HomeMy WebLinkAboutELEVATION CERTIFICATE - 16-00572 - Grace Baptist - AdditionU.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008
Federal Emergency Management Agency Expiration Date: November 30, 2018
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner.
SECTION A - PROPERTY INFORMATION
FOR INSURANCE COMPANY USE
Al. Building Owner's Name � � l
6r -A
Policy Number:
-U , �
A2. Building Street Address (including Apt., Unit, ISuite, and/or Bldg. No.) or P.O. Route and
Box No.
Company NAIC Number:
0(op Z
City r State � ZIP Code e
A3. Property Description (Lot ar4 Block Numbers, Tax Parcel Number, Legal Description, etc.)
P,2 P -x o
A4. Building Use (e.g., Residential, Non-Residentia �dditionAccessory, etc.)
A5. Latitude/Longitude: Lat.lP-3-041 .j�% Long /`i 7 ,(u'� Horizontal Datum: E] NAD 1927 NAD 1983
i
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) 141,4 sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b stL,4 sq in
d) Engineered flood openings? ❑ Yes ❑ No
A9. For a building with an attached garage:
a) Square footage of attached garage 414 sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade AJ �r
c) Total net area of flood openings in A9.b sq in
d) Engineered flood openings? ❑ Yes XNo
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
B2. County Name
B3. State
B4. Map/Panel
B5. Suffix
B6. FIRM Index
B7. FIRM Panel
B8. Flood Zone(s)
B9. Base Flood Elevation(s)
Number
Date
Effective/
(Zone AO, use Base
Revised Date
11914.
Flood Depth)
B10. Indicate the source o the Base Flood Elevation (BFE) data or base flood depth entered in Item B9:
❑ FIS Profile FIRM ❑ Community Determined ❑ Other/Source: t t,J {rte A-J�
r� AIAVD
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929] NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes No
Designation Date: ❑ CBRS ❑ OPA
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6
ELEVATION CERTIFICATE
OMB No. 1660-0008
Expiration Date: November 30, 2018
IMPORTANT: In these spaces, copy the corresponding information from Section A.
FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
Policy Number:
City S ZIP Code
Company NAIC Number
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings*Building Under Construction* Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations - Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, ARAE, AR/A1-A30, AR/AH, AR/AO.
Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: �,�.� I."- Vertical Datum: NX VD
Indicate elevation datum used for the elevations in items a) through h) below.
❑ NGVD 1929 NAVD 1988 ❑ Other/Source:
Datum used for buildin elevations must be the same as that used for the BFE.
Check the measurement used.
a) Top of bottom floor (including basement, crawispace, or enclosure floor) ". 0 feet ❑ meters
b) Top of the next higher floor 4,8&8 feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only). ❑ feet ❑ meters
d) Attached garage (top of slab) Al E] feet E] meters
e) Lowest elevation of machinery or equipment servicing the building 14re40 %Jeet ❑ meters
(Describe type of equipment and location in Comments)
���� low
f) Lowest adjacent (finished) grade next to building (LAG) feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) ;!�,feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including b'o�� . S� feet ❑ meters
structural support
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 certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false
statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? Yes ❑ No ❑ Check here if attachments.
Certifier's Name License Number
NAL
�0 °✓�
Title
ce
Company Name
ea:CLg
Her
Address
33
OF IDP'
��5,J �®L� �
City State ZIP Code
4_=_� /4 Za8 S¢Z-r,
—
Signat ate Telephone
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments (including type of equipment and location, per C2(e), if applicable)
-1 L�-
l 5T1 1 S L A �Cj�--•� - �l� �O �.
uo (:�,VrAwk 5p4, -Le_,'
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6