HomeMy WebLinkAboutBLD2009-00076 Flood Certificate ' Ln 7- 7(42
U.S.DEPARTMLNT OF HOMELAND SECURITY ELEVATION CERTIFICATE • OMB No. 1660-0008
Federal Emergency Management Agency Expires March 31,2012
National Flood Insurance Program Important: Read the instructions on pages 1-9.
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
Al. Building Owner's Name Eugene Bunker Policy Number
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. C
2753 Clearwater Road ,) o m ( t \ t— 11
City Clearwater State WA ZIP Code 98331 I
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Tax Parcel#412192017,situate in Section 19,Township 24 North,Range 12 West,WM.,Jefferson County u `} .:
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential
A5. Latitude/Longitude:Lat.47 34 30 Long. 124 17 37 Horizontal Datum: � y t j
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A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. . hYli
U�111033
A7. Building Diagram Number
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) sq ft a) Square footage of attached garage sq ft
b) No.of permanent flood openings in the crawlspace or b) No.of permanent flood openings in the attached garage
enclosure(s)within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in
d) Engineered flood openings? 0 Yes 0 No d) Engineered flood openings? 0 Yes 0 No
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP Community Name&Community Number B2.County Name B3.State
Jefferson 530069 Jefferson WA
-
B4.Map/Panel Number B5.Suffix B6.FIRM Index B7.FIRM Panel B8.Flood 89. Base Flood Elevation(s)(Zone
530069 1350 B Date Effective/Revised Date Zone(s) AO,use base flood depth)
July 19,1982 A N/A
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 89.
0 FIS Profile ® FIRM ❑ Community Determined ❑ Other(Describe)
B11. Indicate elevation datum used for BFE in Item B9: El NGVD 1929 ❑ NAVD 1988 ❑ Other(Describe)
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' 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. Use the same datum as the BFE.
Benchmark Utilized N/AVertical Datum N/A
Conv rsion/Comments
Check the measurement used.
a) Top of bottom floor(including basement,crawlspace,or enclosure floor) . ®feet 0 meters(Puerto Rico only)
b) Top of the next higher floor . ❑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 . ❑feet ❑meters(Puerto Rico only)
(Describe type of equipment and location in Comments)
f) Lowest adjacent(finished)grade next to building(LAG) . ❑feet ❑meters(Puerto Rico only)
g) Highest adjacent(finished)grade next to building(HAG) . ❑feet ❑meters(Puerto Rico only)
h) Lowest adjacent grade at lowest elevation of deck or stairs,including . ❑feet ❑meters(Puerto Rico only)
structural support
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 tlr,
information. /certify that the information on this Certificate represents my best efforts to interpret the data available. !`•S . .O
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ,g° o,1� OiPO\
❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a A 9 7\
licensed land surveyor? ® Yes ❑ No ♦ `I,''a '11
Certifier's Name Thomas D.Roorda _ V License Number 36825 • i' ''. " 11
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Title Principal Surveyor Company Name Northwestern Territories Inc.(NTI)
6825 ,
Address 717 South Pea City Port Angeles State WA ZIP Code 98362 f� ' `.
•
Signature Date 9/24/09 Telephone (360)452-8491 I
FEMA Form 81-3'1, Mar 09 See reverse side for continuation. Replaces all previous editions
i
IMPORTANT: In these spaces,copy the corresponding information from Section A.
::; :r
Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No.
2753 Clearwater Road
City ClearwaterState WA ZIP Code 98331
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 Base flood elevation has not been determined for this area per the FIRM map.A cross-section through the Clearwater river,a tributary
stream and up through the building site was surveyed.The building site was determined to be 13.4 feet above the OHW mark of the river and 12.4 feet above
the edge of the tributary stream.The river was flowing bank-full at the time of the original survey.Flow in the tributary stream was shallow.The building finish
floor was subsequently constructed at 4.75 feet above the building site elevation.
Signature Date 9/24/09
® 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,crawispace,or enclosure)is 3.20 feet 0 meters (4 above or 0 below the HAG.
b)Top of bottom floor(including basement,crawlspace,or enclosure)is 4.73 [D 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 . ❑feet 0 meters
0
E3. Attached garage(top of slab)Is 0 feet El meters above or metersabovethe ❑below the HAG.
0below HAG.
E4. Top of platform of machinery and/or equipment servicing the building is 0 feet 0 meters ❑above or 0 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 Owner's Authorized Representative's Name
Thomas Roorda Go Northwestem Territories Inc.
Address 717 South Peabod eet City Port,Angeles State WA ZIP Code 98362
Signature '— Date
04/07
Telephone (360)452-8491
Comments
®Check here If attachment;
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 and G9.
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 infonnnation. (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.❑ The following Information(Items G4-G9)Is provided for community floodplain management purposes.
G4.Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued
rtc�o�-OC /13LD—CO0 c2/ lao0?
G7. This permit has been issued for: 0 New Construction 0 Substantial Improvement
GB. Elevation of as-built lowest floor(including basement)of the building: 3 09() Ofeet 0 meters(PR)Datum
G9. BFE or(in Zone AO)depth of flooding at the building site: []feet ❑meters(PR)Datum
G10.Community's design flood elevation ❑feet 0 meters(PR)Datum
Local Official's Name !�..�
`�i�o,(e c6k1T1S' Title Plann IVII rlana�r�r
Communb Name Telephone
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fur C ',?� ( � � Date
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0 Check here if attachment;
FEMA Form 81-31,Mar 09 Replaces all preriour editions
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•Building Photographs
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Continuation Page
For Insurance Company Use:
Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number
2753 Clearwater Road
City Clearwater State WA ZIP Code 98331 Company NAIC Number
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify ail
photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and"Left Side View."
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VIEW OF EAST SIDE OF BUILDING 9/6/09
°Building Photographs S
Continuation Page
For Insurance Company Use:
Building Street Address(including Apt, Unit,Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number
2753 Clearwater Road
City Clearwater State WA ZIP Code 98331 Company WJC Number
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all
photographs with: date taken; "Front View"and"Rear View"; and, if required, "Right Side View" and"Left Side View."
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VIEW OF WEST SIDE OF BUILDING 9/6/09
Building Photographs i
Continuation Page
7 For Insurance Company Use:
Building Street Address(including Apt, Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number
2753 Clearwater Road
City Clearwater State WA ZIP Code 98331
Company NA1C Number
, If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all
photographs with: date taken; "Front View"and"Rear View"; and, if required, "Right Side View"and"Left Side View."
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VIEW OF SOUTH SIDE OF BUILDING 9/6/09
Building Photographs •
Continuation Page
For Insurance Company Use:
Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No Pokey Number
2753 Clearwater Road
City Clearwater State WA ZIP Code 98331 Company NAIC Number
if submitting more photographs than will fit on the preceding page, affix the additional photographs below Identify all
photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and"Left Side View"
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VIEW OF NORTH SIDE OF BUILDING 9/6/09