ElevCert77084MaydePark1615Patel

ElevCert77084MaydePark1615Patel - OMB No. 1660-0008 Expires...

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Unformatted text preview: OMB No. 1660-0008 Expires February 28, 2009 ELEVATION CERTIFICATE U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program Important: Read the instructions on pages 1-8. SECTION A - PROPERTY INFORMATION For Insurance Company Use: A1. Building Owner’s Name Amrishkumar C. Patel Policy Number A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 1615 Mayde Park Ln. Company NAIC Number City Houston State Tx ZIP Code 77084 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LT 4 BLK 1 PARK HARBOR ESTATES SEC 2 A4. A5. A6. A7. A8. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Residential Horizontal Datum: NAD 1927 NAD 1983 Latitude/Longitude: Lat. N/A Long. N/A Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. Building Diagram Number 1 A9. For a building with an attached garage, provide: For a building with a crawl space or enclosure(s), provide a) Square footage of crawl space or enclosure(s) N/A sq ft a) Square footage of attached garage 440 sq ft b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage enclosure(s) walls within 1.0 foot above adjacent grade N/A walls within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b 0 sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number Harris County Unincorporated Area 480287 B4. Map/Panel Number B5. Suffix 48201C0615 L B2. County Name Harris B6. FIRM Index Date 6/18/2007 B3. State Texas B7. FIRM Panel Effective/Revised Date 6/18/2007 B8. Flood Zone(s) AE B9. Base Flood Elevation(s) (Zone AO, use base flood depth) 109.9 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. FIS Profile FIRM Community Determined Other (Describe) NGVD 1929 NAVD 1988 Other (Describe) B11. Indicate elevation datum used for BFE in Item B9: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? CBRS OPA Designation Date N/A Yes No 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 A1-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-g below according to the building diagram specified in Item A7. Benchmark Utilized 040285 Vertical Datum NAVD1988 Conversion/Comments 2001 Adjustment Check the measurement used. a) Top of bottom floor (including basement, crawl space, or enclosure floor) b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment in Comments) f) Lowest adjacent (finished) grade (LAG) g) Highest adjacent (finished) grade (HAG) 109.3 N/A. N/A. 108.8 109.0 feet feet feet feet feet meters (Puerto Rico only) meters (Puerto Rico only) meters (Puerto Rico only) meters (Puerto Rico only) meters (Puerto Rico only) 108.9 109.0 feet feet meters (Puerto Rico only) meters (Puerto Rico only) 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. Check here if comments are provided on back of form. Certifier’s Name Barry D. Adkins License Number 66391 Title Principal Engineer Company Name Daram Engineers, Inc. Address 5455 Dashwood # 700 City Bellaire Signature FEMA Form 81-31, February 2006 Date 9/17/2007 State Tx ZIP Code 77401 Telephone (713)528-1552 See reverse side for continuation. Replaces all previous editions 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. 1615 Mayde Park Ln. Policy Number City Houston State Tx ZIP Code 77084 Company NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments C2e is an outside air-conditioning unit. Signature Date 9/17/2007 Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) 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-E4, 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 adjacent grade (HAG) and the lowest adjacent grade (LAG). . feet meters above or below the HAG. a) Top of bottom floor (including basement, crawl space, or enclosure) is b) Top of bottom floor (including basement, crawl space, or enclosure) is . feet meters above or below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9 (see page 8 of Instructions), the next higher floor feet meters above or below the HAG. (elevation C2.b in the diagrams) of the building is N/A. E3. Attached garage (top of slab) is N/A. feet meters above or below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is N/A. feet meters above or below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community’s floodplain management Yes No Unknown. The local official must certify this information in Section G. ordinance? SECTION F - PROPERTY OWNER (OR OWNER’S REPRESENTATIVE) CERTIFICATION The property owner or owner’s authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or community-issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner’s or Owner’s Authorized Representative’s Name N/A Address City State Signature Date Telephone ZIP Code Comments NONE Check here if 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 in Section 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 information. (Indicate the source and date of the elevation data in the Comments area below.) G2. A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zone AO. G3. The following information (Items G4.-G9.) is provided for community floodplain management purposes. G4. Permit Number G7. This permit has been issued for: G5. Date Permit Issued New Construction G6. Date Certificate Of Compliance/Occupancy Issued 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 Local Official’s Name Title Community Name Telephone Signature Date Comments Check here if attachments FEMA Form 81-31, February 2006 Replaces all previous editions Building Photographs See Instructions for Item A6. For Insurance Company Use: Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number 1615 Mayde Park Ln. City Houston State Tx ZIP Code Company NAIC Number 77084 If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to the instructions for Item A6. Identify all photographs with: date taken; “Front View” and “Rear View”; and, if required, “Right Side View” and “Left Side View.” If submitting more photographs than will fit on this page, use the Continuation Page, following. FRONT VIEW 09/17/2007 REAR VIEW 09/17/2007 Building Photographs Continuation Page For Insurance Company Use: Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number 1615 Mayde Park Ln. City Houston State Tx ZIP Code Company NAIC Number 77084 If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; “Front View” and “Rear View”; and, if required, “Right Side View” and “Left Side View.” LEFT SIDE VIEW 09/17/2007 RIGHT SIDE VIEW 09/17/2007 ...
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