ref. Handbook 4145.1 form HUD-92541 (4/2001)
Page 1 of 3
Previous editions are obsolete.
OMB Approval No. 2502-0496
9 a. Name of Builder's Company or Builder's Agent (type or print)
10 a. Name & Title of Builder or Builder's Agent (type or print)
b. Street Address
b. Signature of Builder or Builder's Agent
c. City, State, & Zip Code
c. Telephone Number (include area code)
Builder or Builder's Agent: I hereby certify that the site analysis information above is true and accurate to the best of my knowledge and belief and
that the plans and specifications were designed to mitigate any foreseeable hazards or adverse conditions. On all properties eligible for maximum LTV
financing, I further certify that I have personally reviewed the plans, specifications, and site information submitted herewith . Based upon my review, I
hereby certify that such plans, specifications comply with the applicable building code specified above as well as complying wi th the HUD construction
requirements listed above. An "X" marked in the blank by each numbered item indicates that provisions from the marked code ap ply.
Property Address (street, city, State, & zip code)
Mortgagee's (Lender's) Name & Address (this is the lender who closed the loan)
FHA Case Number
1. Site Analysis Information: To be completed on all proposed and newly constructed properties regardless of LTV ratio.
a. Flood Hazards. Are the property improvements in a Special Flood Hazard Area (SFHA)?
1) Provide the community number and date of the Flood Insurance Rate Map (FIRM) used to document
your answer. Community Number
2) Is the community participating in the National Flood Insurance Program and in good standing?
3) If "Yes" to 1a. above, attach:
(i) a Letter of Map Amendment (LOMA) or;
(ii) a Letter of Map Revision (LOMR) or;
(iii)a signed Elevation Certificate documenting that the lowest floor (including basement) is built in compliance with 24