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Mar 06 06 04:30p
. Peb~08-2006 01:03 PM
olint w. rogersJJ Roword Enpineer~
2083628088
6468822
p.4
- - ••. -~w ~_~._ •• ___ •.- -...•...•..Si=:CTION A - PROPERTY OWNER !NfORMA liON
rQJ' Irn;urnrn:;v CQr'1lh1fiy 1)..;,,:
~UllDlNif.WN(J'I'~NAMf.:
Policy N...mboJ'r\ .\u.... £"-~~ ~
alII! OING STRE~.AI)DRr:;$$ (lncJud\n:) API., ~t!;I. Sur!~.<IDdlQr -Sldg. /119.) OR P.O. ROUTE AND aox NO.
CiJmpany NAlC NlIl'I'.b ••r__ J_fl1J _ t. ~l1,T.~.~{)W\ \ U J LF-.
FEDERAL EMERGENCY MANAGEMENT AGENCYNATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFJCATEdtb .
\
O.M.B. No. 3007-0077 J
Exp,ifes Decemb' .•r 31. 20Q$
t:IPCODI;.
e&....~~~
SEC1'ION B· FLOOD INSUAANCf: RATE MAP fFlRM) INFORMA"I1cm
1~I~f~~~l~"1E: ~C~:;g~58ER 52..8{JIIlYNMic tjj:ST~.J~. ~V ...'~Ja4, MAP!\NO PANEL B:';.5UfI'IX 86. HRM IND1:!X 69. BASE FI..OOOEI.EVATION(S) I
NUMBER n OATE (ZoneAO. 11';>0> <!upthDCrlt>odin';j)OOD5 Lo 3·.aS...t"M 3-(5-. E.. 3f;l'il.$"t;B 1{):Jndirol+: 111i: $OUfG;: ot illu D3$e Fk..-od Elevation (BFEj -date ;~ depth entered in fi9.
LII"I5 promu I_~IRM I_I Community O~mlmed I_I Other (COOCflbS): ~.~~ __8, 1. Indicato Ihe eJU'11;>!JQn (lal"''''1 ~ed for \he BFE jn 00; U4NGVO 1929 LINAVO 1988 LI Other to()fjcrtb~): _E\12. Is !,hi'!buildi",!) IO~loxI in n C9:lQml B~n1or Ri!)3O\J~ System (CaM)arell or QlhfiJIW!r;:c Pf{)toillOdAra-a (OPA}? I_! y!!:; 1.0No
Designation Oate:._. _~ __ ~ _---~-~-~--------~--------•._--------------~-------SECTIONC • BUILDINt;; I;U~VA1l0N INFORM~.!!ON {S1JRV~ REQU!RED) ,
C j .B!.Iik!Joti!:1Jey.<:iliol1$ am ba$9Q (!t1: L...tc;'~lr'-Jctk>n PriJw!rJgu· I-J~"\g Under ~\mc~kr •...•• tY..IRi'lished CooslrucljOfl'A fK;"V Eleva!iorl <Alrtllicate Wm be reouired wl'W.(I construcllon o( Ihe building is complet£!.
C£. 8uikiino Diagram NumbfJr ~L(~I~l tho building Q~gr~ m9'1( similar 10 UJo building for which Ihi:; certif;catei:; being completed • ~e()
pages 6 and 7. If no dlsgrarn .a",-,l'alely represents the buifdlng. provide a skatcl1 or photogr.lpl1.)C;j. E!t;\I::1:JOn& - :t.OOO$A1,A30. AE. AH. A (with fiFE). VE. V1-V30. v (with SF!:). AR. ARIA. ARJAY=., ARlA1·A30. AAJAH. J\~AO
COmplele Il~sm. C3 .••..•1btilov/ ~ct:Ordl~ 1011\$building diagram spel;ltie~ In Iwrn C:2. Stete the datum !.mod. If the dalurll lD dIM!'f<,nlfromlhc dnlUm ..,:sed fOJ'thQ SF E in $e(;dol'1 e, coollerllhfil datum 10 thal used for tha !;f"c. :Show field mca~urt:mcl1h; <loeJdatum (;()lwo(:;lon
!:,';IJ!:U\alioo. U>;e th9 ~~ proy;..doQQ( 11'1(:COmml':Ji1~ ID'~;:'Qf $Q¢tio,. I) -ct $(:..;;;IIvn~. <I:; :ili'P'"opi'IDltJ. IQ dQelJrnent iile datum CGT1VQrsion.
