FLOOD ELEVATON CERTIFICATE //4 PG Z6 2 7f
U 8 DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No 1660 0008
F&Jeral Emergency Management Agency Expires March 31 2012
National Flood Insurance Program Important Read the instructions on pages 1 9
SECTION A PROPERTY INFORMATION For Insurance Company Use
Al Budding Owner s Name M J kIZA `, 4 N EArN LiC S I M? K I r/ S Policy Number
A2 Building St eet Address ( ncluding Apt Unit Suite and/or Bldg No ) or P 0 Route and Bo No Company NAIC Number
C ' CA e4M4 1.) C,JA 't'T i3o 3eoc cAtOLIt44- 4- 410E'S
Cty SAPJ �..� State ZIP Code Z7 33 O
A3 Property Descnption (Lot and Block Numbers Tax Parcel Number Legal Descnption etc) �/ °°C) Ler 1303 - out S ( Cot CS f/f*Sa 7 ?IN 9585 S5 — ‘11(3
A4 Build g Use (e g R sident I Nov Res dential Add t on Accesso y etc) i< 6-S ( 17EF) I I4 Ls.
A5 Latitude /Longitude Lai 35 • 37 4 1 a Long — n D$ SS 9q Honzontal Datum ❑ NAD 1927 'NAD 1983
A6 Attach at least 2 photographs of the budding f the Cert flcate is b ng used to obtain fl od ins rance
A7 Bu Id ng Diagram N mbar A
AS For a build ng with a crawlspace or enclosure(s) AS For a bu Iding with an attached garage
a) Squa e footage of crawlspace nclosure( ) (AV 6 sq it a) Sq are footage of attached ga age (, 3 0 sq ft
b) No of permanent flood openings n the crawlspace or b) No of permanent flood openings n the attache/ g, rage
enclos re(s) w thin 1 0 foot abo e adjacent grade i w thi 1 0 foot above adjacent grade LJ / �i'
c) Total et area of flood openings n A8 b Lf L' sq in ) Total et area of flood ope gs in A9 b Ai/ / sq in
d) Engi e ed flood open ngs? ❑ Ves Plte d) Eng eered flood openings? ❑ Ves Q-No
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81 NFIP Commun ty Name 8 Community Number B2 County Name B3 State c
F i co," - I412( / or le 3'i 0 32 R j44 ,ar/FT 1�
84 Map /Panel Number B5 Suffi B6 FIRM Inds] B7 FIRM Panel B8 Flood B9 Base Flood Elevation(s) (Zo e
58 Date Effective/Rev sed Date o e(s) g AE. AO e a e flood depth)
Q 1 01D 3/0 Co SAME G. L_
B10 Indicate the source of th Base Fl od Elevation (BFE) data or base flood depth entered in Item B9
❑ FIS Prone Mil C mmunity Determ ned ❑ the (Describe)
811 Ind Cate elevation datum used for BFE in Item B9 ❑ NGVD 1929 u 1988 ❑ Other (Descr be)
B12 Is It e bu Id' g located in a Coastal Bar er Reso rtes System (CBRS) area or Otherwise P otected Area (OPA)? ❑ Ves R
Designat on Dale ❑ CBRS ❑ OPA
SECTION C BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1 Building ele ations a e based on R Drawings ❑ B Id ng Under Constr ction ❑ Finished Constructio
A new Ele ation Certifcate will be required when construction of the bu Id ng ie complete
C2 Ele ations - Zones Al A30 AE AH A (with BFE) VE V1 V30 V (with BFE) AR AR /A AR/AE AR/A1 A30 ARWAH AR/AO Complete Items C2 a h
below accord ng to the build ng diag am specifie/I n Item A7 Use the same dal m as the BFE J D i 9 g
Benchmark Utll zed `h J D G 7 PS t O P A4 S Vertical Datum
Conve s on /Comma is
Che k them rem t sed
a) Top of batten floo (ncluding basement crawlspace or enclos re floor) 2S C o feet ® meters (Puerto R o only)
b) Top of th ne t h gher Boor 5 Beet meters (Puerto Rico only)
c) 6 ttom of the I w st hoc¢ lal st uct al membe (V Zo e only) A- afoot ❑ meters (P erto Rico only)
d) Attached garage (top of slab) Z.5 S f et ❑ meters (Puerto R co only)
e) Lowest ele ation of machinery or eq pment servicing the building Z S 5 a u feet ❑ meters (Puerto R co only)
(Desc ibe type of eq ipment a d location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) as/ 3 it ❑ meters (Puerto Rico only)
g) H ghest adjace t (finished) grade next 10 building (HAG) 7 5 C 3 eel ❑ meters (Puerto Rico only)
h) Lowest adjacent grade at lowest elevation of deck or stairs including 7 eel ❑ meters (Puerto Rico only)
str ct al s pport
SECTION D SURVEYOR ENGINEER OR ARCHITECT CERTIFICATION
This cert (cation is to be signed and sealed by a land surveyor engine o arch t ct a thonzed by law to certify levatio 011 111f(� I /ICI
information
unde that fy the info m
statement i may b ' Certificate fishable by ne represents my best efforts to
nmenf nder 18 U S Code Sect o lab!
