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Home My WebLink About34679-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPA=RTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33928 Date: 09/01/09 T~IS CERTIFIES that the building DECK Location of Property: 4705 MAIN BAY%fIEW RD (HOUSE NO.) County Tax Map No. 473889 Section 76 Subdivision SOUTHOLD (STREET) (HAMLET) Block 1 Lot 23 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 11, 2009 pursuant to which Building Perm/t No. 34679-Z dated MAY 11, 2009 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is DECK ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to DIANA C VANDUZER (OWNER) of the aforesaid building. SUFfOlK COUNTY DEPARTMENT OF ~EALT~APtROVAL ELEOrKICAL CERTIFICAT~ NO. PLOR~BERS u~KTIFICATION DA'r~D N/A N/A N/A Rev. 1/81 Form No. 6 TOWN oF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPAN( This application must be filled in by typewriter or ink and submitted to the Building Depa~ A. For new building or new use: AUG 2 4 ZOO9 · BLDG, DEH. ment wltt$~ ~lt0tl~ l. Fina~ surv~y ~f ~r~perty with ac~urate ~~~ati~n ~f al~ bui~dings~ pmperty ~ines~ streets~ and unusua~ natural ~r topographic features. 2. Final Approval from Health Dept. of Watar supply and sewerage-disposal (8_9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957} non-conforming uses, or buildings and "pre-existing" land uses: t. Accurate survey of property showing all proper~y lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the masons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additious to dwelling $25.00, Alterations to dwelling $25.0G, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy- $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.013, Commercial $15.00 Date. New Construction: Old/~Pre-exis~g Building: Location of Property.'~. '2'/'70 ~-- 'la;n House No. ~ / _ S~Jeet x Owneror Owners of Property: ~', v2)/O~)~ ~-' tOl~ 3 (cheek one) Hamlet Suffolk County Tax Map No 1000, Section '? .~ Subdivision Permit No. ~ qb "~q DateofPermit. . Health Dept. Approval: Planning Board Approval: Block / Lot Filed Map. Lot: Applicant: Underwriters Approval: .Request for: Temporary Certificate Fee Submitted: $ 2~ ~ Final Certificate: (check one) C.-/A ;b[ ant sign t ' FORM NO. 3 . TOWN OF SOUTHOLD BUILDING DEP~RTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 34679 Z Date MAY 11, 2009 Permission is hereby granted to: DIANA C VANDUZER 4705 MAIN BAYVIEW ROAD SOUTHOLD,NY 11971 for : CONSTRUCTION OF A 20'X 13'DECK ADDITION TO AN EXISTING SINGLE DWELLING AS APPLIED FOR at premises located at 4705 MAIN BAYVIEW RD SOUTHOLD County Ta~ Map No. 473889 Section 076 Block 0001 Lot No. 023 pursuant to application dated MAY 11, 2009 and approved by the Building Inspector to expire on NOVEMBER 11, 2010. Fee $ 200.00 Authorized Signature ORIGINAL Rev. 5/8/02 (THIS FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 28329 Z Date APRIL 25, 2002 Permission is hereby granted to: GUY & DIANA VANDUZER PO BOX 852 SOUTHOLD,NY 11971 for : CONSTRUCTION OF 20'X13' DECK ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 076 pursuant to application dated APRIL Building Inspector. 4705 MAIN BAYVIEW RD SOUTHOLD Block 0001 Lot No. 023 23, 2002 and approved by the Fee $ 150.00 ~i~nature ORIGINAL Rev. 2/19/98 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I~JLATION [ ] FRAMING / STRAPPING [~ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: ~'~/~ ~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS.~ATION [ ] FRAMING / STRAPPING [~.]/FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] RRE RESISTAI? CONSTRUCTION [ ] FIRE RESISTANT PENETRATION __~REMARKS: ~) ~--~/-"~ DATE ~:~ INSPECTOR FO~DATION (1ST) FO~ATION (2ND) ROUGH F~G & PL~B~G ~S~ATION PER N. Y. STA~ ENERGY CODE TOWN OF SOUTHOLD BUILDIIqG DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: 765-1802 .1~ Examined t~, 20 Approved ~/)~,, 20 Di~pproved ~c PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying ? Board of Health ""3 sets of Building Plans --'" Survey -----.