HomeMy WebLinkAboutBLD2013-00121 Flood Certificate U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE
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 Paul Ericksen Policy Number:
A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number:
2682 Rain Forest Road
City Forks State WA ZIP Code 98331
A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.)
Parcel#991500007 Lot 7 Rain Forest Lots(Vol.6 Pg.47-Plats) SE1/4 SE1/4 S.30,T27N R1OW,W.M -'
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Garage ' -----__! fl V e ____.
A5. Latitude/Longitude: Lat.47-48'-33" Long. 124-02'-09" Horizontal Datum: ❑ NAD 1927 ® NAD 1983 , 7
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. I.'
A7. Building Diagram Number 1A II �f(JN I,
A8. For a building with a crawlspace or enclosure(s): A9. For a building with art at_a'ched garage: 7 ''r''
a) Square footage of crawlspace or enclosure(s) na sq ft a) Square foots of attached garage na /iq ft
b) Number of permanent flood openings in the crawlspace b) Number of permanent floor openings in the attached garage
or enclosure(s)within 1.0 foot above adjacent grade na within 1.0 foot above adjacent,9'ratle Ot"i1! '-'
c) Total net area of flood openings in A8.b na sq in c) Total net area of flood openings-hi:Al.b'!jrr 1, .. sq in
d) Engineered flood openings? El Yes ® No d) Engineered flood openings? ❑ Yes--- ko
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP Community Name&Community Number B2.County Name B3.State
Unincorp.Jefferson Co.530069-0625-B Jefferson WA
B4.Map/Panel Number B5.Suffix B6.FIRM Index Date B7.FIRM Panel B8.Flood B9. Base Flood Elevation(s)(Zone
625 of 1625 B 7/19/82 Effective/Revised Date Zone(s) AO, use base flood depth)
7/19/82 A Local evidence
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
❑ FIS Profile ❑ FIRM ❑ Community Determined 0 Other/Source:local observation and history
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ❑ NAVD 1988 ® Other/Source:assumed elevation
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes 0 No
Designation Date: ❑ CBRS ❑ OPA -
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevations are based on: ❑ 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 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 {rlP)
below according to the building diagram specified in Item A7. In Puerto Rico only,enter meters. i
Benchmark Utilized: NW cor.PUD pad Vertical Datum: 100.00'assumed �q
Indicate elevation datum used for the elevations in items a)through h)below. 0 NGVD 1929 0 NAVD 1988 ®Other/Source:assumed
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) 100.22 ®feet 0 meters �1
b)Top of the next higher floor n/a. ❑feet ❑meters -
c) Bottom of the lowest horizontal structural member(V Zones only) 100.22 ®feet ❑meters OW'
d)Attached garage(top of slab) n/a. ❑feet ❑meters
e) Lowest elevation of machinery or equipment servicing the building 100.22 ®feet ❑meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent(finished)grade next to building(LAG) 99.60 ®feet ❑meters
g) Highest adjacent(finished)grade next to building(HAG) 100.61 0 feet ❑meters
h) Lowest adjacent grade at lowest elevation of deck or stairs,including structural support na. ®feet ❑meters
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION IN
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation k !`�� -I
information./certify that the information on this Certificate represents my best efforts to interpret the data available. t ••�. 4I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. % r
El Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a 5 Q)`,,C �y
® Check here if attachments. licensed land surveyor? ® Yes ElNo r io ?�tS
Certifier's Name Dan P.Kousbaugh License Number RLS#11983 po; 9 fi. 1 a
1S11 - '
Title President Company Name Dan Kousbaugh Surveying Inc,P.S. 6, 'CIS
Address 450 Spruce Drive City Forks State WA ZIP Code 98331 �+4L LANs'
11111
�� wwr
Signa Date 6/12/14 Telephone (360)374-5720 ` / ':,, ,.
7 r 1 �i l G /L I
FEMA Form 086-0-33( 112) See reverse side for continuation. Replaces . I previous editions.
