Fill - Free fillable Elevation Certificate 2015 2018 PDF (City of Roswell) PDF form

NATIONAL FLOOD INSURANCE PROGRAM

INSTRUCTIONS

AND

ELEVATION CERTIFICATE

2015 EDITION

U.S. DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency

National Flood Insurance Program

ELEVATION CERTIFICATE AND INSTRUCTIONS

Paperwork Reduction Act Notice

Public reporting burden for this data collection is estimated to average 3.75 hours per response. The burden estimate includes the

time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and

submitting this form. You are not required to respond to this collection of information unless a valid OMB control number is

displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the

burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency,

1800 South Bell Street, Arlington, VA 20598-3005, Paperwork Reduction Project (1660-0008). NOTE: Do not send your

completed form to this address.

Privacy Act Statement

Authority: Title 44 CFR § 61.7 and 61.8.

Principal Purpose(s): This information is being collected for the primary purpose of estimating the risk premium rates necessary

to provide flood insurance for new or substantially improved structures in designated Special Flood Hazard Areas.

Routine Use(s): The information on this form may be disclosed as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act

of 1974, as amended. This includes using this information as necessary and authorized by the routine uses published in DHS/

FEMA-003 – National Flood Insurance Program Files System or Records Notice 73 Fed. Reg. 77747 (December 19, 2008); DHS/

FEMA/NFIP/LOMA-1 – National Flood Insurance Program (NFIP) Letter of Map Amendment (LOMA) System of Records Notice 71

Fed. Reg. 7990 (February 15, 2006); and upon written request, written consent, by agreement, or as required by law.

Disclosure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may

result in the inability to obtain flood insurance through the National Flood Insurance Program or the applicant may be subject to

higher premium rates for flood insurance. Information will only be released as permitted by law.

Purpose of the Elevation Certificate

The Elevation Certificate is an important administrative tool of the National Flood Insurance Program (NFIP). It is to be used to

provide elevation information necessary to ensure compliance with community floodplain management ordinances, to determine

the proper insurance premium rate, and to support a request for a Letter of Map Amendment (LOMA) or Letter of Map Revision

based on fill (LOMR-F).

The Elevation Certificate is required in order to properly rate Post-FIRM buildings, which are buildings constructed after publication

of the Flood Insurance Rate Map (FIRM), located in flood insurance Zones A1–A30, AE, AH, A (with BFE), VE, V1–V30, V (with

BFE), AR, AR/A, AR/AE, AR/A1–A30, AR/AH, and AR/AO. The Elevation Certificate is not required for Pre-FIRM buildings unless

the building is being rated under the optional Post-FIRM flood insurance rules.

As part of the agreement for making flood insurance available in a community, the

NFIP requires the community to adopt floodplain

management regulations that specify minimum requirements for reducing flood losses. One such requirement is for the community

to obtain the elevation of the lowest floor (including basement) of all new and substantially improved buildings, and maintain a

record of such information. The Elevation Certificate provides a way for a community to document compliance with the community's

floodplain management ordinance.

Use of this certificate does not provide a waiver of the flood insurance purchase requirement. Only a LOMA or LOMR-F from the

Federal Emergency Management Agency (FEMA) can amend the FIRM and remove the Federal mandate for a lending institution

to require the purchase of flood insurance. However, the lending institution has the option of requiring flood insurance even if a

LOMA/LOMR-F has been issued by FEMA. The Elevation Certificate may be used to support a LOMA or LOMR-F request. Lowest

floor and lowest adjacent grade elevations certified by a surveyor or engineer will be required if the certificate is used to support a

LOMA or LOMR-F request. A LOMA or LOMR-F request must be submitted with either a completed FEMA MT-EZ or MT-1

package, whichever is appropriate.

This certificate is used only to certify building elevations. A separate certificate is required for floodproofing. Under the NFIP, non-

residential buildings can be floodproofed up to or above the Base Flood Elevation (BFE). A floodproofed building is a building that

has been designed and constructed to be watertight (substantially impermeable to floodwaters) below the BFE. Floodproofing of

residential buildings is not permitted under the NFIP unless FEMA has granted the community an exception for residential

floodproofed basements. The community must adopt standards for design and construction of floodproofed basements before

FEMA will grant a basement exception. For both floodproofed non-residential buildings and residential floodproofed basements in

communities that have been granted an exception by FEMA, a floodproofing certificate is required.

Additional guidance can be found in FEMA Publication 467-1, Floodplain Management Bulletin: Elevation Certificate, available on

FEMA's website at https://www.fema.gov/media-library/assets/documents/3539?id=1727.

OMB No. 1660-0008

Expiration Date: November 30, 2018

FEMA Form 086-0-33 (Revised 7/15) Replaces all previous editions. F-053

U.S. DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency

National Flood Insurance Program

OMB No. 1660-0008

Expiration Date: November 30, 2018

ELEVATION CERTIFICATE

Important: Follow the instructions on pages 1–9.

Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner.