-~ Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phonc:~,. ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This apphcation MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a penrdt shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what-so-ever until a Certificate of Occupancy is issued by the Building Inspector. APPLICATION IS HEREBY MADE m the Building Department for the issuance cfa Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demohtion as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations/and to admit authorized inspectors on premises and in building for necessary inspections. //.) //~/7 , ~r'p~O~2~ ~'V g.-~ " tSi"~'~'-'-'-~atureov fapplicant'orn~,j~ac6moration) ¥1~1 i ~i~3'[~/ ~I'-[{H [' IG*~ !1 - (Mailing address of applicant) OF OCCUPANCY State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumb:er~.~r builder / (as on the tax roll ,~r lat~rflwax/5~. ~.~ - ~bYII~'BUILDING D£PAKI~I~ff AT 7~5-1802 g AM TO 4 P~ FO~ TI'lB I£ a~lic~mt is a corporation, s~e o£ du~ autho~c8 officer FOLLm~/, ~C 'U~ECTION~ (Name and tide of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. FO~ ,g,~u~ - TWO REQUIRED 2. RO~)-? - ~F-~AMiNG & PLUMBING 3. INSULATIOII 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL ~'~ET THE REQUIREMENTS OF TH ,N.Y. 8TA?E CONSTRUCTION & E~, :RGY COBES. NOT RESPONSIBM: FOR Dr~IGN OR CONSTRUCTION £. ,dORS Locatioja of land on which pr~osed wor, k will be done: // "7o5 ,,.r/ , o,,/ House Number Street 7' .... Hamlet Coun, a, o. 1000 See,on Subdivision Filed Map No. (Name) 2. State existing use and occupancy of premises and intended use and ac,cup, ahoy ofproposed consmacfion; ~ , a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work (cheek which applicable): New Building. Addition ~ Alteration Repair Removal Demolition Other Work Estimated Cost Fee If dwelling, number of dwelling units If garage, number of cars (Description) (to be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height Number of Stodes Rear Depth_ Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Height Number of Stodes Rear Depth 9. Size of lot: Front Rear Depth 10. Dateofeurchase o~'~.~ Name ofFormer Owner ~"~'C~P7 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be re-graded 14. Names of Owner of premises Address Name of Architect Address Name of Contractor Address 15. Is this property within 1 O0 feet of a tidal wetland? *YES Will excess fill be removed t~om premises: YES NO NO Phone No. Phone No Phone No. IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. (Contractor, Agent, Corporate Officer, etc.) of said ov~er or o,,wners, and is duly authorized~to perform or have performed the said work and to make and file this application; that all statements contained ha this appliea~n are tree to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this , ~, ~' ~ JOYCE M. WlLK~NS Notary Public, State of Now ¥o~ No. 4952246, Suffolk Cou~ Term Expires June 12, ¢~-0 0 '~ Federal MR. GUY VAN DUZER MRS. DIANA VAN DUZER P.O. BOX 852 SOUTHOLD, NY 11971 Emergency Management Agency Washington, D.C. 20472 June 20, 2001 CASE NO.: 01-02-0840A COMMUNITY: TOWN OF SOUTHOLD, SUFFOLK COUNTY, NEW YORK COMMUNITY NO.: 360813 DEAR MR. AND MRS. VAN DUZER: This is in reference to a request that the Federal Emergency Management Agency (FEMA) determine if the property described in the enclosed document is located within an identified Special Flood Hazard Area, the area that would be inundated by the flood having a 1-percent chance of being equaled or exceeded in any given year (base flood), on the effective National Flood Insurance Program (NFIP) map. Using the information