the hghest adlacenl <br />grade Canplele Aems C3 h and C3 i on finnt of brm A/ f( <br />E4 The top d Ate pktlorm of madtneryd anNa equipment serviang the buiding s _ ft.(m) _m (an) ^ above a ^ bebw (chuck one) the hghest adjacent grade (Use <br />natural grade, A avauade) ~vNN/// 1 <br />E5 For Zme AO ony Itro flood depN number ~s awalade, s ule by or use botbm floor elevated n accoNance vnm the cemmurrry's Booddan maregenlent ordinance' <br />^ Yes ^ No ^ Unkrgwn The bcal otfic~al must ceNfy Uvs nforrrefan m Section G <br />SECTION F -PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION <br />The ptopedy ovens a ovmefs aJAgrlmd repesentawe vAq completes Sec4or>s A 8, C (Items C3 h and C3 i only), and E for Zore A (vadtout a FEMA-Issued a carmunAy- <br />sstedBFE)aZoneAOmus(sgnhere The sfaremerusnSecAxrsA,B,C,a'dEaecavctiilotfgbesfolmykrpvAedge <br />PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESEMATIVE'S NAME <br />Same as App. Form <br />ADDRESS CITY STATE ZIP CODE <br />DATE TELEPHONE <br />Check here A attachments <br />G- <br />The bcal oficgl who rs autfbr¢ed by law a onilnarlce b admruster the wrtrrrmiry's floodplain management odinarce can corttplete Sectans A 0, C (or E), and G of ms FJe+ahon <br />Cer6fkate Complete the applcable Aem(s) and sgn bebw <br />Gt ^ The mbmaGOrl n SecGat C eras pken fran outer documentabortthat has been sgned and embossed by a Irznsed surveyor, erlgneer, a archAeU who's authonzed by state <br />oflocal kw b cErtAy elevation nbmtabon (1ldxale the source and date of Ute elevatOn data m the Cannlents area bebw ) <br />G2 ^ A mrrrnvnRy otfraal oanpleled Suction E br a bulMrg bated N Zane A (wAfaut a FEMA-Issued a camtunAyasued BFE) a Zone AO <br />GJ ^ The blbmng nbmuhon (harts G4Gg) is provded br mrmwnAy Aooddan management pugxses <br />G7 Ths permit has been asued for ^ New Construcbort ^ Substantal Imprwernent <br />GB EkvaWn of as-bolt bwest flop Ondudlrg basmlent) of the budtLrg a _ _ft (m) Datun _ <br />G9 BFEa(n Zone AO)depth dfloodmg at the building cries _ _ft(m) Datum <br />LOCAL OFFICIAL'S !JANE TITLE <br />COMMUNITY NAME TELEPHONE <br />^ Check here rf attachments <br />Form 0131, January 2003 Replaces an previous ednions <br />Copy bout sdes of this Elevalpn CeNfirzte br (7) cernmunity offiaal, (~ insurance agenUCOmpany, and (3) btudng avner <br />