f o.m.b. no. 3067-0077 expires december 31, 2005 section b: items (b1-12) must always be completed except as described in b9 for zon

F
O.M.B. No. 3067-0077
Expires December 31, 2005
Section B: Items (B1-12) must always be completed except as described
in B9 for Zone A (without a BFE).
EC QUICK REFERENCE GUIDE FOR CRS COMMUNITIES
Details for Completing an Elevation Certificate are in the
Instructions– See Note on Page 2
Version Date: March 2003
EDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
E
B6 – FIRM Index Date. Enter the date from the latest FIRM INDEX where
the building is located, not the FIRM panel date except as noted. NOTE:
For communities with only one FIRM panel there is no FIRM Index, use
the panel date (same as B7). You may check the NFIP Community Status
Book to ensure that you are using the current FIRM Index and current
panel for the property location. This may be done on the www.fema.gov
website or by calling 1-800-427-4661. Due to recent incorporations or
annexations, the correct FIRM Index may be different than the one for
the community entered in B1.
LEVATION CERTIFICATE
Section A: 911 Address of building location, if possible. Complete all
applicable items. Only the Latitude/Longitude item is optional. Attach
a map or sketch or provide directions in Section D comments on Page 2,
if necessary.
Important: Read the instructions on pages 1 - 7.
SECTION A - PROPERTY OWNER INFORMATION
--------------------------------------
For Insurance Company Use:
BUILDING OWNER’S NAME
=====================================
 
Policy Number  
B1 – Enter the NFIP name and number (six digits) of the community
where the building is located. For a building that is in area that has
been annexed by one community but is shown on another community’s
FIRM, enter the community name and six digit number of the annexing
community. For buildings located in unincorporated areas of a parish,
enter the NFIP name and number for the parish, not the city listed in
the postal address. A countywide FIRM number (5-digits plus “C”) is
not an NFIP community number
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg.
No.) OR P.O. ROUTE AND BOX NO.
 
Company NAIC Number  
CITY STATE ZIP CODE
     
B7 - FIRM PANEL date. Enter the date from the FIRM panel where the
building is located. The panel date may be the same or earlier than
the FIRM Index date but not later. Due to annexations, the correct
FIRM panel may be different than the one for the community entered in
B1.
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel
Number, Legal Description, etc.)
 
BUILDING USE (e.g., Residential, Non-residential, Addition,
Accessory, etc. Use a Comments area, if necessary.)
 
B8 – Flood Zone(s). Enter all flood zones in which the building is
either partially or totally located.
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS (Type): 
( ##o - ##’ - ##.##” or ##.#####o) NAD 1927 NAD 1983 USGS Quad Map
Other:  
 
B4 – Enter the FIRM map and panel number where the building is
located. Due to annexations, this FIRM may be a different than the one
for the community entered in B1. For FIRM panel not in parish wide
format: use the 10-digit (6-digit community and 4-digit panel) number
shown on the map. For FIRM panel in parish wide format: use the parish
wide number (5 digits plus “C”) followed by the 4-digit panel number
shown on the map. For older FIRMs where the panel number is not four
digits add enough zeros in front of the number to make it four digits.
Map/Panel Number does not include the Suffix letter following the
panel number – Enter Suffix letter in Item B5.
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B9 – BFE. Enter BFE determined from the Flood Insurance Study Profile
(preferred source), Flood Elevation Table, FIRM or other source. A BFE
should be provided for each flood zone listed in Item B8. Remember to
enter depth for AO Zones. Leave blank if unnumbered Zone A (and a BFE
has not been determined).
B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER
 
B2. COUNTY NAME
 
B3. STATE
 
B4. MAP AND PANEL NUMBER
 
B5. SUFFIX
 
B6. FIRM INDEX DATE
 
B7. FIRM PANEL EFFECTIVE/REVISED DATE
 
B8. FLOOD ZONE(S)
 