FEMA Form 086-0-33 (7/15) Replaces all previous editions.

Form Page 1 of 6

A1. Building Owner's Name

A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and

Box No.

City State ZIP Code

Policy Number:

Company NAIC Number:

A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)

A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.)

A5. Latitude/Longitude:

Lat. Long.

Horizontal Datum:

NAD 1927 NAD 1983

A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.

A7. Building Diagram Number

A8. For a building with a crawlspace or enclosure(s):

a) Square footage of crawlspace or enclosure(s)

sq ft

b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade

c) Total net area of flood openings in A8.b

sq in

d) Engineered flood openings?

Yes No

A9. For a building with an attached garage:

a) Square footage of attached garage

sq ft

b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade

c) Total net area of flood openings in A9.b

sq in

d) Engineered flood openings?

Yes No

B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)?

Yes No

Designation Date:

CBRS OPA

SECTION B – FLOOD INSURANCE RATE MAP (FIRM) INFORMATION

B1. NFIP Community Name & Community Number B2. County Name B3. State

B4. Map/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 Base

Flood Depth)

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/

Source:

NGVD 1929 NAVD 1988 Other/

B11. Indicate elevation datum used for BFE in Item B9:

Source:

FOR INSURANCE COMPANY USESECTION A – PROPERTY INFORMATION

ELEVATION CERTIFICATE

OMB No. 1660-0008

Expiration Date: November 30, 2018

IMPORTANT: In these spaces, copy the corresponding information from Section A.

FOR INSURANCE COMPANY USE

FEMA Form 086-0-33 (7/15) Replaces all previous editions.

Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.

City

State ZIP Code

Policy Number:

Company NAIC Number

SECTION C – BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)

C1. Building elevations are based on:

*A new Elevation Certificate will be required when construction of the building is complete.

Construction Drawings* Building Under Construction* Finished Construction

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–h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.

Benchmark Utilized:

Vertical Datum:

Indicate elevation datum used for the elevations in items a) through h) below.

NGVD 1929 NAVD 1988 Other/

Source:

Datum used for building elevations must be the same as that used for the BFE.

Check the measurement used.

a) Top of bottom floor (including basement, crawlspace, or enclosure floor)

feet meters

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 and location in Comments)

f) Lowest adjacent (finished) grade next to building (LAG)

g) Highest adjacent (finished) grade next to building (HAG)

h) Lowest adjacent grade at lowest elevation of deck or stairs, including

structural support

feet

meters

feet meters

feet

meters

feet meters

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 attachments.

Yes No

Were latitude and longitude in Section A provided by a licensed land surveyor?

Certifier's Name License Number

Title

Company Name

Address

City

State

ZIP Code

Signature Date

Telephone

Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner.

Comments (including type of equipment and location, per C2(e), if applicable)

Form Page 2 of 6

click to sign

signature

click to edit

ELEVATION CERTIFICATE

OMB No. 1660-0008

Expiration Date: November 30, 2018

IMPORTANT: In these spaces, copy the corresponding information from Section A.

FOR INSURANCE COMPANY USE

FEMA Form 086-0-33 (7/15) Replaces all previous editions.

State ZIP Code

City

Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.

Company NAIC Number

Policy Number:

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).

b) Top of bottom floor (including basement,

crawlspace, or enclosure) is

a) Top of bottom floor (including basement,

crawlspace, or enclosure) is

feet meters

above or below the HAG.

metersfeet

below the LAG.above or

SECTION F – PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION

E2. For Building Diagrams 6–9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 1–2 of Instructions),

the next higher floor (elevation C2.b in

the diagrams) of the building is

feet meters

above or

below the HAG.

feet meters

above or below the HAG.

E3. Attached garage (top of slab) is

E4. Top of platform of machinery and/or equipment

servicing the building is

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 ordinance?

Yes Unknown.No

The local official must certify this information in Section G.

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 or Owner's Authorized Representative's Name

Address City State ZIP Code

Telephone

Comments

DateSignature

Check here if attachments.

Form Page 3 of 6

click to sign

signature

click to edit

ELEVATION CERTIFICATE

OMB No. 1660-0008

Expiration Date: November 30, 2018

IMPORTANT: In these spaces, copy the corresponding information from Section A.

FOR INSURANCE COMPANY USE

FEMA Form 086-0-33 (7/15) Replaces all previous editions.

ZIP CodeStateCity

Company NAIC Number

Policy Number:

Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.

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–G10. In Puerto Rico only, enter meters.

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–G10) is provided for community floodplain management purposes.

G4. Permit Number G5. Date Permit Issued 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

Datum

G9.

BFE or (in Zone AO) depth of flooding at the building site:

feet meters

Datum

G10.

Community's design flood elevation:

feet meters

Datum

Comments (including type of equipment and location, per C2(e), if applicable)

Local Official's Name Title

Telephone

Community Name

Date

Check here if attachments.