Datum ~!:::t\)JL7,..q ConllljroIQnlCQ(!1fT1~nt.., ~ __ -, .• iEleviilion reference mark w.ed fl..'s'I\ - I Coos me elevation re{:;rence mart< used appeaton fhe FIR ") .J! v ••t. I_INO
o a) Top of boUOr/i floor (indlJd!ngOIJlSeliienl Of eoclooure) ;11:1 ~~ . - rqm) 'f #14,
a b) rop oj l!nrl hi9t1or fJQQr 2:J' DC) Q!., .• - ft.{m) ; '~~j V J::3 c) Bonum !;If lowest hoo;z!;llJb! ~tryclurol mefllbf:!' (V zenas only) f\.) EJ . ~ ft.(m} ;; ~ ~ . f -qo~G>~i\
o dj Aiirn;h(!o g~/'<IDe{iop 01 ~ •.•b; 21.\ t... ~~ • ~ fl.(mi -E ~ - ~ ~~\ID ~) I..QWeS\ a~"nlklj\ 1Jf m~hine'-f 811G1ort;qulprmlfti 6!!:' W. ~ 4\7 1. \~
servicing the building (Describe in a CommOJiI$ aJ'<'Ja.) ~ J 2 q -- ._ n.(m} ~ ~ \] (J~-ot,,-U I) Lowesl~l.!jacer\1(fln~h~d) grade (LAG) . :.$ J ~ g i±.£- . _ ft.(m) ~ ~ ~ ~~ •.••-(> R .~~Q 9) HlgoestadJacenl (I1msned)~rad9 {HAG} :3 J ;}. R ::ti!:::... ~ tt.(m)!! _~"\j ~ .of \~'9'~.iJ 1\)No. of peITI~O\Mfitol)!;)l1lngt;{!looo v:mw} IIJ!U'o'n '\ fl. a\)ove adjacenl gradE! • () ~ ~ -.I. tiO~!J i) Tala! <!!e5 of ell pQlmill\3nt opoo!ng-.; (fuIod vents) in C3.h .B.~ SQ. in. (sq. em)
$ECi'IOI\! D - SURVEYOR. ENIj;IN~ OR'~~HITECT CERTIFJC.<\TION
Thit cerurICalion is 1('>be $190(\(/ and sealed by 3 land sUlVeyor. engIneer, or ara.ltect aUU'iOti.\!etl by law to certifyeklV<3tion infOrmaIion.I ~Miiy mat fh<:illioftnatItJll in $••cllctt/5 A, B. BIrd Call m/$ ;;e;tJjjcare reprtlS'Dt'll:s my t;;m;f otrons ro tniotptBr Iha d••la available.I unrfor:;I,;mc! 1hl'1 iIDY flJlstJ sIDI8mont may b~ punidiDblo by fin!) Of' Jmprnror.mrH1l unrkJr 16 U.S. Code, StUillcn 1001.