B9. BASE FLOOD ELEVATION(S) (Zone AO, use depth of flooding)
 
B
B10 – Check appropriate square for source(s) of BFE determination
indicated in B9. “Other” would be Corps, USGS, etc. “Community” or
“Other” normally would be the source used to establish BFE for
unnumbered A Zones. For developments of more than 50 lots or 5 acres,
establishment of BFE’s is required by the community’s floodplain
management ordinance.
10. Indicate the source of the Base Flood Elevation (BFE) data
or base flood depth entered in B9.
FIS Profile FIRM Community Determined Other (Describe):  
B 11. Indicate the elevation datum used for the BFE in B9: NGVD
1929 NAVD 1988 Other (Describe):  
B 12. Is the building located in a Coastal Barrier Resources
System (CBRS) area or Otherwise Protected Area (OPA)? Yes No
Designation Date 
C1 – A post-construction Elevation Certificate is required when
construction is completed for floodplain management purposes and
insurance rating purposes. Select “Finished Construction” which means
all machinery and/or equipment such as furnaces, hot water heaters,
heat pumps, air conditioners, and elevators and their associated
equipment have been installed and the grading around the building is
completed.
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C 1. Building elevations are based on: Construction Drawings*
Building Under Construction* Finished Construction
*
B11 and B12 – Check appropriate boxes.
A new Elevation Certificate will be required when construction of the
building is complete.
C 2. Building Diagram Number _  (Select the building diagram
most similar to the building for which this certificate is being
completed - see pages 6 and 7. If no diagram
accurately represents the building, provide a sketch or photograph.)
C
Section C: Complete for all zones except AO and A (without a BFE)
Zones (unless EC is to be used for LOMA or LOMR-F). Enter elevations
for Items C3.a-g to the nearest tenth of a foot.
3. 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
C
C2 – Enter appropriate diagram number (1 through 8) based on building
type, as illustrated on Pages 6 and 7 of the Instructions. If unsure
of the correct diagram number, select the best option or provide a
sketch or photograph of building and enter all elevations in C3.a-g.
NOTE: Always completed.
omplete Items C3.-a-i below according to the building diagram
specified in Item C2. State the datum used. If the datum is different
from the datum used for the BFE in
Section B, convert the datum to that used for the BFE. Show field
measurements and datum conversion calculation. Use the space provided
or the Comments area of
Section D or Section G, as appropriate, to document the datum
conversion.
D
C3 – Confirm the elevation datum source and any necessary conversions,
then complete C3.a-i according to the instructions for the diagram
number selected in C2. See illustrations on Pages 6 and 7 of the
Instructions.
atum   Conversion/Comments  
E levation reference mark used   Does the elevation
reference mark used appear on the FIRM? Yes No
 a) Top of bottom floor (including basement or enclosure)  .
  ft.(m)

C3.a – Elevation of top of lowest floor. This should never be the
elevation of the attached garage slab (See C3.d). NOTE: Always
completed.
b) Top of next higher floor   .   ft.(m)n

C3.c – Enter elevation only for V Zone buildings. Otherwise, enter
N/A.
c) Bottom of lowest horizontal structural member (V zones
only)   .   ft.(m)
 d) Attached garage (top of slab)  .   ft.(m)

C3.b – Complete only if the building has two floor levels (not
including the attached garage) as shown in the diagram illustrations
on pages 6 and 7 of the Instructions. Otherwise, enter N/A.
e) Lowest elevation of machinery and/or equipment
C3.d – Enter elevation of the top of the attached garage slab. If
none, enter N/A.
servicing the building (Describe in a Comments area)   .   ft.(m)
 f) Lowest adjacent (finished) grade (LAG)   .   ft.(m)

