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HomeMy WebLinkAboutBLD2008-00055 ELEVATION CERTIFICATE r = F3 33: 31p Lawrence and Gail Sherman 425 643-8491 rp. 2 r 0 ;1 pEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 `':Errergency Management Agency - =iced insurance Progpm Important: Read the nstructjons on pages 1_g Expires February 28,2009 SECTION A-PROPERTY INFORMATION M1 %idi"g Owner's NamR l.. For Insurance Company Use: A • ��� -I- !L Sf-i�:,S2 M�4N Policy Number - 7-Street Address(including Apt Unit,Suite,and/or Bldg.No.)or P.O.- Route and Box No. --'vr/A t 1 rot L Grr.t�' a_._. Company NAfC Number v3N. . - State A. ZIP Code "Fe"Y Jescnption(Lot and Block Numbers,Tax Parcel Number,Legal Description.` etc.) 37(0 • ('- 5-•';d;ag Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)_ E t i)akin Ai- dude/{,ongi;ude:Lat.g-7 g j ]�,,�o lV -�c`,at east' 2 photographs of the building if the Certificate is being used t0000btainnffl000d insurance. Horizontal Datum: 'd^,c Ciag ram Number ❑NAD 7 927 ,®NAD 1983 2 a°�ihling with a crawl space or enGosu' p provide: J�5`2 C>c 7 C I) — No P L.nnis So!;a'd footage of crawl space or enclosure(s) A9 For a building with an attached garage,provide: sq N .of permanent flood openings in the crawl space or sq ft a) Square footage of attached garage er�'osure(s)walls within 1.0 foot above adjacent grade b) No.of permanent flood openings in the attached garage 7,'....-.I-let area of flood openings in Al3.b walls within 1.0 foot above adjacent grade sq in c) Total net area of flood openings in A9.b -.�. sq in _ SECTION 13-FLOOD INSURANCE F;A.TE MAP(FIRM)INFORMATION v{-;=Community'Name 4Community Number - '" r•,- aex,5 300`9 4 8 SS 4 B2.County Name U'>rlrFiE k: s�� 83.S1ate /Dana Number 85.Suffix B6.FIRM Index WA87.F.RM Panel 88.Flood 89.Base Flood Elevation :_ ._ c ,7 n �2� Date EffectivelRevised Oate (s)(Zone 7 f�c���Z Zone(s) AO,use base flood depth) 'r%icate the source of the Base Flood Elevation(BFE)data or base flood depth entered ed in Item B9- A �N r r R M!1`!- p L o l5`e FIRM ,�PP f2o k / �.4 p• ❑Community Determined 0 Other(Describe) -' -welkin datum used for BFE in Item 89:12 NGVD 1929 ) air(O V ACGd s s +�`]r t S t CJ.4 G ..1.:'n,•�located in a Coastal Barrier Resources System(CBRS)area ortCC f98s8 []Other(Describe) `- of Date ❑ OPA Otherwise Protected Area(OPA)? No CBRS [� Yes SECTION C-BUILDING ELEVA.T. _ION INFORMATION(SURVEY REOUfRED) ' are based on: Construction Drawings' r-, u.n Certificate will be uired when construction of the building is complete. Construction" • 'F='Mors-Zones A1-A30,AE,AH,A(with BFE),V ❑Finished Construction c;= g ) to V1-V30,V(with BFE),AR.AR/A,AR/AE,AR/A1-A30,AR/AH, acArcing to the buildingdiagram specified in Item A7. ) 7..r,c.-real;Utiazed y., ARlAO- Complete Items C2_a-g Cy.S as, �'^t/Comments Vertical Datum >I 'V A 1 5Q 9 - ^p'�`bottom floor(including basement,crawl space,or enclosure floor)�_ Check the measurement used. Ell ❑ `P of tfe next higher floor meters(Puerto Rico only) ^tt f rf the lowest hgrizontal structural member(V Zones only) ____Li_.. feet ❑meters(Puerto Rico only) _ feet garage(top of slab) - El meters(Puerto Rico only) .cwest elevation((op of Slab) or equipment servicing the building 0 feet ?1 meters(Puerto Rico only) -'a`"=ih t type of equipment in Comments) -- r 1 0 feet ❑meters(Puerto Rico only) + djac.ent(wed)grade(LAG) t d ac:nt{finished)grade(FLAG) 8 G :ej feet ❑meters(Puerto Rico only) /d .3 0 feet ❑meters(Puerto Rico only) SECTION D-SURVEYOR,ENGINEER,OR A-RCHITECT CERTIFICATION ca;3on is to be si nd-sad by a land surveyor,engineer, a0&.. liipyj 1.At;i s. i certify that Uheirrformation on this Certificate represntsmybest architect s to interpret ithorized bthe data available. elevation �� N."d'het any false statement may be punishable by fine or imprisonmen t under 18(/$. Code Section 1001. • ' °-` - �",.'i,`Comments are provided on back of form, ,' �' , �',t'c Woc>0 WA P L 5 2 3 $ -r \ '-,, r n ?: 0 C y-g 11 ,Gt-E S. VIC.a 0 S u/ \10' /,t/G, hrc. bki Number g . [� t='vrh'i%Y �V. _Company Nance - j �0 •r:n• !! t �T City i b v�/ SRAJ I 'P,- 2391; �t , ,� A C S iR7CI �AT 0 7 ate ZIP Code 3(0 8 it •rsl� , h;�Z:. ".