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HomeMy WebLinkAboutBLD2005-00564 Flood Certificate • FEDERAL EMERGENCY MANAGEMENT AGENT• NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No.December077 Expires 31, 2005 ELEVATION CERTIFICATE Important: Read the instructions on pages 1-7. SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Lsl ' i-r t14z/z Cu Z4GK Policy Number BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. 13 7 2 3 !--- rill t of • Company NAIL Number •CITY STATE a ZIP CODE (�2tNO0N wA PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,.L ti 9 8,32 ASS to s.? ©t2.•5 Sepal Descri p qn,etc.) , �A4..cE: No. OZ - 3 t 1--vc Z BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments.area,if necessary.) 1`-.S11)AssTtA A-- LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: 0 GPS( ##°-##'-##.##" or ##.#####c) C)NAD 1927 0 NAD 1983 � ) 0 USGS Quad Map ❑Other. SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 81.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAMES. 3(DO Cog 183.,STATE/ �oC�S13 .� �.�5.$G�.( WIC. B4.MAP AND PANEL B7.FIRM PANEL 89.BASE FLOOD ELEVATION(S) NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVE/REVISED DATE B8.FLOOD ZONE(S) I (Zone AO,use depth of flooding) iGo5 oG►Gz5' B 7//5/92- B10.Indicate the source of the Base Flood Elevation(BFE)data or hasp flood depth entered in B9. I UN��? f�•C n��,"C O 0 FIS Profile ®.FIRM 0 Community Determined 0 Other(Describe): S ag AT?_—d+ev1/4 --- B11.Indcate the elevation datum used for the BFE in B9:lid NGVD 1929 0 NAVD 1988 B12.Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? Other(Describ : ( ► ❑Yes (�,No Designation Date SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1.Buildng elevations are based on:❑Construction Drawings* 0 Build Under Construction* &Frushed Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2 Building Diagram Number_(Select the building diagram most similar to the building for which this certificate is being completed-see pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.) �4t'S C3.Elevations-Zones Al-A30,AE,All,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/Al-A30,AR/AH,AR/AO Complete Items C3.-a-i below according to the building diagram specified in Item C2.Stale the datum used.If the datum is different from the datum used for the BFE in Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G,as appropriate,to document the datum conversion. Datum 25 Conversion/Comments Elevation referer,^ark used Ut 5 Does the elevation reference mark used appear on the FIRM? ❑Yes El No - ,Y.- • •• '" CI a)Top of bottom floor(inducing basement or enclosure) S. ift(m) T. �' ❑ b)Top of next higher floor t t_. 1 ft(m) jj 00 G f t N t.,,•t " 0 ❑c)Bottom of lowest horizontal structural member(V zones only) _ft.(m) N t ; .e + ',,, ❑ d)Attached garage(top of slab) N A. _ft.(m) E� U t f CI e)Lowest elevation of machinery and/or equipment w . Q v 1 c g; -- i servicing the building(Describe in a Comments area) tiJ n,, ft m 1g ; • .� •r i ❑rl Lowest adlaceni(finished)grade(LAG) : ft.(m) ' rn © O�� �� ' ❑ g)Highest adjacent(finished)grade(HAG) 0 7 ft.(m) .eJ �d`b �� PO r i CI h)No.ofpermanent S openings(flood vents)within 1 ft.above adjacent grade e,pr;,N co M 7 t !, --,,,,,„,i�,,,,,,,,,--,...,N..\, ❑ i)Total area of all permanent openings(flood vents)in C3.h sq.in.(sq.cm) j A • 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 in Sections A,B,and C 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. w A 2 79 11 CERTIFIER'S NAME LICENSE NUMBER A/Lr•lo/..p �. 4loc D `'� TITLE \A..1op0 SUrzital /.v6 Ltic- ,. S' ��� o COMPANY NAME �i2�S1 0 NT— pp.2-T TBw,vSa,v I. j /,� �3r; ADDRESS Z.lsJ` lit S o ✓�e4 y �.o A 1) CITY STATE ZI CODE SIGNATURE DATE TELEPHONE 9 8 3 E3 �� ' // • i'//Z/ 3a.0-385- , FEMA Form 81-31,January 2003 See reverse side for continuation. Ranlacac all nroviroic o.iiri.,.,,. .PARr TMENTOF HOMELAND SECURITY LEVATION CERTIFICATE .RAL EMERGENCY MANAGEMENT AGENCYii OMB No. 1660 0008 _Mona!Flood Insurance Program Important: Read the instructions on pages 1-9. Expiration Date:July 31, 2015 SECTION A-PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Wayne DeVaney&Cynthia Cuzick Policy Number: A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Company NAIC Number: 313723 US Highway 101 City Brinnon State WA ZIP Code 98320 A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) TPN 502311002,Section 31,Township 25 North, Range 2 West A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential A5. Latitude/Longitude: Lat.47-37-00.0 Long. 122-58-43.5 Horizontal Datum: 0 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 8 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 960 sq ft a) Square footage of attached garage N/A sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s)within 1.0 foot above adjacent grade 10 within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b 1278 sq in c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes ® No 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 530069 Jefferson WA B4. Map/Panel Number B5.Suffix B6. FIRM Index Date B7. FIRM Panel B8. Flood B9.Base Flood Elevation(s)(Zone 1605 B 7-19-1982 Effective/Revised Date Zone(s) AO,use base flood depth) 7-19-1982 A&C Not determined 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: B11. Indicate elevation datum used for BFE in Item B9: ® NGVD 1929 0 NAVD 1988 0 Other/Source: B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? 