Signature

Form Page 4 of 6

click to sign

signature

click to edit

ELEVATION CERTIFICATE

OMB No. 1660-0008

Expiration Date: November 30, 2018

IMPORTANT: In these spaces, copy the corresponding information from Section A.

FOR INSURANCE COMPANY USE

FEMA Form 086-0-33 (7/15) Replaces all previous editions.

BUILDING PHOTOGRAPHS

See Instructions for Item A6.

Policy Number:

Company NAIC Number

ZIP CodeStateCity

Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.

If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 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." When applicable, photographs must show the foundation with representative examples of the flood openings or

vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page.

Form Page 5 of 6

Photo One

Photo One Caption

Photo Two

Photo Two Caption

ELEVATION CERTIFICATE

OMB No. 1660-0008

Expiration Date: November 30, 2018

IMPORTANT: In these spaces, copy the corresponding information from Section A.

FOR INSURANCE COMPANY USE

FEMA Form 086-0-33 (7/15) Replaces all previous editions.

BUILDING PHOTOGRAPHS

Continuation Page

Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.

Policy Number:

Company NAIC Number

ZIP CodeStateCity

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." When applicable,

photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8.

Form Page 6 of 6

Photo One

Photo One Caption

Photo Two

Photo Two Caption

Instructions for Completing the Elevation Certificate

The Elevation Certificate is to be completed by a land surveyor, engineer, or architect who is authorized by law to certify

elevation information when elevation information is required for Zones A1–A30, AE, AH, A (with BFE), VE, V1–V30, V

(with BFE), AR, AR/A, AR/AE, AR/A1–A30, AR/AH, or AR/AO. Community officials who are authorized by law or

ordinance to provide floodplain management information may also complete this form. For Zones AO and A (without

BFE), a community official, a property owner, or an owner's representative may provide information on this certificate,

unless the elevations are intended for use in supporting a request for a LOMA or LOMR-F. Certified elevations must be

included if the purpose of completing the Elevation Certificate is to obtain a LOMA or LOMR-F.

The property owner, the owner's representative, or local official who is authorized by law to administer the community

floodplain ordinance can complete Section A and Section B. The partially completed form can then be given to the land

surveyor, engineer, or architect to complete Section C. The land surveyor, engineer, or architect should verify the

information provided by the property owner or owner's representative to ensure that this certificate is complete.

In Puerto Rico only, elevations for building information and flood hazard information may be entered in meters.

SECTION A – PROPERTY INFORMATION

Items A1–A4. This section identifies the building, its location, and its owner. Enter the name(s) of the building owner(s),

the building's complete street address, and the lot and block numbers. If the building's address is different from the

owner's address, enter the address of the building being certified. If the address is a rural route or a Post Office box

number, enter the lot and block numbers, the tax parcel number, the legal description, or an abbreviated location

description based on distance and direction from a fixed point of reference. For the purposes of this certificate, "building"

means both a building and a manufactured (mobile) home.

A map may be attached to this certificate to show the location of the building on the property. A tax map, FIRM, or

detailed community map is appropriate. If no map is available, provide a sketch of the property location, and the location

of the building on the property. Include appropriate landmarks such as nearby roads, intersections, and bodies of water.

For building use, indicate whether the building is residential, non-residential, an addition to an existing residential or non-

residential building, an accessory building (e.g., garage), or other type of structure. Use the Comments area of the

appropriate section if needed, or attach additional comments.

Item A5. Provide latitude and longitude coordinates for the center of the front of the building. Use either decimal degrees

(e.g., 39.5043°, −110.7585°) or degrees, minutes, seconds (e.g., 39° 30' 15.5", −110° 45' 30.7") format. If decimal

degrees are used, provide coordinates to at least 5 decimal places or better. When using degrees, minutes, seconds,

provide seconds to at least 1 decimal place or better. The latitude and longitude coordinates must be accurate within 66

feet. When the latitude and longitude are provided by a surveyor, check the "Yes" box in Section D and indicate the

method used to determine the latitude and longitude in the Comments area of Section D. If the Elevation Certificate is

being certified by other than a licensed surveyor, engineer, or architect, this information is not required. Provide the type

of datum used to obtain the latitude and longitude. FEMA prefers the use of NAD 1983.

Item A6. If the Elevation Certificate is being used to obtain flood insurance through the NFIP, the certifier must provide at

least 2 photographs showing the front and rear of the building taken within 90 days from the date of certification. The

photographs must be taken with views confirming the building description and diagram number provided in Section A. To

the extent possible, these photographs should show the entire building including foundation. If the building has split-level

or multi-level areas, provide at least 2 additional photographs showing side views of the building. In addition, when

applicable, provide a photograph of the foundation showing a representative example of the flood openings or vents. All

photographs must be in color and measure at least 3" × 3". Digital photographs are acceptable.

Item A7. Select the diagram on pages 7–9 that best represents the building. Then enter the diagram number and use

the diagram to identify and determine the appropriate elevations requested in Items C2.a–h. If you are unsure of the

correct diagram, select the diagram that most closely resembles the building being certified.

