HomeMy WebLinkAboutBLD2000-00721 Flood Certificate sr" FEDERAL EMERGENCY MANAGEMENT AGENCY
O.M.B. No. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Expires July 31,'2002
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1 - 7.
SECTION A -PROPERTY OWNER INFORMATION For Insurance Company Use:
BUILDING OWNER'S NAME Policy Number
BCM Partnership
BUILDING STREET ADDRESS(Including Apt.,Unit•Suite, and/or Bldg. No.)OR P.O. ROUTE AND BOX NO. Company NAIC Number
CITY STATE ZIP CODE
__port Hadlock
E
PROP MC-7—P'DESCRIPTION(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.)
Assessor's Parcel No. 901013001
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use Comments section if necessary.)
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: U GPS (Type):
( ##°-##'-##.##" or ##.#####°) LI NAD 1927 U NAD 1983 LX I USGS Quad Map U Other:
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION •
81.NFIP COMMUNITY NAME&COMMUNITY NUMBER 82.COUNTY NAME - -83.STATE
530069 Jefferson WA
B4.MAP AND PANEL 85.SUFFIX B6. FIRM INDEX 87. FIRM PANEL B8.FLOOD B9. BASE FLOOD ELEVATION(S)
NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of flooding)
530069 0170 B 7/19/82 7/19/82 A-1 8.0
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9.
I_I FIS Profile IJK FIRM Li Community Determined II Other(Describe):
B11. Indicate the elevation datum used for the BFE in B9: I X I NGVD 1929 II NAVD 1988 Li Other(Describe):
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? II Yes Ix I No
Designation Date:
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: I_'Construction Drawings* !_'Building Under Construction* I X'Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number 6 (Select the building diagram most similar to the building for which this certificate is being completed-see
pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
C3. 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 C3a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from
the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion
calculation. Use the space provided or the Comments area of Section D or Section G,as appropriate,to document the datum conversion.
Datum Conversion/Comments
Elevation reference mark used RM7 Does the elevation reference mark used appear on [al:A440 aw • itqlet
❑ a)Top of bottom floor(including basement or enclosure) 8 .6—ft.(m) v A
❑ b)Top of next higher floor ft.(m) v ��oF'WAS./
❑ •
c) Bottom of lowest horizontal structural member(V zones only) _ft.(m) 'Q, • c
❑ d) Attached garage(top of slab) ft.(m) W ,��' 2
❑ e) Lowest elevation of machinery and/or equipment v h '' ` '•�
servicing the building 8 .6 ft.(m) �, _" r4frl 10 Ic
. ❑ f) Lowest adjacent grade(LAG) 7 .0 ft.(m) z W , 3 ,"
�, 122223 yct,
0 g)Highest adjacent grade(HAG) 7.0 ft.(m) �Cts(E
o h) No.of permanent openings(flood vents)within 1 ft.above adjacent grade SAL LAIC
0 i)Total area of all permanent openings(flood vents)in C3h sq. in. (sq.cm)
7.VIRES--42gf n/
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.
I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAME LICENSE NUMBER
Kenneth A. Clark 12223
TITLE COMPANY NAME
Owner Clark Tanri_Offico
ADDRESS CITY
P. O. Box 2199 Sequim S TE 9IP E
' SIGNATURE DATE /Jj j/�,o TELEPHONE ttii
i/ t 3bII) 581-2154