submitted and the effective NFIP map, our determination is shown un the attached Letter of Map Amendment (LOMA) Determination Document. This determination document provides additional information vz~garding the effective NFW map, the legal description of the property and our determination. Additional documents are enclosed which provide information regarding the subject property and LOMAs. Please see the List of Enclosures below to determine which documents are enclosed. Other attachments specific to this request may be included as referenced in the Determination/Comment document. If you have any questions about this letter or any of the enclosures, please contact the FEMA Map Assistance Centur toll free at (877) 336-2627 (877-FEMA MAP) or by letter addressed to the Federal Emergency Management Agency, P.O. Box 2210, Merrifield, VA 22116-2210. Additional information about the NFl]? is available on our web site at http://www, fema.gov/nfip/. Sincerely, Matthew B. Miller, P.E., Hazards Study Branch Mitigation Directorate LIST OF ENCLOSURES: LOMA DETERMINATION DOCUMENT (REMOVAL) cc: State/Commonwealth NFIP Coordinator Community Map Repository Region Federal Emergency Management Agency Washington, D.C. 20472 LETTER OF MAP AMENDMENT DETERMINATION DOCUMENT (REMOVAL) COMMUNITY AND MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION TOWN OF SOUTNOLD, SUFFOLK Lot 23, Block 1, Section 76, as described in the Executive Deed, recorded in COUNTY, NEW YORK Book 12058, Page 539, filed on July 26, 2000, by the Clerk of the Court, COMMUNITY Suffolk County, New York COMMUNITY NO.: 3608'13 NUMBER: 36t 03C0'166G AFFECTED NAME: SUFFOLK COUNTY, MAP PANEL NEWYORK (ALI. JURISDICtiONS) DATE: 5/4/'19g~ FLOODING SOURCE: GREATPECONICBAY;GOOSECREEK APPRO~MATELATITUDE&LONGITUDEOFPROPERTY:4'I.043,-'/2.429 SOU RCE OF LAT & LONG: PRECISION MAPPING STREETS 4.0 DATUM: NAD83 DETERMINATION OUTCOME 1% ANNUAL LOWEST LOWEST LOT BLOCK/ WHAT IS CHANCE ADJACENT LOT SECTION SUBDIVISION STREET REMOVED FLOOD FLOOD GRADE ELEVATION FROM THE ZONE ELEVATION ELEVATION SFHA (NGVD 29) (NGVD 29) (NGVD 29) 23 1/76 __ 4705 Main Residential Bayview Road Structure X (shaded) 8.0 feet 8.0 feet __ Special Flood Hazard Ama (~FHA) - The S FHA is an area that would be inundated by the flood had ng a 1 ~percent charge of being equaled or exceeded in any given year (base flood). ADDITIONAL CONSIDERATIONS (Please refer to the appropriate section on Attachment 1 for the additional considerations listed below.) PORTIONS REMAIN IN THE SFHA This document provides the Federal Emergency Management Agenc~s determination regarding a request for a Letter of Map Amendment for the property deschbed above. Using the information submitted and the effective National Flood Insurance Program (NFIP) map, we have determined that the structure(s) on the property(les) is/are not located in the SFHA, an area inundated by the flood having a 1-percent chance of being equaled or exceeded in any given year (base flood). This document amends the effective NFIP map to remove the subject properly from the SFHA located on the effective NFIP map; therefore, the Federal mandatory flood insurance requirement does not apply. However, the lender has the option to continue the flood insurance requirement to protect its tinanclal dsk on the loan. A Preferred Risk Policy (PRP) is available for buildings located outside the SFHA. Information about the PRP and how one can apply is enclosed. This determination is based on the flood data presently available. The enclosed documents provide additional information regarding this determination. If you have any questions about this document, please contact the FEMA Map Assistance Center toll free at (877) 336-2627 (877-FEMA MAP) or by letter addressed to the Federal Emergency Management Agency, P.O. Box 2210, Merrifleld, VA 