HomeMy WebLinkAboutE-ELEVATION CERTIFICATE - 128 1ST STREET - POUDRE RIVER (3) 5OV-25-2003 TUE 11:42 AN FT COLLINS UTILITIES FAX NO. 9702216593
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FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
ELEVATION CERTIFICATE
PROPER D SCRIP ION (Lot end Blodt Numbers, Tax Parcel Number, G r' n 52�1
Legal Oeatriptbn, etc.)
SOWING USE (e.g., esidenliel Non-reaidenliel, ddilian, copy, ett. Uee a Commerna area, Irnecssaery.j
( tX''-Ra'-a:a.aH' or aka- pM°) LJ NA01927 (_ NAD 1983 SOURCE: L(GPS(Type):
Lj USGS Quad Mav IJ Other
rag&
08d o2E clog{ c
DATE 1 ZONE(S) I(2er9e AO. u6e depth et
1r ^! Z] "TrioI A)-- 8 -.
810. Indicate the source c(�th,e Base Flood Elevation (BFE) data of base flood depth entered in Be.
Lj FIS Profile 4 FIRM LJ Community Determined Lj Omer (Describe):
811. Indicate the elevation datum used for the BFE in Bg , rA NGVD 1929 Lj NAVD 1988 J Other (Describe):
8i2. Is the building located in a Coastal Barrier Resources System (CBRS) area or otherwise Protected Area (OPA)? Lj Yes N NO
Designation Date:
C1. Building elevations are based on: LjConstruction Drawings- (JBuilding Under Construcfion- ' (Finished rloastruction
•A new Elevation Certificate wig be required when construction of the building is complete.
02. Building Diagram Number,_ (Select tha building diagram most similar to the building for which this ceNfieate is being completed - see
pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
C3. Elevations — Zones Al-A30. AE. AN. A (with BFE), VE, V11430, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, ARIAH, AR/AO
Complete Items C3.a4 below according to the building diagram specified in Item C2. Stets the datum used. If the'datum is different from
the datum used for the BFE in Section vers
8, convert the datum to that used for the BFE. Show field measurements and datum con
ion
calculation. Use the spaoe provided or the Comments area of Section D or Section G, es appropriate
Datum )_ `12 9 ConversioNComments , to document me datum conversion.
Elevation reference mark used �_i f02, Does the elevation reference mark used appear on the FIRW?
O a) Top of bottom floor (including basement or enclosure) 1{ 3 fl (m)1� No
O b) Top Of next higher floor C5 ft (� ,
O c) Bottom of lowest horizontal structural member V zones only)
O d) Attached garage (top of slab) ( � ' _ (m,
O a) Lowest elevation of machinery andfocequipment
servicing the building (Describe In a Comments area.)
O 0 Lowest adjacent (finished) grade (LAG)ft.(m) z i
O g) Highest adjacent (finished) grade (HAG)
R(m) 1t
O h} No. of permanent openings (woad onto) within 1 R above adjacent grade 7491:
0 Q Total area of all permanent openings hood vents In C3.h -8" aq. In. (sq. an)
7 P( )
a
SECTION O - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and seated by a land surveyor, engineer, or architect authorized by law to certify elevation information.
I corg7y that lire information In Sactians A, B, and C on this eerl;rcafe represents my Dest efibRs to interpret me dare available.
Iunderstand Mat env fsisamatemenrran,.ee,,.,..r...-.,._.._�__ __. _
e
reverse side for continuation. Replaces all previous
?OV-25-2003 TUE 11:42 AM FT COLLINS UTILITIES
FAX NO, 9702216593
P. 05
P u cad tm M
Lopy omn awes or tms eaevanon %;sruncate ror (1) community official. (2) insurance aaantica inamr- and 131 huildim nwnnr
For Zone AO and Zone A (without BFE), complete Items Et. through E5. If the Elevation Certificate is intended for use as supporting
information for a LOMA or LOMR-F, Section C must be completed.
El. Building Diagram Number (Select the building diagram most similar to the bulkling for which this certificate is being completed -
see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph)
E2. The top of the bottom floor (including basement or enclosure) of the building Is I I I ft. (m) IJJ in. (cm) L.J above or I I below
(check one) mq highest adjacent grade. (Use natural grade, If available.)
E3. For Building Diagrams 6-a with openings (see page 71 the next higher floor or elevated floor (elevation b) of the building is
1JJ ft. (m) JJ_,lin. (cm) above the highest adjacent grade. Complete Items C3.h and C3.1 on front of form.
E4. The top of the platform of machinery, and/or equipment servicing fhe building is IJJ ft. (m) L-IJ In. (cm) IJ above or I_i below
(check one) the highest adJacem grade. (use natural grade, If available.)
E5. For Zone AO only. If no flood depth number is available, is the top o1 the bottom floor elevated in accordance with the communhv's
or
or
or Zone AO must sign here. The statements in Sections A, B, C, and E are correct to
ADDRE53 CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMME S -
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Sections A, 8, C (or E), and G of this Elevation Certificats. Complete the applicable Itam(s) and sign below.
G1. J—J The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor,
engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source end date of the
elevation data in the Comments area below.)
G2. J_J A community official completed Section E for a building located In Zone A (without a FEMA-issued or community -Issued BFE) or
Zone AD.
G3. 44The following information (items G4-09) Is provided for community floodplain management purposes.
G7. This permit has been issued for.. W New Construction 1"J Substantial Improvement
438. Elevation of as-buift lowesttoor (including basement) of fffe building Is: it 3 R(m) Datum: GV40
09. BFE or (in Zone AO) depth of flooding at the building site b: tt 9 1 K . Q ff. (m) Oetum:�G
-ptt�, TOIr- +y' g of- m Ilaran« !`t rteS� ci,y,d �"prod� tle b4eeo wLeA (see
'V&da0ce 4-11PATTkiis mr4ikra-k I`s ant 4'r 90 add,41oit. _ _ _
(_ 1 cheek hem i1 eltnichmeras
FEMA Form 81-31, January 2003 Replaces all previous ediliorw