HomeMy WebLinkAboutBLD2010-00038 Flood Certificate U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE I OMB No. 1660-0008
Federal Emergency Management Agency Expires March 31,2012 I
National Flood Insurance Program likportant: Read the instructions on pages
SECTION A-PROPERTY INFORMATION For Insurance Compa- -tJe:
Al. Building Owner's Name Mike Stevens
Policy Number
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No.
Beckett Point Road across from 960 Company NAIL Number
City Port Townsend State WA ZIP Code 98368-5717
A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.)
Tract"A"Beckett Pt.So.Beach,Beckett Pt.Fisherman's Club Assessor's Plat,GL 1,Sec 23,T3ON,R2W,WM.TP#932200801
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Garage Recreational usel
A5. Latitude/Longitude:Lat.48 04 37.8 Long. 122 53 24.1 Horizontal Datum:
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. ❑ NAD 1927 ® NAD 1983
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) 588 sq ft a) Square footage of attached garage i/fT• 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 11 /
within 1.0 foot above adjacent grade ��c) Total net area of flood openings in A8.b 990 sq in c) Total net area of flood openings in A9.b d) Engineered flood openings? ❑ Yes ® No �_ sq in
d) Engineered flood openings? 0 Yes ,$r No
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP Community Name&CommunityNumber B3.State
B2.County Name
Jefferson Co.530069 I Unincorporated area Se.Werson 0.00 WA
64. u N
Map/Panel mber 65.Suffix B6.FIRM Index B7.FIRM Panel
530069 0135 Nu B 68.Flood B9.Base Flood Elevation(s)(Zone
Date Effective/Revised Date Zone(s)( ) AO,use base flood depth)
July 19,1982
ably )a, rag. Al 9.0
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 0 NAVD 1988
❑ Other(Describe)
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes
Designation Date ❑ CBRS ElOPA ® No
SECTION C-BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based on: 0 Construction Drawings* ❑ Building Under Construction*
*A new Elevation Certificate will be required when construction of the building is complete. ® Finished Construction
C2. Elevations-Zones Al-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 GP16101-2Vertical Datum NAVD 1988
Conversion/Comments NAVD 1988-3.51'=NGVD 1929 7 %!
Check the measurement used.
a) Top of bottom floor(including basement,crawlspace,or enclosure floor)4.91. ®feet ❑meters(Puerto Rico only)
b) Top of the next higher floor 1') /.19 ❑feet
c) Bottom of the lowest horizontal structural member(V Zones only) ❑meters(Puerto Rico only)
d) � ❑feet ID meters(Puerto Rico only)Attached garage(top of slab)
_Wit_ ❑feet El meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building El feet
(Describe type of equipment and location in Comments) ID meters(Puerto Rico only)
f) Lowest adjacent(finished)grade next to building(LAG) 4.30 ®feet
g) Highest adjacent(finished)grade next to building(HAG) 4.80 ❑meters(Puerto Rico only)
®feet ❑meters(Puerto Rico only)
h) Lowest adjacent grade at lowest elevation of deck or stairs, including El feet
El structural supportmeters(Puerto Rico only)
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 J
information. /certify that the information on this Certificate represents my best efforts to interpret the data available. ` . KO B I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. �� 0. w`s y SO
,. 4,
® Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a P cT 'f.
licensed land surveyor? ® Yes
El No 2
Certifier's Name Kent L.Robinson License Number 19583 -o cG
4.
Title Surveyor Company Name Northwestern Territories Inc.(NTI) Cic 19583
Address 717 South Peabody City Port Angeles State WA ZIP Code 98362 �s/O ��'rSTL1t,-1--
'v'AL LAND
Signature ate Sept. 9,2010 Telephone (360)452-8491 r ti
rmrutt I ANT: In these spaces,copy the corresponding information from Section A.
Building Street Address(including Apt.,Unit,Sud/or Bldg.No.)or P.O.Route and Box No. For(nsutar0,ce Company Usa 960 Beckett Point Road
F'olfcy Ntmbet �;.
City Port TownsendState WA ZIP Code 98368-5717
0om06Y NAIL" ►ambit'
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 This certificate is for completed construction of a detached garage located in Tract"A"Common Area across the road from and serving the
existing house on Lots 13/14 of Beckett Point South Beach. Garage is slab on grade and the walls are constructed of treated material above top of stem wall
which is set at elevation 6.03.
li -.
Sig ure
Date 9/9/10
Check here if
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)attachments
WITHOUBFE)ents
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 b)Top of bottom floor(including basement,crawlspace,or enclosure)is 0 feet 0 meters 0 above or❑below the HAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and❑/or 9(se feet ❑e pages 0meters above or 0 below the LAG.
8-9 of Instructions),the next higher
(elevation C2.b in the diagrams)of the building is
E3. Attached garage(top of slab)isEl feet El meters 0 above or 0 below the HAG. floor
0 feet 0 meters ❑above or ❑below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is
E5. Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated feet EI meters ❑above or❑below the HAG.
in accordance with the commun
ordinance? 0 Yes 0 No IDUnknown. The local official must certify this information in Section G. rty's floodplain management
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
Signature ZIP Code
Date Telephone
Comments
SECTION G-COMMUNITY INFORMATION(OPTIONAL) ❑Check here if attachments
fhe 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.
31. 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.)
32.0 A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO.
33.>1 The following information(Items G4-G9)is provided for community floodplain management purposes.
G4. Permit Number G5. Date Permit Issued
1 . / - • 4j(,a IO�..3 e S//Q. / O I O G6. Date Ce ificate Of Compliance/Occupancy Issued
7. This permit has been issued for:
)41ew Construction ❑Substantial Improvement
8. Elevation of as-built lowest floor(including basement)of the building:
D. BFE or(in Zone AO)depth of flooding at the building site: �� feet ❑meters(PR)Datum
_CA_ .Meet ❑meters(PR)Datum
10. Community's design flood elevation
• 0 feet 0 meters(PR)Datum
ocal Official's Name
C I n S Title
ommunity Nameeem n>n in an
-ttt-- Telephone
ignature 0, _ 3
Date
93 /
)mments aDl t�
CL! LW]
11
n!`hone h.ncs if.fi nhmnnM
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Building Photographs
See Instructions for Item A6.
For Insurance Company Use:
Building Street Address(including Apt, Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number
960 Beckett Point Road
City Port Townsend State WA ZIP Code 98368-5717 Company NAIC Number
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to
the instructions for Item A6. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right
Side View" and "Left Side View." If submitting more photographs than will fit on this page, use the Continuation Page on the
reverse.
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FRONT AND SIDE VIEW
IP
Building Photographs Photo ra ID
Continuation Page
Building Street Address(includingBldg. For Insurance Company Use:
Apt., Unit, Suite, and/or No.)or P.O. Route and Box No.960 Becket Point Road
City Port Townsend State WA ZIP Code 98368-5717 Policy Number
Company NAIL 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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