Item A8.a. Provide the square footage of the crawlspace or enclosure(s) below the lowest elevated floor of an elevated

building with or without permanent flood openings. Take the measurement from the outside of the crawlspace or

enclosure(s). Examples of elevated buildings constructed with crawlspace and enclosure(s) are shown in Diagrams 6–9

U.S. DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency

National Flood Insurance Program

OMB No. 1660-0008

Expiration Date: November 30, 2018

NFIP Elevation Certificate Instructions –

Page 1 of 9

Instructions for Completing the Elevation Certificate (continued)

on pages 8–9. Diagrams 2A, 2B, 4, and 9 should be used for a building constructed with a crawlspace floor that is below

the exterior grade on all sides.

Items A8.b–d. Enter in Item A8.b the number of permanent flood openings in the crawlspace or enclosure(s) that are

no higher than 1.0 foot above the higher of the exterior or interior grade or floor immediately below the opening. (A

permanent flood opening is a flood vent or other opening that allows the free passage of water automatically in both

directions without human intervention.) If the interior grade elevation is used, note this in the Comments area of

Section D. Estimate the total net area of all such permanent flood openings in square inches, excluding any bars,

louvers, or other covers of the permanent flood openings, and enter the total in Item A8.c. If the net area cannot be

reasonably estimated, provide the size of the flood openings without consideration of any covers and indicate in the

Comments area the type of cover that exists in the flood openings. Indicate in Item A8.d whether the flood openings

are engineered. If applicable, attach a copy of the Individual Engineered Flood Openings Certification or an

Evaluation Report issued by the International Code Council Evaluation Service (ICC ES), if you have it. If the

crawlspace or enclosure(s) have no permanent flood openings, or if the openings are not within 1.0 foot above

adjacent grade, enter "0" (zero) in Items A8.b–c.

Item A9.a. Provide the square footage of the attached garage with or without permanent flood openings. Take the

measurement from the outside of the garage.

Items A9.b–d. Enter in Item A9.b the number of permanent flood openings in the attached garage that are no higher

than 1.0 foot above the higher of the exterior or interior grade or floor immediately below the opening. (A permanent

flood opening is a flood vent or other opening that allows the free passage of water automatically in both directions

without human intervention.) If the interior grade elevation is used, note this in the Comments area of Section D. This

includes any openings that are in the garage door that are no higher than 1.0 foot above the adjacent grade. Estimate

the total net area of all such permanent flood openings in square inches and enter the total in Item A9.c. If the net

area cannot be reasonably estimated, provide the size of the flood openings without consideration of any covers and

indicate in the Comments area the type of cover that exists in the flood openings. Indicate in Item A9.d whether the

flood openings are engineered. If applicable, attach a copy of the Individual Engineered Flood Openings Certification

or an Evaluation Report issued by the International Code Council Evaluation Service (ICC ES), if you have it. If the

garage has no permanent flood openings, or if the openings are not within 1.0 foot above adjacent grade, enter

"0" (zero) in Items A9.b–c.

SECTION B – FLOOD INSURANCE RATE MAP (FIRM) INFORMATION

Complete the Elevation Certificate on the basis of the FIRM in effect at the time of the certification.

The information for Section B is obtained by reviewing the FIRM panel that includes the building's location. Information

about the current FIRM is available from the Federal Emergency Management Agency (FEMA) by calling

1-800-358-9616. If a Letter of Map Amendment (LOMA) or Letter of Map Revision (LOMR-F) has been issued by FEMA,

please provide the letter date and case number in the Comments area of Section D or Section G, as appropriate.

For a building in an area that has been annexed by one community but is shown on another community's FIRM, enter

the community name and 6-digit number of the annexing community in Item B1, the name of the county or new county, if

necessary, in Item B2, and the FIRM index date for the annexing community in Item B6. Enter information from the

actual FIRM panel that shows the building location, even if it is the FIRM for the previous jurisdiction, in Items B4, B5,

B7, B8, and B9.

If the map in effect at the time of the building's construction was other than the current FIRM, and you have the past map

information pertaining to the building, provide the information in the Comments area of Section D.

Item B1. NFIP Community Name & Community Number. Enter the complete name of the community in which the

building is located and the associated 6-digit community number. For a newly incorporated community, use the name

and 6-digit number of the new community. Under the NFIP, a "community" is any State or area or political subdivision

thereof, or any Indian tribe or authorized native organization, that has authority to adopt and enforce floodplain

management regulations for the areas within its jurisdiction. To determine the current community number, see the

NFIP Community Status Book, available on FEMA's web site at https://www.fema.gov/national-flood

-insurance-

program/national-flood-insurance-program-community-status-book, or call 1-800-358-9616.

NFIP Elevation Certificate Instructions –

Page 2 of 9

Instructions for Completing the Elevation Certificate (continued)

Item B2. County Name. Enter the name of the county or counties in which the community is located. For an

unincorporated area of a county, enter "unincorporated area." For an independent city, enter "independent city."

