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ELEVATION CERTIFICATE O.M.B. No 3tM7-0077 Eaprres May 31, 7993 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to provide elevation information necessary to ensure compliance with applicable community floodptain management ordinances, to determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (COMA or LOMR). Instructions for completing this Corm can be found on the following pages. SECTION A PROPERTY INFORMATION I FOR INSURANCE COMPANY USE BUILDING OWNER'S NAME STREET ADDRESS (Including Apt., Unn. Suite anapr 91dg. Number) OR P.O. ROUTE AND BO% NUMBER OTHER DESCRIPTION (Lot and Blarh Numbers. etc.} POLICY NUMBER COMPANY NAIC NUMBER CITY STATE ZIP CODE SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM (See Instructions): 1. COMMUNITY NUMBER 2. PANEL NUMBER 3. BUFFI% ~. DATE OF FIRM INDEX 5. FIRM ZONE 6. BASE FLOOD ELEVATION tin AO Zones. use degnl I. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): r~ NGVD'29 U Other (describe on back) 8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this builtling site, indicate the community's BFE: i i I I I I . U feel NGVD (or other FIRM datum-see Section B, Item 7). SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level _ . 2(a). FIRM Zones A7-A30, AE. AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation of ~ ~ :.! 'feet NGVD (or other FIRM datum-see Section B, Item ~). (b). FIRM Zones V1-V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from the selected diagram, is at an elevation of I ; .I I feet NGVD (or other FIRM daNm-see Section B, Item 7). (c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is ~ .I~ feet above ~.-i or below _ (check one) the highest grade adjacent to the building. (d). FIRM Zone AO. The floor used as the reference level from the selected diagram is ~-.',_ leet above ~: or below I-. (check one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference level) elevated in accordance with the community's floodptain management ordinance? ! ~ Yes ~_ No L_' Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations: I ' NGVD'29 L' Other (describe under Comments on Page 2). (NOTE: 1! the elevation datum used in measuring the elevations is di!lerent than that used on the FIRM /see Section B. Item 7J, then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page?.) 4. Elevation reference mark used appears on FIRM: L Yes L No (See Instructions on Page 4) r 5. The reference level elevation is based on: _ actual construction L_' construction drawings (NOTE: Use of construction drawings is only valid it the building does no! yet have the reference level l/oor in place, in which case this certificate will only be valid for the building during the course of construction. A post•constructlon Elevation Certificate will be required once construction is complete.) 6. The elevation of the lowest grade immediately adjacent to the building is: . ` feet NGVD (or other FIRM datum-see Section B, Item 7). SECTION D COMMUNITY INFORMATION t. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1 is not the "lowest floor" as defined in the community's floodptain management ordinance, the elevation of the building's'lowest Iloor" as defined by the ordinance is: -' i I '.`~ feet NGVD (or other FIRM datum-see Section B, Item 7). 2. Date of the start of construction or substantial improvement FEMA Form 81-37r MAY 90 REPLACES ALL PRE VIOUS EDITIONS SEE REVERSE SIDE FOR COMINUATION