HomeMy WebLinkAboutBLD2003-00514 Flood Certificate ,'Y1 L.I}D 3 `f(, / I-tUEItAL CMtKtit.Nt;T MANAt5tMtN1 AtitNGT O.M.B. No. 3067-0077
1 NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002
ELEVATION CERTIFICATE
Important:.Read the Instructions on pages 1-7.
M
A F OWNER INFORMATION ' '-'��"":
SECTION -PRO PROPERTY 1. ��%�,�i
BUILDING OWNERS NAME ;:.» •-fig. '1;.`-.�'
Keith Belly_ � "�_ ••`rr �.
BUILDING STREETADDRESS(Indudng Apt,Unit,Suite,andfcr Bldg.N 3-)OR P.O.ROUTE AND BOX NO. '• ��'_ �ifiErWt k It
Not yet assigned ." '"•'w :�'`r`?„"'''""
CITY STATE ZIP CODE
Bri nnon WA 98320
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Numbe;,Leger Description,etc.)
Pin.Sec.35,Twp.28 N,Rge.2W,W.M.;Jefferson County.WA
- BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,eta Use a Cornrnems area,if necessary.)
Residential
LATTRJOE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM:IJM SOURCE: ❑GPS(Type):
(o°-tr-tator or t#JAWAtilf) ❑NAD 1927 0 NAD 1983 ❑USGS Quad Map D Other
_SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME a COMMI'?NUMBER 82 COUNTY NAME B3.STATE -
530069 Jefferson WA
B4.MAP Mr PANEL 135.SUFFIX B7.RPM PANS. —
NUMBER IX FM INDEX DATE rtrtCTIVFJREVISED DATE ea FLOOD ZONE(S) r
1235 B 7/19B2 7M9V82 A-4 C ` f ,
B10,krdeate the source of the Base Rood Elevation(BFE)data or base flood depth entered in B9.
❑AS Profile IS FIRM ❑Carrrauriity Detemminec ❑Other(Describe):
B11.Incicate the elevation datum used for the BFE in B9:EI NGVD 1929 ❑NAVD 1988 ❑Other(Desaibe).f . { If:
B12.Is the bullring loafed in a Coastal Barrier Resources System(CBRS)area or Other*.Protected Area(OPA)? ❑Yes 0 No I p ,r n 0*_.. _ s.. :
SECTION C•BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) 1''ti I
,
Cl.Bulking elevations are based on:(El Construction Drawings' • ❑Bulking Under Cordon' 0]Finished Construction i 1 s I JUL 2003
'A new Elevation Certificate wil be required when conshrt(Jibe the bt ing is complete. i. I- 1 i.
CZ Bullring Diagram Number 8(Select the bonding dtlagrartl most similar b the tiling for whidr this certificate is being completed-see 6 7. If no diagram
want*represents the building,Provide a sketch or photograph.) J L f F E R':`. i• C f..:01l T Y
C3.Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1 V30,V(wih BFE;,AR ARIA,AR/AE,AWA1,A30,AR/AK AR/AO DEFT. OF C C.'"I!_'.'=;`'; f-t:�;;1s i
Complete Items C3.-a-I below accorring to the building diagram specified in tern C2.State the datum used.tithe datum is dfferent from the datum used(Oahe BFEin _.. -._----..
Section B,convert the datum to that used for the BFE.Show field measurers ents and datum to version calculation Use the space provided or the Comments area of
Section D or Section G,as appropriate,to document the datum carversion.
Datum NOVD 1928 Conversion/Comments ;- ,,,�„r,.. .a,.,pi��,.
Elevation reference mat used RM26 Does the elevation reference mark used appear on the FIRM? Yes 0 No v' ��� A,
o a)Top of bottom floor foduding basement or enclosure) 12 5 ft.(m) / �.-. 7
o b)Top of and hgherfloa __,h(m) o ; OF k - .
o c)Bottom of lowest horizontal sbudurai rumba(V zones any) ft,(m) o , AO ;lrE' C' t A ,
o d} t (t p of ice) 10.5 R(m) E'2 i;' I :.y 4 j s
w o:9 -r.4-
o e)t esteiwaticoofma hineryand/orequrprrrent , i'•• IL. ,Y•;
servicing the brulki ng(Describe in a Comments area) 12.5 ft(m) E 4f11,/� a
o fl Lowest (finished)grade(1AG) 9Q.Oft.(m) 2 v;i .�\ ,, I ,
o 91 (finished)9 (HAG) 1Q.0 ft(mj % L Ate'
o h)Nor elf permsnerrt openirx,�s(flood vents)within 1 it above advent geode§ A i '
o I)Total area of al permanent openings(flood vents)inCU asq.in.(N.cm) EXPIRES 4/26/a 3 i
SECTION D-SURVEYOR, GINEER,OR ARCHITECT CERTIFICATION �7'• y► cr••''''.":,EN
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,8,and Con this certificate::presents my best efforts to interpret the data available.
