FEMA Form FF-206-FY-22-152: Elevation Certificate

In A1, enter the Building Owner's Name; in A2, the Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No., City, State and ZIP Code; in A3, the Property Description (e.g., Lot and Block Numbers or Legal Description) and/or Tax Parcel Number; in A4, the Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.).

In A5, enter the Latitude/Longitude: Lat. and Long., and check the Horiz. Datum: NAD 1927, NAD 1983 or WGS 84.

Enter the Building Diagram Number.

For a building with a crawlspace or enclosure(s), enter the Square footage of crawlspace or enclosure(s) in sq. ft. and check No or Yes (or N/A): Is there at least one permanent flood opening on two different sides of each enclosed area?

For a building with an attached garage, enter the Square footage of attached garage in sq. ft. and check Yes, No or N/A for: Is there at least one permanent flood opening on two different sides of the attached garage?

In B1.a, enter the NFIP Community Name and in B1.b the NFIP Community Identification Number; then enter the County Name, State, Map/Panel No., Suffix, FIRM Index Date, FIRM Panel Effective/Revised Date, Flood Zone(s), and the Base Flood Elevation(s) (BFE) (Zone AO, use Base Flood Depth).

Indicate the source of the BFE data or Base Flood Depth entered in Item B9: FIS, FIRM, Community Determined or Other.

Indicate elevation datum used for BFE in Item B9: NGVD 1929, NAVD 1988 or Other/Source.

Check Yes or No: Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Designation: CBRS or OPA. Check Yes or No: Is the building located seaward of the Limit of Moderate Wave Action (LiMWA)?

In C1, check the Building elevations are based on: Construction Drawings*, Building Under Construction* or Finished Construction; *a new Elevation Certificate will be required when construction of the building is complete.

For Zones A1-A30, AE, AH, AO, A (with BFE), VE, V1-V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO, and A99, complete Items C2.a-h according to the Building Diagram specified in Item A7. In Puerto Rico only, enter meters.

Enter the Benchmark Utilized. Indicate elevation datum used for the elevations in items a) through h): NGVD 1929, NAVD 1988 or Other. Datum used for building elevations must be the same as that used for the BFE.

Conversion factor used? Check Yes or No. If Yes, describe the source of the conversion factor in the Section D Comments area.

Check the measurement used, feet or meters, for: a) Top of bottom floor (including basement, crawlspace, or enclosure floor); b) Top of the next higher floor (see Instructions); c) Bottom of the lowest horizontal structural member (see Instructions); d) Attached garage (top of slab).

Check feet or meters for: e) Lowest elevation of Machinery and Equipment (M&E) servicing the building (describe type of M&E and location in Section D Comments area); f) Lowest Adjacent Grade (LAG) next to building: Natural or Finished; g) Highest Adjacent Grade (HAG) next to building: Natural or Finished; h) Finished LAG at lowest elevation of attached deck or stairs, including structural support.

The certifier certifies the information on this Certificate represents the certifier's best efforts to interpret the data available.

Any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.

Check Yes or No: Were latitude and longitude in Section A provided by a licensed land surveyor? Check here if attachments and describe in the Comments area.

Enter the Certifier's Name, License Number, Title, Company Name, Address, City, State, ZIP Code, Ext., Email and Telephone, place the seal at Place Seal Here and sign at SIGN.

In Comments, include the source of conversion factor in C2; type of equipment and location per C2.e; and description of any attachments.

For Zones AO, AR/AO, and A (without BFE), complete Items E1-E5. For Items E1-E4, use natural grade, if available.

In Section F, the property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without BFE) or Zone AO must sign.

In Section G, the local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Section A, B, C, E, G, or H of this Elevation Certificate.

In Section H, the property owner, owner's authorized representative, or local floodplain management official may complete Section H for all flood zones to determine the building's first floor height for insurance purposes. Sections A, B, and I must also be completed.

In Section I, the property owner or owner's authorized representative who completes Sections A, B, and H must sign. The statements in Sections A, B, and H are correct to the best of my knowledge.

Note: If the local floodplain management official completed Section H, they should indicate in Item G2.b and sign Section G.

Identify all photographs with the date taken and "Front View," "Rear View," "Right Side View," or "Left Side View." Photographs must show the foundation. When flood openings are present, include at least one close-up photograph of representative flood openings or vents, as indicated in Sections A8 and A9.

Insert the third and fourth photographs.

The Elevation Certificate may be used to support a LOMA, CLOMA, LOMR-F, or CLOMR-F request. Lowest Adjacent Grade (LAG) elevations certified by a land surveyor, engineer, or architect, as authorized by state law, will be required if the certificate is used to support a LOMA, CLOMA, LOMR-F, or CLOMR-F request.

Submit a LOMA, CLOMA, LOMR-F, or CLOMR-F request with either a completed FEMA MT-EZ or the MT-1 application package, whichever is appropriate.

This certificate is used only to certify building elevations. A separate certificate is required for floodproofing.