CLCVAIIVIv VCKIIr•IVNIC, page c
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:
2682 Rain Forest Road
City Forks State WA ZIP Code 98331 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 On 2/1/13 a benchmark was established on the property at the NW corner of the base pad for the PUD transformer at 100.00'. Two local
property owners were consulted as to their highest observed flood levels in this area. They picked different sites about 500'east-west of each other. Flood
level noted was 91.31'at each site. The original Brandeberry homestead floor level comes in at 92.51'. The 100 year flood level was set at 91.31' The floor
of garage falls at 100.22'.
Signature p, ^,'j 004,(4-tOott04,1Date 6/12/14
SECTION E—rBUI�L`DING ELEVATION INFION(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.
E1. 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 0.39 ®feet 0 meters ❑above or®below the HAG.
b)Top of bottom floor(including basement,crawlspace,or enclosure)is 0.62 ®feet El 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 n/a. ❑feet ❑meters ❑above or El below the HAG.
E3. Attached garage(top of slab)is n/a. ❑feet ❑meters ❑above or ❑below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is na. ®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? ®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 Dan P.Kousbaugh
Address 45 Spruce Drive P City Forks State WA ZIP Code 98331
Signature 7 Date 6/12/14 Telephone (360)374-5720
Comments The floor elevation of the garage is 100.22'whic . well above the estimated 100 year flood level of 91.31'.
®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—G10.In Puerto Rico only,enter meters.
GI:1K 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.❑ The following information(Items G4—G10)is provided for community floodplain management purposes.
G4. / t Number G G5. at er�d sye 6 !S G6. Date Certificate Of Compliance/Occupancy Issued
Ni - tom l
G7. his permit has been issued for: New Construction 0 Substantial Improvement
G8. Elevation of as-built lowest floor(including basement)of the building: . 0 feet ❑meters Datum .
G9. BFE or(in Zone AO)depth of flooding at the building site: . ❑feet ❑meters Dat
G10.Community's design flood elevation: El feet ❑meters D £. l�/�\\
V
:-=---17))
Local Official's Name Title r/t/,!/ ' /
Community Name Telephone
Signature Date
Comments
❑Check here if attachments.
FEMA Form 086-0-33(7/12) Replaces all previous editions.
u
1 c E A
w �p1 E
LL a u c
o
— -- E yyE
g aL0.
o et m ,;�N ti s-0,
G� ep O
0.W W V2 v g471 C ^ < m�...oK
J Z ` Z =C3 SW� 0.p1 og Z o
elep
ce O'i �y.,1 t0 1. U rj N
U W O Q'ca Iraw p
saaz C 2. W t0 n -+ HIll
WC
H
Q lt
o OC CD p G4 W. rEEi
\J 1 VI
�w' N o
o ` c "CS $ to: a 5 LL
a ze p � V/ x �< t� o aLp
0. _ S" yr‘.. (t'''''') ,I., ..a Et..
pp.. V. Ww t, 1 nOli
N- - .t� E$p
W EEyg
v E
memo
3 0 D d
) 11
_ii
7
It
t
�r
_r
n
South pork //
I I 4.1
!/
0 (r i ' `e (NI
N / N r m
%, c0
it
tr-s 4g4, el 1t N \,
j r ! `
LL
F... : c` (. -i) 0 '�, .//�'4> xx �� i:' - 11 y 1, Y .s In
21-
x
4 ! 1 1-
S //
::Yid: \vim\`
1 ............../
Q
7
I.P-VoI lr r9417
i?: QJE'!I1
Q iti?= t
s Dili. 1.1
I x g V *V141 a.
ill . s. s .
