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HomeMy WebLinkAbout935700024- 175 N BEACH DR POST EC CONSTRUCTION DUPELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30 2022 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: 491 Duckabush Road City State ZIP Code Company NAIC Number Brinnon Washington 98320 SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑X Construction Drawings" ❑ 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 below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: RTK GPS using WSRN Vertical Datum: NAVD 88 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 Fx] 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) 21.3 ® feet ❑ meters b) Top of the next higher floor N/A ❑ feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A ❑ feet ❑ meters d) Attached garage (top of slab) N/A ❑ feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) N/A ❑feet ❑meters f) Lowest adjacent (finished) grade next to building (LAG) 19.3 © feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 19.9 ® feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 19.3 ❑X feet ❑ meters 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 information. / certify that the information on this Certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Were latitude and longitude in Section A provided by a licensed land surveyor? © Yes ❑ No ❑ Check here if attachments. Certifier's Name License Number James C Almaden 44623 'sal o�.a •� Title Professional Land Surveyor Company Name q i Clark Land Officep 4623 6- Address P.O. Box 2199 LAI'1D a — - city State ZIP Code Sequim Washington 98382 Signature 1, Date Telephone Ext. 09-09-2022 (360)681-2161 Copy all pa es of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) I established a Benchmark on a large rock near the SW corner of the property at elevation 21.09' and transfered this elevation to 3 existing Benchmarks (60d spikes) established by septic designer. TBM #1 elev- 20.50', TBM #2 elev- 22.73' and TBM #4 elev- 19.21' .Proposed elevations listed in section C2. a, f, g and h were derived from measurements taken by this office 8/16/21 to the existing older mobile home located on the subject property at the time of the survey. This elevation certificate is to assist with the placement of a new mobile home (or manufactured) in the place of the existing. This pre -construction certificate assumes the skirting will be aluminum or vinyl material which is not considered an enclosure . FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 2 of 6 U.S. DEPARTMENT OF HOMELAND SECURITY [Expiration B No. 1660-0008 Federal Emergency Management Agency Date: November 30, 2022 National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Policy Number: Debra Piecora A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number: 491 Duckabush Road City State ZIP Code Brinnon Washington 98320 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Tax Parcel #982201804 Portion of the SW 1/4 Section 16, Township 25N, Range 2W W.M. A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residental A5. Latitude/Longitude: Lat. 47°39'19.5" Long.-122'56'31.8" Horizontal Datum: ❑ NAD 1927 ❑x 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 5 A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) N/A sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b N/A sq in d) Engineered flood openings? ❑ Yes ❑ No A9. For a building with an attached garage: a) Square footage of attached garage N/A sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes ❑ No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP Community Name & Community Number B2. County Name B3. State Jefferson County 530069 Jefferson Washington B4. Map/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth) Revised Date 53031 C 06-07-2019 06-07-2019 AE 20.10 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: ❑ FIS Profile x❑ FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 x❑ NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ❑x No Designation Date: ❑ CBRS ❑ OPA FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 1 of 6