25C-256 Yeskie Elevation Certificate preconstruction^
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency ManagementAdency E pi
Important: Read the instructions on pages 1-9.
National Flood Insurance Program
` SECTION PROP _^ . .._^.~,..O.,
Al. BuildingOwner's*Nbme.....
A2. Building Street Add*ress.(Including Apt., Unit, Suite, and/orBidg. No.) orP.O. RouteandBoxNo..
A3
132. County Name
B3. State
p-Resideritial, Addition, Accessory, etc)
4. Building Use,(e.g�; Residential N
A6. Atta6h at least 2,photographs of the building if the Certificate is being used
to obtain flood insurance.
B4. Map/Pahb] Number
A7' Building Diagram Number
B6. FIRM Index
B7. FIRM Panel
A8. For a build,ing 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
S61
b) No,.of permanent flood.openings in the.crawlspace or
b) No. of permanent flood openings in the attached
g ar or,
mclosure(s) within 1:,Oootabove adjacent. grade
within 1.0 foot above adjacent grade
c Total I ' 0 -, , , 'A&b,
c) Total,.net area of flood openings I n A9.b
ngJpe,ere
flood,openings? El Yes
El No.
T. UkMtE RATE'MAP (FIRM) INFORMATION
`=
�.�E
h Elevatign.L(PFE),data or base flood depth entered1n ItemB9.,
inf s,'[]J,"rIRM, [I : 'Commupity. Determined El Other (Describe)
.4t d.in a.Qo'9staI Barrier ResourcesSystem (CBRS) area or Otherwise Protected Areb.(QPA)?. r Yes LZ--;10
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. - q�`I 'b d El"Construction Drawings— - 71 Building Under Construction* R Finished d
*A new �Elevatioh" will be required when construction of the building is complete,
C2. Elevations—ZonesAl-A30, AE, AH, A (with BFE), VE, Vl-V30 V (with BFE),AR, AR/A, AR/AE, ARW-A30, AR/AH, AR/AO. ..Complete a-h
below-acc0clin : t J building diag ram specified in.Item A7 the same datum asthe BFE.
Benchmark,'Utilized.-'-, Vertical Datum
d* El feet meters (Puerto,Rico only)
u� ers (Puerto Rico only)
onzontalstrbcturan
.( I El meters (Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building F7 feet El meters (Puerto Rico only)
I (Desc�ibe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) M feet, [I meters (Puerto Rico only)
g) Highest adjacent (finished) grade next to building (HAG) El feet El meters (Pyerto Rico only)
h) Lowest adjacent grade _at lowest elev6tion of deck or stairs, includin 171 feet 6, 1
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
."" ' ce rtif y t t "" t Ce "�'""="°
understand that any false statement may be punishable bv fine o/ imprisonment under 18 U.S. Code Section 1001.1771
Check here if comments are provided on bac k of�nn Wee|a�udoand kmghudvinOecUnnApmv�edUya '
licensed land surveyor? [I Yes 11-2 s h
J.;Bl. NFIR ommuni y arnd'&. nity.Number
132. County Name
B3. State
B4. Map/Pahb] Number
B5. Suffix
B6. FIRM Index
B7. FIRM Panel
B8, no d
B9. Base Flood Elevation(s) (Zone.
Effective/Revised Date
Zone
AO, use base flood
ti
IMIDORTANT: In. these space.S," copy the. corresponding. iiffGr is at un. iiom S.ectio.n A.
Building Street Address (including Apt., Unit, Suite -, and /or Bldg. No:) or P 0 Route and Box No: P�lt`mb�t
City Mate ZIP Code af'IAfirber��
SECTION D - 8 URVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION: (CONTINU
Copy both sides of this Elevation Certificate for (1') community official, (2) insurance agent /company, and (3) building owner
Comments
.... ., . .. ,. .,
❑ Checkhere if at achm ° nts it
SECTION E - BUILDING ELEVATION INFOMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITH
For Zones AO and A (without BFE), complete Items E1 -E5. If the Certificate is intended to support a LOMA or LOMR -F request, complete Sections A B ,',
and C. For Items E1 -E.4, use natural grade, if available. Check the measurement used. In Puerto Rico only„ enter" meters.
E1'. 'Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adfacen# a
grade (HAG) and the lowest adjacent grade (LAG)
p ( ment crawlspace, or enclosure) is . E] feet E] meters, E] above or ❑below "the HAG
a To of bottom floor includi ng base
b)�,Top of;bgttom:floor ( includinng basemen# crawlspace;,or.enclosureJ is : ❑.:feet ❑. meters .❑ above or.❑ below the LAG
E2 For Building.Diagrams 6 -9 with permanent flood openings provided "in "'Section A lfeins'8 "and /o`r "9 (see pages'8 =9 of Instructions); the next high er floor
(elevation: C2 .b in the diagrams). of the building is __ _ _ ❑ feet -❑ meters .❑ above or .❑ below the HAG..
E3: Attached garage;'(top of slab);is below the HAG.
❑ feet ❑ meters F1 above or . El below the HAG.
p P ,... or E4. To of,. latform" of machinery ndlo[.equlpment servicing_ the, p of the bottom floor elevated in accordance with the c uilding is ,_ ❑..feet ; ❑meters ,❑ abo ve or"
E5. Zone AO only. if no flood depth number is available, is the to ommunity s fioodptain management
ordinance? ❑ Yes ❑ No ❑ Unkno T he loc officia must certify this information in Section G.
SE - i ton F - rR0PE — RTY - OWlS EF,. tOR OWI R i:ERRESS N IATNE-) CERrIFICATi "Oil :
T,he pcopetty owner or owner's authorized representative who completes Sections A, B., and E.for Zone A (withouta FEMA rssued:or.:community issued BFE)
o r Zone An ml ict Sinn harp The .ctatamenk in Sections A. B. and E are "correct to the best of my knowledge.
_...__. ..
Property
rs -or uwner:,E
144
p
Address
Sign nature
Goniments _
City
Date -
_ SECTION G - COMMUNITY: INFORMATION OP.TIONAL).
The local official who is authorized bylaw or ordinance to.administer.th.ecommunity's floodplain management ordinance can complete Sections A, B,,,C (or E)
and G of this Elevation Certificate. Complete the applicable items) and sign below.' Check the measurement used in Items G8 and'G9. jl
G•1 ❑ The information iri Sectioh:C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who
is authorized by law to certify elevation tnformation (lndicate;the source and.date of the elevat<on data in the Comments area below.)
G2 ❑ X# community official completed Sections E for a building located in Zone A (without a FEMA issued orcommunity- issued BFE) or Zone AO.
G3. ❑ The following• information (Items G4 G9) is: provided for community floodplain tnanagernent purposes_
G4 Permit Number I G5. Date Permit Issued I G6. Date - .Certificate Of Compliance /Occupancy Issued
G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement
G8. Elevation of as -built 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) Datum
G10. Community's design flood elevation ❑ feet ❑ meters (PR) Datum
Local Official's Name Title
Community Name _ Telephone
Signature Date
Comments
FFMA Form 81 -31: Mar 09 Reolaces all previous edifions:'