C3.g – Enter elevation of finished highest adjacent grade (ground,
sidewalk, patio slab or deck support immediately next to the
building). For Zone AO, use natural grade, if available. Measure to
nearest tenth of a foot if certificate is used for LOMA or LOMR-F
request. NOTE: Always completed.
g) Highest adjacent (finished) grade (HAG)  .   ft.(m)
 h) No. of permanent openings (flood vents) within 1 ft. above
adjacent grade  

C3.e – Enter the lowest elevation of the equipment servicing the
building. If installed, servicing equipment elevation must be entered
for the certificate to be based on Finished Construction. Describe
equipment in comments. Enter N/A only if servicing equipment will not
be installed.
i) Total area of all permanent openings (flood vents) in C3.h
  sq. in. (sq. cm)
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
----------------------------------------------------------
C3.h – Number of permanent openings that are no higher than 1.0 foot
above the adjacent grade. If none, enter 0.
C3.f – Enter elevation of finished lowest adjacent grade (ground,
sidewalk, patio slab or deck support immediately next to the building.
For AO Zone, use natural grade, if available. Measure to nearest tenth
of a foot if certificate is used for a LOMA or LOMR-F. Note: Always
completed.
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 in Sections A, B, and C 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.
C3.i – Total area of permanent openings as described in C3.h. If none,
enter 0.
CERTIFIER’S NAME   LICENSE NUMBER  

Place signature and embossed seal in box to certify elevations. Flat
stamp is authorized only in states that do not authorize embossed seal
over the signature of a professional.
ADDRESS CITY STATE ZIP CODE
       
Section D: Complete as indicated by person authorized to certify
elevations.
SIGNATURE DATE TELEPHONE
     
Note: The comments in this guide do not supercede the FEMA
Instructions and are not intended to cover all situations when
completing an elevation certificate. Please refer to the FEMA/NFIP
Elevation Certificate and Instructions for full details.
IMPORTANT: In these spaces, copy the corresponding information from
Section A.
For Insurance Company Use:
Repeat address information from Section A in order to correctly match
pages 1 and 2.
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or
Bldg. No.) OR P.O. ROUTE AND BOX NO.
 
Policy Number  
Section D (continued): Use comments section to provide datum,
elevation or other relevant information not specified on the front.
Copy both sides of the certificate for the community official,
insurance agent and building owner. When an elevation for item C3.e is
entered, describe machinery/equipment type here.
CITY STATE ZIP CODE
     
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
 
 
Section E: Use only for AO or Zone A (without a BFE) and certificate
is not used to support information for a LOMA or LOMR-F. Otherwise,
complete Section C instead.
 
E2 - This corresponds to the elevation of “a” in the illustration of
the diagram number selected for E1. Indicate how much this floor is
above or below the highest adjacent grade.
Check here if attachments
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT
REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
--------------------------------------------------------------
Section G: The community 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. If the authorized community official completes
Sections C, E, or G, complete the appropriate item(s) and sign this
section.
Check Item G1. If Section C is completed with elevation data from
other documentation, including elevations obtained from the Community
Rating System Elevation Software, that has been signed and embossed by
a licensed surveyor, engineer, or architect who is authorized by law
to certify elevation information. Indicate the source of the elevation
data and the date obtained in the Comments area of Section G. If you
are both a community official and a licensed land surveyor, engineer,
or architect authorized by law to certify elevation information, and
you performed the actual survey for a building in Zones A1-A30, AE,
AH, A (with BFE), VE, V1-V30, V (with BFE), AR, AR/A, AR/A1-A30,
AR/AE, AR/AH, or AR/AO, you must also complete Section D.
Check Item G2. If information is entered in Section E by the community
for a building in Zone A (without a FEMA-issued or community-issued
BFE) or Zone AO.
Check Item G3. If the information in Items G4.-G9. has been completed
for community floodplain management purposes to document the as-built
lowest floor elevation of the building. Section C of the Elevation
Certificate records the elevation of various building components but
does not determine the lowest floor of the building or whether the
building, as constructed, complies with the community’s floodplain
management ordinance. This must be done by the community.
E1 - Enter appropriate diagram number (1 through 8) based on building
type, as illustrated on Pages 6 and 7 of the Instructions.