1001 ` CAROZ j/ �
0 Check here if comments are p o ided o b ck of form We e tat tude and long ludo n Se n A pro ded by a i.,
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se
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I censed land sury yor'' es ❑ No `'Y� L.
tc. /lvc = CC z,
Certifiers Name L ense Number x
Mr Q �adF #- AS / 5 /y 2 : :ICI S 151�4 fr
z. Ttle Company Na ne S.
PP/249 S p y / �F_L 1 t'_Sv /lrco!/ S �fs2 a C s � O p Q = :
Sgoalure eO Co - �� G/ D / lT .0 Telephone GO ZIP code �.(� s � cV F S I I N . 1 � � ```
Ai �/t 4 1,,,
FEMA Form 81 31 1 ar 09 See reve a side for continuation Replaces all previous editions
IMPORTANT In these spaces copy the corresponding information from Section A Fo Insurance Company Use
BIIding Street Address ( ncluding Apt Un t S to a d /or Bld No ) or P 0 Route a d Box No Pol cy Number
O1r. r(44 Z u.'4 i 4 - err 13o5 - ow 5 C4' eocrg/A 44
City State , ^ C ZIP Code Company NAIL Number
/— Z ?33
SECTION 0 SURVEYOR ENGINEER OR ARCHITECT CERTIFICATION (CONTINUED)
i
Copy both sdes of th s Elevation Cart ficate for (1) community off c al (2) Insurance agent/comp ny and (3) bu Id ng owner
C mments
Signature Date
❑ Check he e f att I ments
SECTION E BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
Fo Zo s AO nd A (w th t BFE) complete Items El E5 If the Certificate is intended to s pport a LOMA or LOMR F request complete Sections A B
and C For Item El E4 use natural grade if available Check the measurement used In P erto R co o ly enter meters
El Pr v de elevation nfo nal n for the following and check the appropriate boxes to show whether the elevation is abo a or below the h ghest adjacent
grade (HAG) and the lowest adjacent grade (LAG)
a) Top of bottom fl or (including basement wlspace or enclosure) is _ ❑feet ❑meters Dabove o El below the HAG
b) Top of bottom floor (includ ng basement crawlspace or enclosure) is ❑feel ❑meters ❑abo e or Dbelow the LAG
E2 For Building Diagrams 6 9 with permanent flood openings provided in SectioM Items 8 and /or 9 (see pages 8 9 of Instruct ons) the ne t h gher floor
(ele abort C2 b in the diagrams) of the building is _ ❑ feet u meters El abo e o u below the HAG
E3 Attached ga age (top of slab) s ❑ feet ❑ meters ❑ above or ❑ below the HAG
E4 Top of platform of machinery and /o equ pment servicing the budding Is ❑ feet ❑ meters ❑ above or ❑ below the HAG
E5 Zone AO only If no flood depth number is available s the top of the bottom floor ele ated acco dance with the community floodpla m ageme 1
ordinance'? ❑ Yes ❑ No ❑ Unknown The local official must certify this information n Section G
SECTION F PROPERTY OWNER (OR OWNER S REPRESENTATIVE) CERTIFICATION
The property owner or owner s authorized rep esentatve who completes Sections A B and E for Zone A (without a FEMA issued or comm n ty iss ed BFE)
Zone AO m st s g here The statements n Sect ons A B and E are correct to the best of my knowledge
Property Owner s o Owner s A thon ed Representative s Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑ Check here d 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 B C (or E)
and G of this Elevation Certificate Complete the applicable item(s) and sign below Check the measurement used in Items G8 and G9
G1 ❑ The information n Section C was taken from other documental* that has been signed and sealed by a licensed surveyor engineer o architect who
is authorized by law lo certify elevation information (Indicate the source and date of the elevat o data in the Comments ar a b low )
G2 ❑ A community official completed Sect on E for a building located in Zo e A (without a FEMA su d o commun ty s ed BFE) o Zo e AO
G3 ❑ The follow ng Informal on (Items G4 G9) is provided for community floodplain management purposes
G4 Permit Number G5 Date Permit Issued G6 Date Certificate Of Compliance /Occupancy Issued
G7 Th s permit has bee issued for ❑ New Construction p Substantial Improvement
G8 Ele at on of as b At lowest floor (including basement) of the building ❑ feet ❑ meters (PR) Datum
G9 BFE or (in Zone AO) depth of flooding at the building site ❑ feet ❑ meters (PR) Dat m
010 Community s design flood elevation ❑ feet ❑ meters (PR) Datum
Local Offcial s Name T tie
C mmunity Name Telephone
Signature Date
Comments
❑ Check here d attachments
FEMA Form 81 31 Mar 09 Replaces all previous editions