Item B3. State. Enter the 2-letter state abbreviation (for example, VA, TX, CA).

Items B4–B5. Map/Panel Number and Suffix. Enter the 10-character "Map Number" or "Community Panel Number"

shown on the FIRM where the building or manufactured (mobile) home is located. For maps in a county-wide format,

the sixth character of the "Map Number" is the letter "C" followed by a 4-digit map number. For maps not in a county-

wide format, enter the "Community Panel Number" shown on the FIRM.

Item B6. FIRM Index Date. Enter the effective date or the map revised date shown on the FIRM Index.

Item B7. FIRM Panel Effective/Revised Date. Enter the map effective date or the map revised date shown on the

FIRM panel. This will be the latest of all dates shown on the map. The current FIRM panel effective date can be

determined by calling 1-800-358-9616.

Item B8. Flood Zone(s). Enter the flood zone, or flood zones, in which the building is located. All flood zones

containing the letter "A" or "V" are considered Special Flood Hazard Areas. The flood zones are A, AE, A1–A30, V,

VE, V1–V30, AH, AO, AR, AR/A, AR/AE, AR/A1–A30, AR/AH, and AR/AO. Each flood zone is defined in the legend of

the FIRM panel on which it appears.

Item B9. Base Flood Elevation(s). Using the appropriate Flood Insurance Study (FIS) Profile, Floodway Data Table, or

FIRM panel, locate the property and enter the BFE (or base flood depth) of the building site. If the building is located

in more than 1 flood zone in Item B8, list all appropriate BFEs in Item B9. BFEs are shown on a FIRM or FIS Profile

for Zones A1–A30, AE, AH, V1–V30, VE, AR, AR/A, AR/AE, AR/A1–A30, AR/AH, and AR/AO; flood depth numbers are

shown for Zone AO. Use the AR BFE if the building is located in any of Zones AR/A, AR/AE, AR/A1–A30, AR/AH, or

AR/AO. In A or V zones where BFEs are not provided on the FIRM, BFEs may be available from another source. For

example, the community may have established BFEs or obtained BFE data from other sources for the building site.

For subdivisions and other developments of more than 50 lots or 5 acres, establishment of BFEs is required by the

community's floodplain management ordinance. If a BFE is obtained from another source, enter the BFE in Item B9.

In an A Zone where BFEs are not available, complete Section E and enter N/A for Section B, Item B9. Enter the BFE

to the nearest tenth of a foot (nearest tenth of a meter, in Puerto Rico).

Item B10. Indicate the source of the BFE that you entered in Item B9. If the BFE is from a source other than FIS

Profile, FIRM, or community, describe the source of the BFE.

Item B11. Indicate the elevation datum to which the elevations on the applicable FIRM are referenced as shown on

the map legend. The vertical datum is shown in the Map Legend and/or the Notes to Users on the FIRM.

Item B12. Indicate whether the building is located in a Coastal Barrier Resources System (CBRS) area or Otherwise

Protected Area (OPA). (OPAs are portions of coastal barriers that are owned by Federal, State, or local governments

or by certain non-profit organizations and used primarily for natural resources protection.) Federal flood insurance is

prohibited in designated CBRS areas or OPAs for buildings or manufactured (mobile) homes built or substantially

improved after the date of the CBRS or OPA designation. For the first CBRS designations, that date is October 1,

1983. Information about CBRS areas and OPAs may be obtained on the FEMA web site at https://www.fema.gov/

national-flood-insurance-program/coastal-barrier-resources-system.

SECTION C – BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)

Complete Section C if the building is located in any of Zones A1–A30, AE, AH, A (with BFE), VE, V1–V30, V (with

BFE), AR, AR/A, AR/AE, AR/A1–A30, AR/AH, or AR/AO, or if this certificate is being used to support a request for a

LOMA or LOMR-F. If the building is located in Zone AO or Zone A (without BFE), complete Section E instead. To

ensure that all required elevations are obtained, it may be necessary to enter the building (for instance, if the building

has a basement or sunken living room, split-level construction, or machinery and equipment).

Surveyors may not be able to gain access to some crawlspaces to shoot the elevation of the crawlspace floor. If

access to the crawlspace is limited or cannot be gained, follow one of these procedures.

• Use a yardstick or tape measure to measure the height from the floor of the crawlspace to the "next higher floor,"

and then subtract the crawlspace height from the elevation of the "next higher floor." If there is no access

to the

NFIP Elevation Certificate Instructions –

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Instructions for Completing the Elevation Certificate (continued)

crawlspace, use the exterior grade next to the structure to measure the height of the crawlspace to the "next

higher floor."

• Contact the local floodplain administrator of the community in which the building is located. The community may have

documentation of the elevation of the crawlspace floor as part of the permit issued for the building.

• If the property owner has documentation or knows the height of the crawlspace floor to the next higher floor, try to

verify this by looking inside the crawlspace through any openings or vents.

In all 3 cases, use the Comments area of Section D to provide the elevation and a brief description of how the elevation

was obtained.