��$ '�� Oa Telephone �:' I �a T ;� � or _________ EXPIRES 1/17/p 8 �. ary 2006 See reverse side for continuation. Replaces all previous editions all previous editions JEf fEllsoN coin flcID p. 3 Q3: 31p Lawrence and Gail Sherman 425-64 w8491 _...0„ "—. -.r AN In tttesaspaces,copy the corresponding information from Section A.'`di a Street Address(InI:Wing-Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. For Insurance Company Use: I _____1_, V `e./A -V tM Cs .D. WA Policy Number 58 374 '7G ZIP Code Company NAIL Number SECTION D-,SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) y':ati sides oPthis EtevatiorrCe rtiflcate for(1)community official,(2)insurance a ent/com,71 9 pany,and(3)building owner. c'a P t A VxiotrTERM,n,ea- .1 USEP Mi rt E Ea.E.v, V O.cam. ) \Ait-/ccw t -2-0 A055: 141.E . - ta~ mE' CE © o..� t.y s,-nature /4oa -E o>x-. A.ti./,AY FR oM S cma 3Ec7- C.. Date SI C TION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A Check here if attachments (WITHOUT BFE) =or 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, nd C. For Items E1-E4,use natural grade,if available. Check the measurement used. In Puerto Rico only,enter meters. ravide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent --riC (HAG)and the lowest adjacent grade(LAG). Tep of bottom floor(including basement,crawl space,or enclosure)is ❑feet ❑ ' o of bottom floor(including basement,crawl space,or enclosure)is meters ❑above or �� El El meters ❑above or ❑below the HAG. '',1)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 o-':.2.b in the diagrams)of the building is ❑below the LAG. le garage(top of slab) 0 feet 0 meters ❑above or (below the HAG. �. Top of platform of machinery lab and/or equipment servicing feete the building meters a above or 0 below the HAG. • Zone AO only: If no flood depth number is available,is the top of the bottom floor elevat• ed in fe acc�ance 0 mers �below the HAG. with the community's floodplain management ordinance? D Yes 0 No 0 Unknown. The local official must certify this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION • `'E Trooerty owner or owner's authorized re -,co-e AO must Presentative who completes Sections A.B.and E for Zone A(without a FEMA_issued or community issued BFE) _ Slgrt here. The statements in Sections A,B,and E are correct to the best of my knowledge. =.`-l'-•Dwnees,pr et's Authorized ntative's Name 'ss / t- �l• Le./r•'/ C / s t c k-kit-C 1- �.�! J `/y r�r I r( I GiC�% City 1 , LrL Slat ZIP Code n s ----- y._Qate 1(_01. 2 Ce ph SECTION G-COMMUNITY INFORMATION(OPTIONAL) ❑Check here if at arhments atri o:`aat who is authprized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B C G^,this Elevation Cer tificate. Complete the applicable item(s)and sign below. Check the measurement used in Items G8.and G9. -� The information in (or E), -`authorized byIwo ion C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who • IllAt to certify elevation information' (Indicate-the source and date of the elevation data in the Comments area below.) - _fiTmuaily official completed Section E for a building located in Zone A(without a FEMAissued or community-issued BFE)or Zone AO. -- 'Ma'allowing infoRttetiDn ('Items G4.-G9.)is provided for community floodplain management purposes. v tuber G5. Date Permit Issued G6. Date Certificate Of CompliancelOCcupancy Issued 11 zetri.issued for: 0 New Construction 0 Substantial Improvement .s belt IrtlStest floor-(including basement)of the building: 5FE or(in Zone A4}depte.of flooding' ❑feel ❑meters(PR) Datum at the building site: - - --- ❑feet ❑meters(PR) Datum u: ,...id's Name Title Telephone Date t. . In$t-3?,February 2006 ❑ heck here if ttachmenls APR 2 5,2008 Replaces all previous editions JEFFERSON COUNTY OCD = 3 33: 31p Lawrence and Gail Sherman 425-64 -8491 1 p. 4 / / 9. 18 / / / / / / / / / /sx34 FENCE RECifivEr APR 2 5 2008 JEFPERSON COUNTY DCD 9. 57 8. 94 A / ti i .....1 1.-..) J is Q 0 9. 94 9. 26 I--. d C7 Q C:4 14 Q. X 8. 95 Ct- x,. yk 71 X 9. 35 . . I:� 10. 25L.�, i , 11.64 10. 76) �/ QNLy' 9, 40 9. 53 \ \ 9, 84 SHED 10. 04 8, 63 8 X 57 9. 31 9. 59 S. (39. 17 'I SOUTH PROPERTY LINE 8.37 WELL .'1 0 TVH