Fema Form 086-0-33 Elevation Certificate Page 5
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17OMB No. 1660-0008
ELEVATION CERTIFICATE
Expiration Date: November 30, 2018
IMPORTANT: In these spaces, copy the corresponding information from Section A.
FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
Policy Number:
City
State
ZIP Code
Company NAIC 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).
a) Top of bottom floor (including basement,
crawlspace, or enclosure) is
feet
meters
above or
below the HAG.
b) Top of bottom floor (including basement,
crawlspace, or enclosure) is
feet
meters
above or
below the LAG.
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.
E3. Attached garage (top of slab) is
feet
meters
above or
below the HAG.
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
No
Unknown.
The local official must certify 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 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
Signature
Date
Telephone
Comments
Check here if attachments.
Form Page 3 of 6
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
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