22116-2210. Additional information about the NFIP is available on our web site at http:/A~ww.fema.gov/nfip/. Matthew 8. Miller, P.E., Chief Hazards Study Branch Mitigation Directorate Version 1.3.3 MX173010003G3820LOMAG3820SPF1 P,9o 2 of 2 I I o ate: June 20, 2001 I Case No.: 01-02-0840A I LOMA Federal Emergency Management Agency Washington, D.C. 20472 LETTER OF MAP AMENDMENT DETERMINATION DOCUMENT (REMOVAL) ATTACHMENT 1 (ADDITIONAL CONSIDERATIONS) PORTIONS OF THE PROPERTY REMAIN IN THE SFHA (This Additional Consideration applies to the preceding 1 Property.) This Determination Document has removed the subject of the determination from the Special Flood Hazard Area (SFHA). However, portions of the property may remain in the SFHA. Therefore, any future construction or substantial improvement on the property remains subject to Federal, State/Commonwealth, and local regulations for floodplain management. This attachment provides additional information regarding this request. If you have any questions about this attachment, please contact the FEMA Map Assistance Center toll free at (877) 336-2627 (877-FEMA MAP) or by letter addressed to the Federal Emergency Management Agency, P.O. Box 2210 Metrifield, VA 22116-2210. Additional information about the NFIP is available on our web site at http:/hvww.fema.gov/nfip/. Matthew B. Miller, P.E., Chief Hazards Study Branch Mitigation Directorate Version 1.3.3 MX173010003G3820LOMAG3820SPF1 4 Here are the facts you need to know before you decide. Disaster assistance will be available if my home (or business) is flooded. I don't need to buy flood insurance[ Did you know that, before most forms of Federal disaster assistance are offered, the President must declare a major disaster? Did you know that the Federal Emergency Management Agency's Individual and Family Grant Program (for Personal Property) and Temporary Housing Program (for Home Repair and Rental Assistance) arc available only if the President declares a maj~w disaster and makes that assistance availablc~ Did you know that more than 90 percent of all disasters are not Presidentially declared? Did you know that the most typical form of Federal disaster assistance is a loan that must be paid back with interest? Did you know that the average Individual and Family Grant payment is less than $2,500? Did you know that, to qualify for Home Repair Assistance, your home must have relatively minor damage that can be repaired quickly? Did you know' you cannot qualify for Rental Assistance unless your home has been destroyed or significantly damaged? ADDITIONAL INFORMATION REGARDING LETTERS OF MAP AMENDMENT For Letters of Map Amendment (LOMAs), the Federal. Emergency M~nsgement Agency (FEIMA) bases iks determination on the flood hazard information a~ilable at the tlm~ of the determlnafion Requestors should be aware that flood conditions may change or new information may be generated that would supersede FEMA's determination In such cases, the commttnity will be informed by letter. Requestors also should be aware that removal of a property (parcel of land or smacture) from the Spedal Flood Ha?ard Area (SFItA) me~n~ FEMA has determlned that the property is not subject to inundation by the flood having a 1-percent chance of being' equaled or exceeded ia any given year (base flood). This does not mean th, p ~.mPerty is not subject to other flood hazards. The property could be inundated by a flo6d with a magnitude greater than the base flood or by localiTed flooding not shown on th* effective National Flood Insurance Program (NFIP) map. The effect of a LOMA is that it removes the Federal requirement for the lender to require flood insurancea:overage for the property. The I.OMA/s not a waiver of the condition that the property owlxex r~alntaln flood ~ce coverage for the property. On/y thc lender can waive the flood