CERTIFISP:;PJi\ME ..:, Ll . J ," • ( ..• l-!CENSE.N~eR. VAJ:.N)£.S v. rrDWAJ1d . "0..' -::.. ~.,&'j,;. 2.L~7/
TITLe .•••.• ~ I ~ NAMf::. •OWN1t/L .J"'.v. rr¢~, tT.fAlE£I"1J7a.-
_.•.!JI'J~~ <a "Y 'T'-"-.JL>:.c==.:'-=-:...::..:::.G-F,.A-:r ..••E--~-l-IP~C-O-\.J1::-~~---/.5'30.£ Ckt:am~r~~J.-.Ay£. ME.£I.dl"';'~ ;:{J:f,A-hO 'i/B/:,¥2.SIGNATURE OA11: 'fellif'HON!O
____ ~ ~~_~_~_~.(.~ •• =2o,_;...O_~.o...-•••.••••.8 i/[.t.-.::.a.~_~~SC{> rC\lt.W,;c ~idQ iQr «Intinua!ion. Repb;lt;es aUpr~\'icu:; Qditio/'lt;
Mar 06 06 04:31p olint w. rogers. f'i?b-OB-2006 01; 03 PM J J Howard Eng inepn:;
2083628088
8468822
p.55/7
For Inwrance Ccmpsny US~:
Po!i!;y·Numb5r
lMPO?TANT: If! tho~ ~iIC_. ~py the CDTrc:spol'\din9 in1ormat1on from $olOtion A.
VUIWJNG S'I}!EET AOORESS (1rn:JlIdin~ AjlI., Unil. S\llt", ~ndJOt'Sldg. No.) OR ~,O. ROUTE ANQ BOX NQ,-1Lu....~e..~-'"t.. ~ Q!l.~C..1Lr.h~ ~ ... _.erN • _: STATE h 1!f CODE ICcmpany NAte i'lumiJur;D t'77E.- $d.:.. &;} S"3~
5E;.CTION D • SURVEYOR, eNG!NEER, OR A~CH!TI!CT C~R1'IHCATION (CONiJNUF.Oj
COpy Dolh :;id"5 or Ihls ~Iev.alion Cenlflcatfl tor (1) community offICial. (2) insurance agent/cofj)P9M. ~1!C!(~) buildJr1.g o\%"t!cr.
ern..iM·F.NTS . - . ,
I_IChec;!f.lwre il Ijl1acMlef1: ••
$t:CTlON e . BlIILOING ELEVATION INfORMATION {SURVEY NOT REQUIRED} FOR ZONE AO AND ZONE A {WITHal.!! SF!::)
For ZDne AD and ZO,ie A (without 8FE). complete lIems E1, through ES. If 1M EIe'iatlon Certificate Is Intendi:d (or use as :mppot1inl/in!anllaiQ,'1 for:> LO/l.1A Of 1..0MR-F, 5CCUofi C must be complete(L
E1.Suilding Diagt3rn Number __ ($(lI~ th& bUilding di.agr.<:irnlnozt similar \Q the buildil\j) for wttich this c"'rlificmc is bei,~ .(;()mp~t~d ~O€ f'<JijC56 Md 7. If no qi,,!]r~M »r,;c\Jra\o1y rCpn;!J!Qnt~the tJuikllnc. praY/de a sketch or pholograpl1.)
E2. '[hi! :09 altho bonom flOO{(inciudirn:l bi:JsemeOI or encfosure) of the building i$ L/-I fl. (m) 1-1-1in. (ern) I_I ~DOYC or 1-1l:Jeltjw{chuck one} U\Chigh~1 lIUjacsl1t grade. Wse natural grade, if ~\lajJable.}
E3, I=l',Ir 8\.1iklino Di:agr.Jrrw 6-:9 wltn oponings (see pHil'" 1). the n~XI higoof floor or 9!CV~ !!QQr {(lwvatic-n b) ;;;! the builclinq is
l~t_I1t. (m) LJ_!in. (ern} 6bol.'G !hI;! hi\JhClst«djClccot gnl~. CQI"Optete Items C3.11 and C3.i 00 frontof form.I::'1.the top or m~ platfom\ of n, ••cMlery and/or equipmenl servicing Ihe building is 1_1-1(L (In) I--Lf 1ft. (GIn) I_I .move or I-I 118!Ow
{chock om~}th ••hj9h~t a<Jjacenl grode. (U~ naturel gral!e. 113vailable.) .E:5.I=or20n<;>AO Dnly: II no 1Ioc9d~p!h flymber is wallab!t!. i!!. ttw t~ ~r tM boHom nool' olavQtod in 1:1I;cordl1!'H;o ",nth thl' <;:ommunity'::;
~ •. (loodplilin OIGf1am~mentordlnilnc~? L_I Yo~ I_I No '-_I UnknQllVrl. Tho 1t;JJ;,.,'offici!11 fTlLI~ ceMlfy 'hi:;: infQlTlla~ in Secl~on G.SE¢iION F - PROPI;:RTY OWNeR {OR OWNER'S REPRESENTATIVE. CEitTIFlCA1l0N