K ei-= Z
F :} 'i U
a -
--._ --T:---—-- ——'----50_fr».-hr...:.o! - - .•� " ------
d - s. it Ys
`l <y •� �.QAit : 1
y f E
4- 0 t - , "
0 \.mil QG ..r• .rs b • \ .." S Y
0z 3> \�'' `� � I N keix a
e'
l. Z Cr D a \ . a a". 3.�. o � \ >z iv, w p - eq 15 U q ;
z
�'' v N o \ cp.\\ \ •Nr- - -\\ .§ 6-
t t it\ ga p `i'
_ z \\ F 1 It \' r �Y
rx
...• U uj 4" 4 i l-A.f� 8. .„,.„�.Mg. Z �I filM
F.4 r: kli ili;Of 0 '
!: sSVLse�7
41 i .- Thik0.-tii ir, 4,.t
7 -4# i. 01 Y ! lc
! C,
iiD a ' \ I � =oa
. Fall
411*41 : ..) ,?,s
iqj
fall
:i € l'il; 3BP;- iFin tip 1 12.110 g +3I 'IS w s 1 sz a I
fps a kiiIIU;
"'27.1,... r. ii- IVE. . iii.-: go '-Ft i ih g
Ln MI n:!!' gP r s ee'^ 3 LA i ?a iffsiF' ,a
•. Z — � NT•t � '
570770 PGS : 1 SWD
10/15/21112 03:111 PM $72 00 JEFFE7t 1 TITLE go Inc
J•ff�rson Cc+ity Yet fidl[or'• f0 Tiq-Oo. Ejdifri, pyyltor
When recorded return to:
Jefferson County Excise Tax
Paul D.Ericksen and Cindy S.Erickson Alf # 1 8 C to (b 1��0�Z
92 Ruby Road
Port Angeles,WA 98362 Tax S.53 A;n;3
P.y eputy Treasurer
78089-JTc STATUTORY WARRANTY DEED
Escrow No.: 3597
Title Order No.: ' gael
THE GRANTOR(S)
Karen Culver,as her separate estate
for and in consideration of tan dollars and of er good and valuable co ••.•n • d paid,conveys,
and warrants to
Paul D.Ericksen and Cindr S.Ericksen,husband and wife
the following described real estate,situated In the Cou f Je f Washington:
Lot 7 d Rain Forest Lots Division 1,as per Plat ed in V m 6 d Plats,page 47,records
of Jefferson County.Washington
Subject to: Easements recorded under Auditor's File 20 and 375207
Covenants,conditions,restrictions and/or ements under Auditor's File No.254563
Restrictions, conditions, dedications, t , easements and provisions contained and/or
delineated on the face of the Plat record der ditor's Fife No.254585
Loss or damage by reason that there appears rded right of access b and from the
land herein described to a public right of
Tax Parcel Number(s): 991500007 O
Culver
STATE OF WASHINGT
`COUNTY OF • )ss
I certify that I know or Ali evidence that Karen Culver is the person who appeared before
me,and said pe at the signed this instrument and acknowledged it to be her free
and voluntary act for nd purposes mentioned in this instrument
Dated: 1(:)f
TERESA I.WAY
Notary Public
State of Washington
NotaryP ic' the stat W 'ngton My Commission Expires
Reaidin May 15,2016
My a nt s
•
L138 10-05(W)
•
DELORME •
Topo USA®6.0
Ericksen Exhibit Map
CO
Z
to
to
m
Highest observed flood=91.31'in this area
A
yy �
T_
Proposed Ericksen Homesite
Brandeberry Homestead Floor Elev.=92.51' X Ground Elev. 98.58'to 100.09'
RANDEBERRY RD
88-2"-I13,andrlxuti-F.J
ea
Scale 1:6.400
ft
0 200 400 600 800 1000
MN(16.8°E) 1"=533.3 ft Data Zoom 15-0
H-1000
Data use subject to license.
®2006 DeLorme.Topo USA®6.0.
www.delorme.com
ELEVATION CERTIFICATE, page 3 Building Photographs
See Instructions for Item A6.
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:
2682 Rain Forest Road
City Forks State WA ZIP Code 98331 Company NAIC Number:
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 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." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as
indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page.
i� ttq
5/241: .:32 A , . t s„.M `,, il;�"
,,
, .
,,,r ed.,4, ; 4,"
i
. ,,,..
jf • 1
V 7
b 1.+1 •
• y` •` •.,. - • C;
Frll
11
1 i I T414. -
,f r
._. . ter, .- r .'
FEMA Form 086-0-33 (7/12)
..,-..,,,.u„ ,,revious editions.