insurance purchase requirement because the lender imposed the requlxement. The property owner must request and receive a written waiver from the lender before canceling thepolicy, The lender may determine, on its own as a business deci~inn, that it wishes to continue the flood insurance requirement to protect its financial risk on the loan: If the lender decides to release the property owner from the flood insurance requirement, and the property owner derides to cancel the policy and seek a refund, the NFIP will refund the premium paid for the current policy yea.r, provided that no claim is pending or has been paid on the policy during the current policy year. The property owner must provide the written waiver to the property insurance agent or company that is sendcing his or her policy. The agent or company will then process the refund request. The LOMA orovides FEMA's comment on the mandatory flood insurance requirements of the NFIP as'they apply to a particular property. A LOMA is not a building permit, nor should it be construed as such. Any development, new construction, or subsf~ntial improvement of a property impacted by a LOMA must comply with all appHeable State/Commonwealth, local, and other Federal criteria Even though the property is not located in an SFHA, as mentioned in the LOMA, it could be flooded by a flooding event with a greater magnitude than the base flood. In fact, more than 25 percent of all losses in the NFIP occur to property located outside the SFHA in Zones B, C, X (shaded), or X (unshaded). More than one-fourth of all policies purchased under the NF[P protect property located in these zones. That risk is just not as great as the flood risk to property located in SFI-IAs. To offer flood insurance protection to owners of such property, the NFIP offers two types of flood insurance policies: the Standard Policy TWIN FORK SIDING CO. ROUTE 48 MATTITUCK. NEW YORK 11952 Phone 298-5111 REFERRED BY: 19 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important: Read the instructions on pa~les 1 - 7. SECTION A - PROPERTY OWNER INFORMATION BUILDINGv~NNER'S NAIvtF~__ ~ /;,3.,~.. Z")/v---~ ,~'~.~ BUILDING STRE~ET ADDRESS (l~clud~ng Ap~., Unit, Suite, and/or,Bldg. No.) OR P.O. ROUTE AND BOX NO. PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) BUILDING USE (e.~, Resident[iai, I~lon-residential, Addition, Accessory, etc. Use Comments section if necessary.) LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: LI GPS (Type): ( f~o. ~W~' - ~.f~" or ~.::;/:/:;2°) ~VNAD 1927 LI NAD 1983 I__1 USGS Quad Map O.M.B. No. 3067-0077 Expires July 31, 2002 ZIP CODE I__lOther: SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B2. COUNTY NAME c°MMU"IT "AME °°MMU"'TY NUMBERI"3'sTATE IB4. MAP AND PANEL B5 SUFF X B6. FIRM NDEX B7 F RM PANEL B8. FLOOD Bg. BASE FLOOD ELEVATION(S) NUMBER ] ~-~ I pATE/ EFFECTIVE/REVISED DATE ZONE({~) (Zone AC, use depth~of flooding) BiO. Indicate the soume of the Base Flood ElevatiOn (E~FE~) data or bas~ flood depth entered n B9. ' · I--.J FIS Profile ~:~FIRM LJ Community Determined [~1 Other (Deschbe): Bll. Indicate the elevatioh datum used for the BFE in Bg: ~:1'NGVD 1929 ~ NArD 1988 [~ Other (Descdbe): B12, Is the building located in a Coastal Barrier Resources System (CBRS) area or Othen~ise Protected Area (CPA)? I.-.} Yes I.~ No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: L_lConstruction Drawings* I_JBuilding Under Construction* ~:~:inished Construction *A new Elevation Certificate will be required when constmctlen of the building is complete. C2. Building Diagram Number ~-- (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. IfaD diagram aCCurately represents the building, provide a sketch or photograph.) C3 Elevations - Zone~A1-A30, AE ~H A (with BFE), YE, Vl-V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH AR/AC Complete ItemS C3a'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 d~lum conversion. Datum ~ Conversion/Comnients Elevation reference mad( used Does the elevation reference mark used appear on the FIRM?