E5: - Community official must determine if building in Zone AO was
constructed according to the community’s floodplain management
ordinance.
F
E3 - This corresponds to the elevation of “b” in the illustration of
the diagram number selected for E1. Enter how much this floor is above
the highest adjacent grade. Enclosures below the elevated floor (as
shown in the illustrations for building diagrams 6, 7 and 8) require
openings. Items C3.h and C3.i must also be completed for these diagram
numbers.
or Zone AO and Zone A (without BFE), complete Items E1 through E4. If
the Elevation Certificate is intended for use as supporting
information for a LOMA or LOMR-F, Section C must be completed.
E1. Building Diagram Number   (Select the building diagram most
similar to the building for which this certificate is being completed
– see pages 6 and 7. If no diagram accurately represents the building,
provide a sketch or photograph.)
E2. The top of the bottom floor (including basement or enclosure) of
the building is   ft.(m)  in.(cm) above or below (check one) the
highest adjacent grade. (Use natural grade, if available).
E3. For Building Diagrams 6-8 with openings (see page 7), the next
higher floor or elevated floor (elevation b) of the building is  
ft.(m)   in.(cm) above the highest adjacent grade. Complete items
C3.h and C3.i on front of form.
E
E4 – Enter the lowest elevation of the equipment servicing the
building. Describe equipment in comments in Section F. Enter N/A only
if servicing equipment will not be installed.
4. The top of the platform of machinery and/or equipment
servicing the building is __ ft(m) __ in(cm) above or below (check
one) the highest adjacent grade. (Use natural grade if available)
E5. For 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 ordinance? Yes No Unknown. The local official
must certify this information in Section G.
SECTION F - PROPERTY OWNER (OR OWNER’S REPRESENTATIVE) CERTIFICATION
====================================================================
Section F: Certification of property owner or owner’s representative
who completes Sections A, B, C (Items c3.h and c3.i only) and E for
Zone AO and Zone A (without a BFE). The address indicated must be the
actual mailing address of the property owner or representative who
provided the information on the certificate. If a community official
completes Section E, certification is done in Section G.
The property owner or owner’s authorized representative who
completes Sections A, B, C (Items C3.h and C3.i only), 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, C, and E are correct to the
best of my knowledge.
PROPERTY OWNER’S OR OWNER’S AUTHORIZED REPRESENTATIVE’S NAME
 
ADDRESS CITY STATE ZIP CODE
       
SIGNATURE DATE TELEPHONE
     
COMMENTS  
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.
G1. The information in Section C was taken from other documentation
that has been signed and embossed by a licensed surveyor,
engineer, or architect who is authorized by state or local 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 - 9 – Complete as indicated to determine if a structure has been
built in accordance with your community’s floodplain management
ordinance.
G4. Permit Number
 
G5. Date Permit Issued
======================
 
G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED  
=======================================================
G 7. This permit has been issued for: New Construction
Substantial Improvement
G 8. Elevation of as-built lowest floor (including basement) of
the building is:  .  ft.(m) Datum:  
G 9. BFE or (in Zone AO) depth of flooding at the building site
is:   .   ft.(m) Datum:  
Enter all the listed information for the community official. Official
must sign and date the certificate.
LOCAL OFFICIAL’S NAME   TITLE  
COMMUNITY NAME   TELEPHONE  
Enter comments as necessary. When items G4-G9 are completed, the local
official can use the comment section to document building compliance
for building features such as machinery/equipment and openings.
SIGNATURE   DATE  
COMMENTS  
Version Date: March 2003
 
Check here if attachments
FEMA Form 81-31, January 2003 SEE REVERSE SIDE FOR CONTINUATION
REPLACES ALL PREVIOUS EDITIONS

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