I understand that any false statement may be punishable by tine or lrnjwisonment under 18 U.S.Code,Section 1001.
CERTIFIERS NAME LICENSE NUMBER
Kenneth A.Clark 12223
TIRE . COMPANY NAME
Owner Clark Land Office
ADDRESS • CITY STATE ZIP CODE
P.O.Box 2199 Sequim. WA 96382
SIGNATURE DATE TELEPHONE
ote, 1/30103 (360)681-2161 _
—
FEMA Form -31,JUL 00 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
ZO'd L£6# SZ:TT L0-Z0'£00Z L '80 TS£ £SZ
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I M IMPORTANT In these spaces,copy the corresponding information fnxn Section A. _ " 1 ; =- 'e:-' rg
BUILDNG STREET ADDRESS(I cWog Apt..Uni;,Su m,andor Bldg.No.)OR P.0.ROltE,iND BOX Na �w _ y.-,.„.`. .,Mw -:- "' ,;4,,.:
Not V
CITY STATE 2 N
:
BinOn WA s8320 ' „
y , ;4T:_
SECTION D•SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) ,,..:._...._...
Copy both sides of the Elevation Certificate to(1)ccrrxnunlyy official,(2)Insurance agenUaxr►peny,and(3)building owner, '-} 1-, ! i,_ .4 )_.. , ;
COMMEN 1 - ).11 -
11
; JUL 7 :ii.
03
9�i c..
E.
F:
SECTION E-BUILDING ELEVATION INFORMATIONJSURVEY NOT REQUIRED)FOR NE AO AND ZONE ASWITHO }-E► -------
For Zone AO and Zone A(wihout BEE),complete Items El through E4. If the Elevation Certificate is intended for use as supporting information fora LOMA o LOMR-F,
Section C must be completed. see 6 and 7. If no diagram xnhratt�y
Ei.Budding Diagram Number_paled the hiking d�gram most simifarto the buicing to which this certificate is being completed pages age^
represents the building,provide asketch or photograph.)
EZ The top of the bottom floor(inducing basement a osure)of the burg is _ft.(m)_in.(cn)0 above or 0 below(check cne)the highest adacent grade.(Use
natura►Bade,i anablel
E3.For Buicting Diagrams 68 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is _ft.(m)_in.(an)above the highest adjacent
grade.Complete items C3h and C3.1 on front Worm.
E4.For Zone AO only:If no food depth number is available,is the lop of the bottatt floc elevated in accordance with the oonmunitys tloodplain management ordinance?
D Yes ❑No ❑Unknown.The local official must certiftthis a dama6un in Section G. —
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owns o mixes authorized representative who completes Sedan A,B,C(Items C3.h and C3.I only),and E for Zane A(withal a FEMA-issued or community-
issued BFE)coon AO must sign here.The statements in Sec ons A,B,C,and E are=eat to the best of my km/Madge.
PROPERTY OWNERS OR OWNER'S AUTHORIZED REPRESENTATIVES(SAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE - DATE TELEPHONE
COMMENTS
❑Check here if attachments
SECTION G•COMMUNfTY INFORMATION(OPTIONAL)
The local ofiaal who is authorized by taw or=Rinance to administer the conuntu itlls floodelan management oninance can cvnp►ete Sections A,B.C(or E),and G of this Eievatlon
Certificate,Cordate the Apt rk n(s)and sign below.
Cl.❑The information in Section C was talon from other docsnentatian that has been signed and embossed by a licensed surveyor,engineer,a architect who Is authorized by
state or loaf Iwo to cat elevation khforma cn.(Incticalethesoume ad dale Lift elevation data in the Cornetts area below_)
G2.❑A community official completed Section E for a building located i i Zone A(without a FEMArissued orcommunkyissued BFE)or Zone AO.
G3.0 The foltwiing information(heats caws)Is provided for community loocplain management purpose,.
G4.PERMIT NUMBER 05.n TEPERMITISSUED ---GB.DATE CERTIFICATEOFCOMPLANCE;O ANCY ISSUED I
G7.This permit has been Issued for.❑New Conskudion ❑Substa>tki Improvement
GS-Elevation of as-buit lowest floor(including basement)of the butting ix tt(m) Dun
G9.BFE or(in Zone AO)depth c4 flooding at the bulldog site is: =—= -ft(m) Daunt
LOCAL ---
LOCAL OFFICIAL'S NAME . TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
fl Check here if attachments
•
FEMA Form 81-31,JUL 00 REPLACES ALL PREVIOUS EDITIONS
£0-d L£6# 9Z:TT 2.0-ZO'£00Z Ltr80 TS£ £SZ
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