_,.~.J~ Yes ~ No Q a)c) Top of bottom floor (including basement Or enclosure) ~ . ~ ~.(m) 13 b) Top of next higher floor ~ I ~ · _L. ft.(m) [3 Bottom of lowest ho~zontal structural member (V zones only) ,~_~a~-=,~lt.(m) [3 d) Attached garege (top of slab) I ~--. ~ lt.(m) [3 e) Lowest elevation of machinery and/or equipment servicing the building -7 . _~_.~ lt.(m) [3 f) Lowest adjacent grade (LAG) <~ . ~ ft.(m) [3 g) Highest adjacant grade (HAG) I ~ - ~ ft.(m) [3 h) No. of permanent openings (flood vents) within 1 fl. above adjacent grade ~ [3 i) Total area of all permanent openings (flood vents) in C3h I (".'~ ~ sq. i__..n. (sq. cra) 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 in SecUons 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. LICENSE NUMBER COMPANY NAME TITLE [.~A-/..4 .1") _Sol2_,.4~O~--, L-,~A MCC~t~ ! g.['~ I /',,J /--,'~OO ADDRESS ...... Cl STATE~,.~ .~_~ , ZIPCOD~,.~ q ~ S,GNATUR TELEP.O. . FEIVlA Form 81-3i ~t~G 9~.~ ~ SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: BUILDIN~ STREET ADDRESS ~ncluding Ap~. Unit. Suite, and/9,%Bldg No) OR PO. ROUTE AND BOX NO Policy Number 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 I__l Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AC AND ZONE A (WITHOUT BFE) For Zone AC and Zone A (without BFE), complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a L OMA or L OMR-F, Section C must be completed. El. 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 k~_l ft.(m) I__l__lin.(cm) I__1 above or J~.~below (check one) the highest adjacent grade. E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is I I I ft.(m) I__Llin.(cm) above the highest adjacent grade. E4. For Zone AC 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? LI Yes l,,-~l No ~--I Unknown, The local official must certi~ this information in Section G. 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 AC must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CiTY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS I__1 Check here if attachments SECTION (3 - 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 itam(s) and sign below. Gl. I I The information in Section C was taken from other documentation that has been signed and embossed by a licensed sunreyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the ~ource and date of the elevation data in the Comments area below.) G2: I I A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zone AC. G3. I.~1 The following information (Items G4-Gg) is provided for community floodplain management purposes. [ G4. PERMIT NUMBER ] GS. DATE PERMIT ISSUED 1G6. DATE cERTIFIcATE OF cOMPLIANcEIOCOuPANOYISSUED G7. This permit has been issued for: I--1 New Construction L_l Substantial Improvement G8. Elevation of as-built lowest floor (including basement) of the building is: ft.(m) Datum: G9. BFE or (in Zone AC) depth of flooding at the building site is: . __ ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS I--I Check here if attachments FEMA Form 81-31, AUG 99 REPLACES ALL PREVIOUS EDITIONS OWNER TOWN ~OF SO~IOLD ~OPERTY RECORD CARD LAND AGE NEW Form Tillable 1 IMP. NORMAL Acre VL N S TOTAL /~0 VILLAGE W FARM DATE DISTRICT ACREA~I~E BUILDING CONDITION SUB. TYPE OF BUILDING BELOW Value Per Acre COMM. IND. [ CB. , MISC. Est. Mkt. Value · O-- ABOVE FRONTAGE O~ WATER Value rillable 2 ~,/Z-~// Fillable 3 Noodland 10/~ ~wampland ~ lrushland 4ouse Plot Fora I FRONTAGE ON ROAD BULKHEAD M. Bldg. Extension Extension Extension Breezeway Garage tCdation Basement Ex,t. Walls Fire Place Vatia Bath Porch: Roof Type Porch I Rooms 1st Floor Rooms 2nd Floor Dormer ,,4/_~/ '. O0 ' ~/ fly,. 0~" / f