Fillable FEMA-Elevation-Certificate-and-Instructions F-053 Elevation Certificate

Fill Online, Printable, Fillable, Blank FEMA-Elevation-Certificate-and-Instructions F-053 Elevation Certificate Form

Use Fill to complete blank online INCORPORATED VILLAGE OF BAYVILLE (NY) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

FEMA-Elevation-Certificate-and-Instructions F-053 Elevation Certificate

On average this form takes 38 minutes to complete

The FEMA-Elevation-Certificate-and-Instructions F-053 Elevation Certificate form is 8 pages long and contains:

  • 3 signatures
  • 78 check-boxes
  • 105 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Incorporated Village of Bayville

BROWSE INCORPORATED VILLAGE OF BAYVILLE (NY) FORMS
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another 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
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:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)?
Yes No
Designation Date:
CBRS OPA
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
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
Ext.
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
Clear Photo One
Clear Photo Two
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 Three
Photo Three Caption
Photo Four
Photo Four Caption
Clear Photo Three
Clear Photo Four
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

FEMA-Elevation-Certificate-and-Instructions F-053 Elevation Certificate

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 11 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document