HomeMy WebLinkAboutELEVATION CERTIFICATE - 23-00222 - 125 Valley River Dr - Goodwill - Suite 201U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Federal Emergency Management Agency Expires March 31, 2012
National Flood Insurance Program Important: Read the instructions on pages 1-9.
SECTION A - PROPERTY INFORMATION *F�rinsurance Co"m'oarivllse:
Al. Building Owner's Name Gf • =`Polley Numbef-
A2. Building Street Address (including Apt., Unit Suite, and/or Bldg. N .) or P.O. Route and Box No. Company NAIL IN b-
City 1-7 , 1 State /Jl1411
A3. Property Description (Lot afid Block Numbers, Tax Parcel Number, Legal Description, etc.)
A4. Building Use (e.g., Residential, on -Residential, ddit on, Accessory, etc.) �C� +
A5. Latitude/Longitude: Lat. Long. Horizontal Datum: NAD 1927 NAD 1983
A5. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
AT Building Diagram Number—LL3
A8. For a building with a crawlspace or enclosure(s): A9, For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) sq ft a) Square footage of attached garage sq ft
b) No. of permanent flood openings in the crawlspace or b) No. of permanent flood openings in the attached garage
enclosure(s) within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in
d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes ❑ No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Communi Name & Community Number 132. County Name B3. State
B4. Map/Panel Number
B5. Suffix
56. FIRM Index
B7. FIRM Panel
138. Flood
B9. Base Flood Elevation(s) (Zone
f(o to COn
Date
J e s /29
Effective/Revised Date
Zone(s)
AO, use base flood depth)
610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9..! /
❑ FIS Profile ❑ FIRM Community Determined her (Describe) e, op Z, �L"r5
811. Indicate elevation datum used for BFE in Item 89: ❑ NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) �+
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes )E� No
Designation Date ❑ CBRS ❑ OPA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' I� Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete. Z
C2. Elevations - Zones Al-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, ARIA, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-h
below according to the buildin Cc as the BFE.
Benchmark Ufilized C.
diofm speci ied in Item AT Use the same dVertical Datum
Conversion/Comments mA "-^J A! .J a J(d s'•S�/ G,' }c%iu�
Ch,eck th_g measurement used.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) `f�/� t feet meters (Puerto Rico only)
b) Top of the next higher floor feet meters (Puerto Rico only)
c) Bottom of the lowest horizontal structural member (V Zones only) _❑ feet ❑ meters (Puerto Rico only)
d) Attached garage (top of slab) ❑ feet ❑ meters (Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building _❑ feet ❑ meters (Puerto Rico only)
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 8 S reet ❑ meters (Puerto Rico only)
g) Highest adjacent (finished) grade next to building (HAG) 8(0-7 eet ❑meters (Puerto Rico only)
h) Lovrest adjacent grade at lowest elevation of deck or stairs, including ❑ feet ❑ meters (Puerto Rico only)
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 e',evation
information. I certify that the information an this Certificate represents my best efforts to interpret the data available. S�pC1A D SUS
I understand that any false statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001. �c�45 ITi �
❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a C� Q?�t�AfJ �
licensed land surveyor? Dyes ❑ No
Certifier's Name v License Number
urT-5./1zn/ p
Title -/ / Company Name
Address city state V zl cada8� b
Signature Cate Telephone ��yS
FEMA Form -31, M ee re4erse side for continuation.
`69
7iAT� OF ��Q
is J. R�\
Replaces all previous editions