Item C1. Indicate whether the elevations to be entered in this section are based on construction drawings, a building

under construction, or finished construction. For either of the first 2 choices, a post-construction Elevation Certificate will

be required when construction is complete. If the building is under construction, include only those elevations that can be

surveyed in Items C2.a–h. Use the Comments area of Section D to provide elevations obtained from the construction

plans or drawings. Select "Finished Construction" only when 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.

Item C2. A field survey is required for Items C2.a–h. Most control networks will assign a unique identifier for each

benchmark. For example, the National Geodetic Survey uses the Permanent Identifier (PID). For the benchmark utilized,

provide the PID or other unique identifier assigned by the maintainer of the benchmark. For GPS survey, indicate the

benchmark used for the base station, the Continuously Operating Reference Stations (CORS) sites used for an On-line

Positioning User Service (OPUS) solution (also attach the OPUS report), or the name of the Real Time Network used.

Also provide the vertical datum for the benchmark elevation. All elevations for the certificate, including the elevations for

Items C2.a–h, must use the same datum on which the BFE is based. Show the conversion from the field survey datum

used if it differs from the datum used for the BFE entered in Item B9 and indicate the conversion software used. Show the

datum conversion, if applicable, in the Comments area of Section D.

For property experiencing ground subsidence, the most recent reference mark elevations must be used for determining

building elevations. However, when subsidence is involved, the BFE should not be adjusted. Enter elevations in Items

C2.a–h to the nearest tenth of a foot (nearest tenth of a meter, in Puerto Rico).

Items C2.a–d. Enter the building elevations (excluding the attached garage) indicated by the selected building diagram

(Item A7) in Items C2.a–c. If there is an attached garage, enter the elevation for top of attached garage slab in Item C2.d.

(Because elevation for top of attached garage slab is self-explanatory, attached garages are not illustrated in the

diagrams.) If the building is located in a V zone on the FIRM, complete Item C2.c. If the flood zone cannot be determined,

enter elevations for all of Items C2.a–h. For buildings in A zones, elevations a, b, d, and e should be measured at the top

of the floor. For buildings in V zones, elevation c must be measured at the bottom of the lowest horizontal structural

member of the floor (see drawing below). For buildings elevated on a crawlspace, Diagrams 8 and 9, enter the elevation

NFIP Elevation Certificate Instructions –

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Instructions for Completing the Elevation Certificate (continued)

of the top of the crawlspace floor in Item C2.a, whether or not the crawlspace has permanent flood openings (flood

vents). If any item does not apply to the building, enter "N/A" for not applicable.

Item C2.e. Enter the lowest platform elevation of at least 1 of the following machinery and equipment items: elevators

and their associated equipment, furnaces, hot water heaters, heat pumps, and air conditioners in an attached garage

or enclosure or on an open utility platform that provides utility services for the building. Note that elevations for these

specific machinery and equipment items are required in order to rate the building for flood insurance. Local floodplain

management officials are required to ensure that all machinery and equipment servicing the building are protected

from flooding. Thus, local officials may require that elevation information for all machinery and equipment, including

ductwork, be documented on the Elevation Certificate. If the machinery and/or equipment is mounted to a wall, pile,

etc., enter the platform elevation of the machinery and/or equipment. Indicate machinery/equipment type and its

general location, e.g., on floor inside garage or on platform affixed to exterior wall, in the Comments area of Section D

or Section G, as appropriate. If this item does not apply to the building, enter "N/A" for not applicable.

Items C2.f–g. Enter the elevation of the ground, sidewalk, or patio slab immediately next to the building. For Zone

AO, use the natural grade elevation, if available. This measurement must be to the nearest tenth of a foot (nearest

tenth of a meter, in Puerto Rico) if this certificate is being used to support a request for a LOMA or LOMR-F.

Item C2.h. Enter the lowest grade elevation at the deck support or stairs. For Zone AO, use the natural grade

elevation, if available. This measurement must be to the nearest tenth of a foot (nearest tenth of a meter, in Puerto

Rico) if this certificate is being used to support a request for a LOMA or LOMR-F.

SECTION D – SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION

Complete as indicated. This section of the Elevation Certificate may be signed by only a land surveyor, engineer, or

architect who is authorized by law to certify elevation information. Place your license number, your seal (as allowed by

the State licensing board), your signature, and the date in the box in Section D. You are certifying that the information on

this certificate represents your best efforts to interpret the data available and that you understand that any false

statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Use the Comments area of

Section D to provide datum, elevation, openings, or other relevant information not specified elsewhere on the certificate.

SECTION E – BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED)

FOR ZONE AO AND ZONE A (WITHOUT BFE)

Complete Section E if the building is located in Zone AO or Zone A (without BFE). Otherwise, complete Section C instead.

Explain in the Section F Comments area if the measurement provided under Items E1–E4 is based on the "natural grade."

