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Home My WebLink AboutBLD2008-00072 Flood Certificate U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE lJLk 0 FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 National 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 Earl&Linda Miller Policy Number: A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Company NAIC Number: 207 Ludlow Bay Road City Port Ludlow State WA ZIP Code 98365 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Lot 8,Ludlow Beach Tracts No. 1 Tax: 968 700 112 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential A5. Latitude/Longitude: Lat.47°54'52" Long. 122°41'14" 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 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) 2.400 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 att ched garage or enclosure(s)within 1.0 foot above adjacent grade 18 within 1.0 foot above adjacent grade A/ c) Total net area of flood openings in A8.b 2.300 sq in c) Total net area of flood openings in A9.b 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 JEFFERSON COUNTY 530069 JEFFERSON COUNTY WASHINGTON B4.Map/Panel Number B5.Suffix B6.FIRM Index Date B7.FIRM Panel B8.Flood B9 Base Flood Elevation(s)(Zone 0470 B 7/19/1982 Effective/Revised Date Zone(s) AO,use base flood depth) 7/19/1982 A2 8 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 ❑ NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes ® No Designation Date: ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: 0 Construction Drawings* ❑ 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:JEFFERSON COUNTY NO.9114 Vertical Datum: NVGD 1929 Indicate elevation datum used for the elevations in items a)through h)below. ®NGVD 1929 0 NAVD 1988 ❑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) 12.8 ®feet ❑meters b)Top of the next higher floor 15.3 ®feet ❑meters c) Bottom of the lowest horizontal structural member(V Zones only) r( _. 0 feet ❑meters d)Attached garage(top of slab) /V,1- . ❑feet ❑meters e) Lowest elevation of machinery or equipment servicing the building r" , ❑feet ❑meters (Describe type of equipment and location in Comments) Lowest adjacent(finished)grade next to building(LAG) v f) i 8.7 ®feet ❑meters g) Highest adjacent(finished)grade next to building(HAG) 9.6 ®feet ❑meters h) Lowest adjacent grade at lowest elevation of deck or stairs,including structural support 9.0 ®feet ❑meters SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION information.This I certification certify that the in information oed and n this Certificate by a land eyor,engineer,or represents my bestrchitect effo s to interpret d by thelaw data avail bleify levation p///////////i/��\\\\��N�i�/ I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. 1-N.,!joc J AI V�❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a W AShy`�❑ Check here if attachments. licensed land surveyor? ® Yes ❑ No '1'�, Jl Certifiers Name MICHAEL J.ANDERSON License Number 27665 ri) z t P Title OWNER Company Name ANDERSON CE&LS O Address 330 CLEVELAND STREET City PORT TOWNSEND State WA ZIP Code 98368 P.� C�r ,vsss ISTE�� Signatur • 7 rv/zw Telephone 360-531-1011 1 j0/Y/4L OR S� FEMA Form 086 0 33(7/12) See reverse side for continuation. 4 1\ �iiiiii/iiin1‘ ELEVATION CERTIFICATE, page 2 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: 207 Ludlow Bay Road City Port Ludlow State WA ZIP Code 98365 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 N/iJ a7g-444(7)(--d 7//la/C- Si natur Date 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 Certiflcatrs is/Intehded to s o 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 P o 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 feet ❑meters 0 above or❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is 0 feet 0 meters 0 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 0 feet ❑meters ❑above or 0 below the HAG. E3. Attached garage(top of slab)is . 0 feet 0 meters 0 above or 0 below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is . ❑feet ❑meters 0 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? 0 Yes 0 No 0 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 Owners Authorized Representative's Name '/ •// • bf 1V/L��% Cix/ C e••s C /` City r -s State ZIP Code �� Address C %� >/, /'L%r/Z� G ev5. 6tit) to_ /$ Signature Date -- Telephone Comments 0 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 GB-G10.In Puerto Rico only,enter meters. G1.0 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.) G2.0 A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.0 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 ❑Substantial Improvement G8. Elevation of as-built lowest floor(including basement)of the building: . ❑feet ❑meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet 0 meters Datum G10.Community's design flood elevation: . 0 feet ❑meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments • �• El Check here if attachments. FEMA Form 086-0-33(7/12) Replaces all previous editions.