~erty ownor or ownor'$ ;JolhorizGd 11)j;!Te:lOTllalive who completes Sections A. a, C (Items C31\ and C.3,i Ci'l!y), ;..'" E ror Z~na A\Wl1!'Jout ~ fEMA-It>5ued Of CfJmmunity-1S5ued BFE} ¢r Zone AO m!J~ sign heIe. Too sratetnatlf:; in SectjOi1$ A. B. C. ~ncl E: {Jt'U cOrroel to
.!.hl1 bD~tor trI'1l<nowlod(JB.AAOPERW OIN"IER'$ OR OWNeR'S AUiHORI7.ED Rl,i7RE3ENT p.:rn.'t:'1,> NAM€
AOORES::;
-SiCNl>.TURE
CITY
DATE
STAT!:
T~LEPHOHE
ZIP COOC
---------~----------------~.~~----_._-----------_.-._----~--~~-~-~--
lOCAl. Of.J:IC!J\!.:$ NJ>,M~
~\UNliY NAME.
COMMENTS
TIlLE
CATE
J_I Ched hot •• II"U~hI1!Anl:i
-.-"',~.-_.,-,",-------__._._-------------~.-'-~._"~.~~-------------=----------IChoGk hef!' ;t 'H!!lI<"mE'nl5
~",ol,lces all I)(/>"jo"" "'!ohn"~
II!
D-''IE .7- 7--0'5'
DESCRIPTION OF PROPOSED VORKS:
--X-- HEVBUILDING MOBILE HOME PLACEMENT------__X_ReSidential
OnSingleLot-----Non/Residential
InMobileRo.ePark----- -----------
ADDITION/ALTERATION_____ Replaceaent
SUBDIVISION
OF LAND New Place.ent------ -----FILL
------WATERCOURSE ALTERATION
OTHER.------ ------
Market Value of Exist. Property $ ~ __ ~~~ __
Estimated Cost of Proposed Construction $__ ~~q~----If this is an Addition/Alteration, is the iaproveaent
50 X or more of t~e market value of the already existingBuilding? Yes No
Attach the following information where applicable: Plans of the development to be undertaken including any filling and any watercourse or drainage way alteration.
Specifically, the following information is required; (1) Mean sea level (MSL) eleva-tion of the lowest floor (including basement) of all proposed structures; (2) MSL elevation to which a proposed structure will be floodproofed; (3) certification by a registered professional engineer or architect that t~e floodproofing aethod meets the coamunity floodproofing criteria; (4) a description of tbe extent to which any watercourse willbe altered or relocated, and (5) base (lOO-year) flood elevation data for a developmentor subdivision greater than 50 lots or 5 acres.
----------------------------------------------------------------------------------------
THE FOLLOWING IS TO BE COMPLy BY THE LOCAL ADMINISTRATORProposed development is located in Flood Rzd.Area Floodway
Base Flood Elev. of Site is:_ ;fJ-I'..) Source: FIRM Map EfLDate: /J1~ lr;q'lPLAN REVIEW
MSL Elevation/Depth Number structure is to be.elev~ted/floodproofed
Are necessary information, certificates and other permits attached?
ACTION TAKEN
feet.
Yes No
The proposed development is in conforaance with applicable floodplain standards.PEMIT IS APPROVED
The proposed develop.ent is not in conforaance with applicable floodplain standards (explanation attached). PERMIT IS DENIED
The proposed addition/alteration is not SOX or .ore of the .arket value of theexisting building. NO FLOOD PElU1ITREQUIRED
Da te :~~ __ ~~ __
City Bldg. Permit No.
Local Ad.inlstrator:~