Items E1.a and b. Enter in Item E1.a the height to the nearest tenth of a foot (tenth of a meter in Puerto Rico) of the top

of the bottom floor (as indicated in the applicable diagram) above or below the highest adjacent grade (HAG). Enter in

Item E1.b the height to the nearest tenth of a foot (tenth of a meter in Puerto Rico) of the top of the bottom floor (as

indicated in the applicable diagram) above or below the lowest adjacent grade (LAG). For buildings in Zone AO, the

community's floodplain management ordinance requires the lowest floor of the building be elevated above the highest

adjacent grade at least as high as the depth number on the FIRM. Buildings in Zone A (without BFE) may qualify for a

lower insurance rate if an engineered BFE is developed at the site.

Item E2. For Building Diagrams 6–9 with permanent flood openings (see pages 8–9), enter the height to the nearest

tenth of a foot (tenth of a meter in Puerto Rico) of the next higher floor or elevated floor (as indicated in the applicable

diagram) above or below the highest adjacent grade (HAG).

Item E3. Enter the height to the nearest tenth of a foot (tenth of a meter in Puerto Rico), in relation to the highest

adjacent grade next to the building, for the top of attached garage slab. (Because elevation for top of attached garage

slab is self-explanatory, attached garages are not illustrated in the diagrams.) If this item does not apply to the building,

enter "N/A" for not applicable.

Item E4. Enter the height to the nearest tenth of a foot (tenth of a meter in Puerto Rico), in relation to the highest

adjacent grade next to the building, of the platform elevation that supports the machinery and/or equipment servicing the

building. Indicate machinery/equipment type in the Comments area of Section F. If this item does not apply to the

building, enter "N/A" for not applicable.

NFIP Elevation Certificate Instructions –

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Instructions for Completing the Elevation Certificate (continued)

Item E5. For those communities where this base flood depth is not available, the community will need to determine

whether the top of the bottom floor is elevated in accordance with the community's floodplain management ordinance.

SECTION F – PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION

Complete as indicated. This section is provided for certification of measurements taken by a property owner or property

owner's representative when responding to Sections A, B, and E. The address entered in this section must be the actual

mailing address of the property owner or property owner's representative who provided the information on the certificate.

SECTION G – COMMUNITY INFORMATION (OPTIONAL)

Complete as indicated. 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. Section C

may be filled in by the local official as provided in the instructions below for Item G1. 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 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 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–G10 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.

Items G4–G10 provide a way to document these determinations.

Item G4. Permit Number. Enter the permit number or other identifier to key the Elevation Certificate to the permit issued

for the building.

Item G5. Date Permit Issued. Enter the date the permit was issued for the building.

Item G6. Date Certificate of Compliance/Occupancy Issued. Enter the date that the Certificate of Compliance or

Occupancy or similar written official documentation of as-built lowest floor elevation was issued by the community as

evidence that all work authorized by the floodplain development permit has been completed in accordance with the

community's floodplain management laws or ordinances.

Item G7. New Construction or Substantial Improvement. Check the applicable box. "Substantial Improvement" means

any reconstruction, rehabilitation, addition, or other improvement of a building, the cost of which equals or exceeds 50

percent of the market value of the building before the start of construction of the improvement. The term includes

buildings that have incurred substantial damage, regardless of the actual repair work performed.

Item G8. As-built lowest floor elevation. Enter the elevation of the lowest floor (including basement) when the

construction of the building is completed and a final inspection has been made to confirm that the building is built in

accordance with the permit, the approved plans, and the community's floodplain management laws or ordinances.

Indicate the elevation datum used.

Item G9. BFE. Using the appropriate FIRM panel, FIS Profile, or other data source, locate the property and enter the

BFE (or base flood depth) of the building site. Indicate the elevation datum used.

Item G10. Community's design flood elevation. Enter the elevation (including freeboard above the BFE) to which the

community requires the lowest floor to be elevated. Indicate the elevation datum used.

Enter your name, title, and telephone number, and the name of the community. Sign and enter the date in the

appropriate blanks.

NFIP Elevation Certificate Instructions –

Page 6 of 9

Building Diagrams

The following diagrams illustrate various types of buildings. Compare the features of the building being certified with

the features shown in the diagrams and select the diagram most applicable. Enter the diagram number in Item A7,

the square footage of crawlspace or enclosure(s) and the area of flood openings in square inches in Items A8.a–c,

the square footage of attached garage and the area of flood openings in square inches in Items A9.a–c, and the

elevations in Items C2.a–h.

In A zones, the floor elevation is taken at the top finished surface of the floor indicated; in V zones, the floor elevation

is taken at the bottom of the lowest horizontal structural member (see drawing in instructions for Section C).

DIAGRAM 1A

All slab-on-grade single- and multiple-floor buildings

(other than split-level) and high-rise buildings, either

detached or row type (e.g., townhouses); with or

without attached garage.

Distinguishing Feature – The bottom floor is at or above

ground level (grade) on at least 1 side.*

DIAGRAM 2A

All single- and multiple-floor buildings with basement

(other than split-level) and high-rise buildings with

basement, either detached or row type

(e.g., townhouses); with or without attached garage.

