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HomeMy WebLinkAboutBLD2006-00070 Flood Certificate! • U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660 0008 Expires February 28. 2009 IP Federal Emergency Management Agency National Flood Insurance Program Important: Read the instructions on pages 1-8. SECTION A-PROPERTY INFORMATION For Insurance Company Use: Al. Building Owner's Name Policy Number DANA MbiLGs R. P.O.A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or Route and Box No. Company NAIC Number No. 293935 I-tv/Y 101 _ City State Q v 11..C E N e ,mil A ZIP Code 58 3 7 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) A P NoS. 7co Z- 132. - 4t4 -4- 7o 2.- r32 - OLS A4. Building Use(e.g.,Residential,Non-Resi ndential,Addition,Accessory,etc.) CZ C S 1 re-.. NIl A 1... A5. Latitude/Longitude:Lat. 4 7 e 4 g 01.2`5 Long.t Z.Z o $ a' e5 d,47.54 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 S A8. For a building with a crawl space or enclosure(s),provide: A9. For a building with an attached garage,provide: a) Square footage of crawl space or enclosure(s) 9 70 sq ft a) Square footage of attached garage sq ft b) No.of permanent flood openings in the crawl space or b) No.of permanent flood openings in the attached garage enclosure(s)walls within 1.0 foot above adjacent grade 3 walls within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b Z 9 8 o sq in c) Total net area of flood openings in A9.b sq in SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number 82.County Name B3.State a gFfr. Co. 93$ of l 4. Z. S ?-lery a 1.2...Sor.i \✓"!A 84.Map/Panel Number B5.Suffix15. 30049 eaB3S B B6.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone Date Effective/Revised Date Zone(s) AO,use base flood depth) 7 �a9�82 /1ld�eE (3-�-HZ. 74. 5 ' 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(Describe) B11. Indicate elevation datum used for BFE in Item B9: ® NGVD 1929 ❑NAVD 1988 ❑Other(Describe) B12. Is the building located in a Coastal Barrier Resources System(CBRS)area cr Otherwise Protected Area(OPA)? ❑ Yes , No Designation Date ❑CBRS ]OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Cl. Building elevations are based on: ❑Construction Drawings* ❑ Building Under Construction* © Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations-Zones Al-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,ARIA,AR/AE,AR/A1-A30,AR/AH,AR/AO. Complete Items C2.a-g below according to the building diagram specified in Item A7. Benchmark Utilized U.S.C +co S. Q t-4 (a- l S 1 9 9`_Vertical Datum t 9 z 9 I-» oe-P.-r 6.0 A-i uc.t'tor..+ of ;•-iw"7/ lol -f-vl(L-av-looa Check the measurement used. a) Top of bottom floor(including basement,crawl space,or enclosure floor) 74 . Z N feet ❑meters(Puerto Rico only) b) Top of the next higher floor 7 7 .7 ®feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) _❑feet ❑meters(Puerto Rico only) d) Attached garage(top of slab) ❑feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 7 7 . 7 ❑X feet ❑meters(Puerto Rico only) (Describe type of equipment in Comments) f) Lowest adjacent(finished)grade(LAG) 7 3 .4- ©feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade(HAG) 7 3 .Ci ®feet ❑meters(Puerto Rico only) SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION �:Y� ‘*���� This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation 11 "'��'"�y'R�� l/ information. I certify that the information on this Certificate represents my best efforts to interpret the data available. ,A,D C. �, r I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. \ 4 WAS/t O0 O 1, ,6 / cx Check here if comments are provided on back of form. �4, C' A 2,04ot,t7 C. Woa o \nIA• PLS 23911 C Certifiers Name License Number t a t 411, Title Company Name % O.r +{� 23911 tic ' S v rL1l GY o cZ + PIZ S. `n/ego 1> 5 LS re-N e••/jr/4; To4‹.. �, s �.rsrr� Address City �6�,�,�-r-+ State ZIP Code f fps '2t55 1)1<sc.c7vcrmyRo. owN5E140 \ /A 9s34.8 ► _ �� . ., N. Signature Telephone l C.. �crr�t/ Date/�16106 360 gS-.S94, $ % EXPIRFs v»Iog f 11l , ��...�Nr:�.mill-// /ii/lI� FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions III • 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. 1•Lo Q. a 9 3 9 3 s jl- y4 Y t 0( Policy Number City U c iL. C-� N E. State ZIP Code Company NAIC Number �� 9B 3 74, 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 r 1 / "TH 14- I S 0ME t_cA/J1w1 L(Es w iTN/r r^/ /(„oot] zo. 0 A Z. As THE Es.a VA io. $ OF TL4E. G4.o(.,,.ao N.1 Gx-r ToTiirt VIoNtF IS 3 Fe-aG�Low —TNIE 13AsE NLo0o E.L..civ of= `74. $ Signature Z /� Date ~ T C t)o.$�/ /p/42/4 Co ® Check here if attachments 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,crawl space,or enclosure)is ❑feet ❑meters ❑above or ❑below the HAG. b)Top of bottom floor(including basement,crawl space,or enclosure)is . ❑feet ❑meters CIabove or ❑below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9(see age 8 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 El 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's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑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.and G9. 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 G2. ❑ is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) 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:G9.)is provided for community floodplain management purposes. IG4.Permit Number I G5. Date Permit Issued I 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(PR) Datum G9.BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters(PR) Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments FEMA Form 81-31, February 2006 Replaces all previous editions 1 ..... r i 0 w - o J • W z ZONE Ccc • o z_ O 9 1 94 92 Refer to the FLOOD INSURANCE RATE MAP EFFECTIVE date �`. 11i I shown on this map to determine when actuarial rates apply to 5 - :.: structures in the zones where elevations or depths have been estab- 1 90 i fished. ,t I v. s, c. 4-G.S To determine if flood insurance is available in this community, 1� �$�Ie.i-11 p,(lll� (�.► /S 199Co contact your insurance agent,or call the National Flood Insurance i,% 86 NI. tV 0 l 9 2.9 r1.-a4 Program,at (800) 638 6620. I o 5. Z. j Fd.4T 1 ' ',, ZONE A2 ON E B I ''.'40 6 ut..B4- . RM . 7 t/1 ti X C�.f3 APPROXIMATE SCALE 71 1000 0 \ 1000 FEET ROAD , 13 66 `0\ ZONE B h� b� a a .� ` ll NATIONAL FLOOD INSURANCE PROGRAM \ ZONE B i RM19 FIRM _..., FLOOD INSURANCE RATE MAP ii �� JEFFERSON COUNTY, Jf WASHINGTON \ (UNINCORPORATED AREAS) I \\\I RM21 A 0 PANEL 835 OF 1625 (SEE MAP INDEX FOR PANELS NOT PRIM ) i I ZONE B 4 �" a vE ti• I J a 4�i�l ?} f '� ,v.„ • S tae IyG , �' { f f MK, ! i4^It t 1, ,' 1 !t',,, ` 1'.. �'� .� ,, }S t t . ZO E B I COMMUNITY-PANEL NUMBER I ZONE c 530069 0835 B I l __ VY,N Y M 4,, EFFECTIVE DATE: itspiN, DULY 19, 1982 y,'/. la f;i 4 Fed4a1 Emergency Management Agency