0 Yes 0 No Designation Date: 0 CBRS 0 OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: 0 Construction Drawings* 0 Building Under Construction* ® Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. 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:BM U15 Vertical Datum: NGVD 29 Indicate elevation datum used for the elevations in items a)through h)below. ® NGVD 1929 0 NAVD 1988 0 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) 11.10 0 feet 0 meters b)Top of the next higher floor 13.81 0 feet 0 meters c) Bottom of the lowest horizontal structural member(V Zones only) N/A. 0 feet ❑meters d)Attached garage(top of slab) N/A. El feet 0 meters e)Lowest elevation of machinery or equipment servicing the building 13.81 0 feet El meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 8.90 0 feet 0 meters g)Highest adjacent(finished)grade next to building(HAG) 11.50 0 feet ❑meters h) Lowest adjacent grade at lowest elevation of deck or stairs,including structural support 8.90 0 feet 0 meters SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION �t/"-'"' ---- ''.`1"+0, This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation t -, . KO$7 5 information.l certify that the information on this Certificate represents my best efforts to interpret the data available. e+ j OF WAR S' I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001. `k�' x c. - r 0 Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a f t i ® Check here if attachments. licensed land surveyor? 0 Yes ❑ No lo* =�Certifier's Name Kent L.Robinson t� I #4 44V,•= O ;:., License Number 19583 i��;J , , 1� 7 9583 ki Title Surveyor Company Name Northwestern Territories, Inc. .air"- ` '`f' t,';t51.t;Rle , ���si- Address 717 So City Port Angeles State WA ZIP Code 98362 SAL LAN' Signature at Telephone (360)452-8491 +�x-i-,`..\`��,,.,,, I^ FEMA Form 086-0-33(7/12) See reverse side for continuation. Replaces all previous editions. LLILYMI IVI• JI_I\I IvIVM I L, t.Iauc L IMPORTANT: In these spaces, copy the esponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit,Sui and/or Bldg. No.)or P.O. Route and Box No. Policy Number: 313723 US Highway.101 City Brinnon State WA ZIP Code 98320 Company NAIC Number: SECTION D—SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner. Comments The pre-construction certificate prepared by Arnold Wood, PLS suggests a BFE of 10.00 based upon prior studies but does not referance the source. P Sign re Date 3-4-2015 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 El—E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C. For Items El—E4,use natural grade, if available.Check the measurement used. In Puerto Rico only,enter meters. El. 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 0.40 ®feet ❑meters ❑above or® below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is 2.20 ®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 8-9 of Instructions),the next higher floor (elevation C2.b in the diagrams)of the building is 2.31 ®feet ❑meters ®above or ❑below the HAG. E3. Attached garage(top of slab)is N/A. ❑feet ❑meters ❑above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is 2.31 ®feet ❑meters Z 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's or Owner's Authorized Representative's Name Kent L.Robinson(Northwestern Territories, Inc). Address 717 South P,..bod City Port Angeles State WA ZIP Code 98362 Signature '4410 •04 W Date 3-4-1015 Telephone (360)452-8491 Comments •ee Section D ® Check here if attachments. 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 lit Substantial Improvement G8. Elevation of as-built lowest floor(including basement)of the building: /I . 10 Xfeet ❑meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: I 0 , et, feet ❑meters Datum G10.Community's design flood elevation: ❑feet ❑meters Datum n ,, Local Official's Name ea 7.-z- Title ��/ 1 �KV . I.�l�e /— Community Name t J"re ( fe Ou,I,`k Telephone 3(.- 3 1 t _ L. Signature t 1.450 ,i. - Date 3 /6/2/,) Comments ❑Check here if attachments. FEMA Form 086-0-33(7/12) Replaces all previous editions.