Distinguishing Feature – The bottom floor (basement

or underground garage) is below ground level (grade) on

all sides.*

* A floor that is below ground level (grade) on all sides is considered a basement even if the floor is used for living purposes, or as an office,

garage, workshop, etc.

DIAGRAM 2B

All single- and multiple-floor buildings with basement

(other than split-level) and high-rise buildings with

basement, either detached or row type

(e.g., townhouses); with or without attached garage.

Distinguishing Feature

– The bottom floor (basement or

underground garage) is below ground level (grade) on all

sides; most of the height of the walls is below ground level

on all sides; and the door and area of egress are also

below ground level on all sides.*

DIAGRAM 1B

All raised-slab-on-grade or slab-on-stem-wall-with-fill

single- and multiple-floor buildings (other than split-

level), either detached or row type (e.g., townhouses);

with or without attached garage.

Distinguishing Feature – The bottom floor is at or above

ground level (grade) on at least 1 side.*

NFIP Elevation Certificate Instructions –

Page 7 of 9

Building Diagrams

DIAGRAM 3

All split-level buildings that are slab-on-grade, either

detached or row type (e.g., townhouses); with or without

attached garage.

Distinguishing Feature – The bottom floor (excluding

garage) is at or above ground level (grade) on at least

1 side.*

DIAGRAM 4

All split-level buildings (other than slab-on-grade),

either detached or row type (e.g., townhouses); with or

without attached garage.

Distinguishing Feature – The bottom floor (basement

or underground garage) is below ground level (grade) on

all sides.*

DIAGRAM 5

All buildings elevated on piers, posts, piles, columns,

or parallel shear walls. No obstructions below the

elevated floor.

Distinguishing Feature

– For all zones, the area below the

elevated floor is open, with no obstruction to flow of floodwaters

(open lattice work and/or insect screening is permissible).

DIAGRAM 6

All buildings elevated on piers, posts, piles, columns,

or parallel shear walls with full or partial enclosure

below the elevated floor.

Distinguishing Feature

– For all zones, the area below the

elevated floor is enclosed, either partially or fully. In A Zones, the

partially or fully enclosed area below the elevated floor is with or

without openings** present in the walls of the enclosure. Indicate

information about enclosure size and openings in Section A –

Property Information.

* A floor that is below ground level (grade) on all sides is considered a basement even if the floor is used for living purposes, or as an office,

garage, workshop, etc.

** An "opening" is a permanent opening that allows for the free passage of water automatically in both directions without human intervention.

Under the NFIP, a minimum of 2 openings is required for enclosures or crawlspaces. The openings shall provide a total net area of not less than

1 square inch for every square foot of area enclosed, excluding any bars, louvers, or other covers of the opening. Alternatively, an Individual

Engineered Flood Openings Certification or an Evaluation Report issued by the International Code Council Evaluation Service (ICC ES) must be

submitted to document that the design of the openings will allow for the automatic equalization of hydrostatic flood forces on exterior walls. A

window, a door, or a garage door is not considered an opening; openings may be installed in doors. Openings shall be on at least 2 sides of the

enclosed area. If a building has more than 1 enclosed area, each area must have openings to allow floodwater to directly enter. The bottom of

the openings must be no higher than 1.0 foot above the higher of the exterior or interior grade or floor immediately below the opening. For more

guidance on openings, see NFIP Technical Bulletin 1.

NFIP Elevation Certificate Instructions –

Page 8 of 9

Building Diagrams

DIAGRAM 8

All buildings elevated on a crawlspace with the floor of

the crawlspace at or above grade on at least 1 side,

with or without an attached garage.

Distinguishing Feature

– For all zones, the area below the first

floor is enclosed by solid or partial perimeter walls. In all A zones,

the crawlspace is with or without openings** present in the walls

of the crawlspace. Indicate information about crawlspace size

and openings in Section A – Property Information.

DIAGRAM 9

All buildings (other than split-level) elevated on a sub-

grade crawlspace, with or without attached garage.

Distinguishing Feature

– The bottom (crawlspace) floor is below

ground level (grade) on all sides.* (If the distance from the crawlspace

floor to the top of the next higher floor is more than 5 feet, or the

crawlspace floor is more than 2 feet below the grade [LAG] on all

sides, use Diagram 2A or 2B.)

DIAGRAM 7

All buildings elevated on full-story foundation walls

with a partially or fully enclosed area below the elevated

floor. This includes walkout levels, where at least 1 side

is at or above grade. The principal use of this building is

located in the elevated floors of the building.

Distinguishing Feature

– For all zones, the area below the

elevated floor is enclosed, either partially or fully. In A Zones, the

partially or fully enclosed area below the elevated floor is with or

without openings** present in the walls of the enclosure. Indicate

information about enclosure size and openings in Section A –

Property Information.

NFIP Elevation Certificate Instructions –

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