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HomeMy WebLinkAboutE-ELEVATION CERTIFICATE - 304 EAST LINCOLN AVENUE - POUDRE RIVER (3)FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Read the 1-7. O.M.B. No. 3067-0077 Expires July 31, 2002 SECTION A - PROPERTY OWNER INFORMATION I For Insurance Company Use: BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX N0. Company NAIC Number sT LttyOA A CITY304- EASTATE ZIP CODE FO12T COL(-7/VS GO RDS74 W ERTY DFOCRIPTION Lot and Slick Numbers, Tax Parcel Number, Le al Descn lion, etc. 13�grN AT r SOH 4•19 N 1 9•e7•V /Bod•+ Ar •S3 9 Fp ) S'2.Oe'--+ o z•r;r !c/ A R9 ac £2?Ce TRsM ✓c /s lo•1�412-7-tf+/'�ee•53•E �32 d'—+pd9°e7, BUILDING USE (e.g., Residential, Non residential: Addition, Accessory, etc. use a Comments area, if necessary.) _ RF—stDI=.'.VT/A/ 0rl,tnA1 rBfIAIQ.±r_o. any% a0(a 14-101, LATITUDEILONGITUOE (OPTIONAL) HORIZONTAL DATUM: SOURCE: 1-1 UPS (Type):_ _ or #k.k#✓#°) )_� NAD 1927 1_1 NAD 1983 1_1 USGS Quad Map 1_1 Other:_ _ SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION a1. N COMMUNITY NAME a COMMUNITY NUMBER B2. COUNTY NAME B3. STATE G IYY OP )oje-r COLLtMS OB61OZ LAR)MF2 r'O o 64. MAP AND PANEL B5. SUFFIX i l : FIRM INDEX 10 FIRM PANEL 88. FLOOD 89. BASE FLOOD ELEVATIONS) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding) 080102 OAbd C Meo_ /a 1441 A, w I A = A A A_ -1 810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in 139. I-_1 FIS Profile 1X1 FIRM 1__1 Community Determined 11 Other (Describe): ______________ B11. Indicate the elevation datum used for the BFE in B9: X1 NGVD 1929 -- 1 11 NAVD 1988 1__1 Other (Describe): ______ _ ____ 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1_1 Yes 12<1 No Designation Date:______________________ _ SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: 1__1Construction Drawings- 1__1Building Under Construction' 1XFinished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number-_!.__ (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 Al-A30, AE, AH, A (with BFE), VE, VI-V30, V (with BFE), AR, AR/A, AR/AE, AR/Al-A30, AR/AH, AR/AO Complete Items C3.a-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 _S1 CVV19Z9 Conversion/Comments Elevation reference mark used_�QOj� _J qg Does the elevation reference mark used appear on the F F, fW2 1, Yes 1X1 No a) Top of bottom floor (including basement or enclosure)ORrctA*z. _4_Y_4G ___ . 2_ v P . ❑ b) Top of next higher floor 400rttoU_gZ 4L . _� ° ¢°' �r•- O c) Bottom of lowest horizontal structural member (V zones only) JJ__A____ . ___ ft,(m) ?.��G19T� ❑ d) Attached garage (top of slab) ____ A),_A___ ___ ft.(m) E a U ❑ e) Lowest elevation of machinery and/or equipmentiy028 servicing the building (Describe in a Comments area.) 4',1_¢!��i_ ft.(m) E a 2 /03 ❑ f) Lowest adjacent (finished) grade (LAG) _ 4 ¢�. 7_ ft,(m) z 21 ? �A 5 f F O Highest adjacent finished &tea 9) 9 1 (finished) grade (HAG) ft.(m) •-'� a ❑ fi) No. of permanent openings (flood vents) within 1 ft. above adjacent grade O i) Total area of all permanent openings (flood vents) in C3.h O s q. in. (sq. cm) ---I wn v - aVKVETUK, 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, 8, 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. FFKAA Fnrm R7-.41 it It on RFF RFVFR.CF RIDF Fr1R r:r1NTINI IATIr1N RFPI ARFC AI 1 P F,inni I.0 Fr11T r1NR �„Itr�.�., aGG�� s/zs�� IMPORTANT: In these spaces, copy the corresponding information from Section A. I For Insurance Comnanv Use: and/or ZIP CODE SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenticompany, and (3) building owner. COMMENTS $ M g 40 E Ey.- 4'939n 3 ME C F/Au/ aAg, IS FVA2.(/ r- WATE Z NEAMSe In ci'e• i.S IA +40et C 3-at i5 Orre/nal d 12-J a„d C 3-b ii AI 1 Check here if attachments SECTION E - BUILDING_ ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFEI For Zone AO and Zone A (without BFE), complete Items El. through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. Building Diagram Number ----- (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.) E2. The top of the bottom floor (including basement or enclosure) of the building is 1__1__1 IL(m) 1__1__lin.(cm) 1__1 above or 1__1 below (check one) the highest adjacent grade. (Use natural grade, if available.) E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is (__1__1 ft.(m) 1__1__lin.(cm) above the highest adjacent grade. Complete Items C3.h and C3.i on front of form. E4. For 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? 1__I Yes 1__1 No I__1 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. C (Items C3.h and C3.i only), 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, C, and E are correct to the best of my knowledge. PROPERTY OWNER S OR OWNERS AUTHORIZED REPRESENTATIVES NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE I 1 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. G1. 1__1 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 and date of the elevation data in the Comments area below.) G2. )) 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 (34-139) is provided for community floodplain management purposes. 2- ISSUED G7. This permit has been issued for: 131New Construction 1__1 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: _"��,�(.,�. _ ft.(m)Datum:OC\i G9. BFE or (in Zone AO) depth of flooding at the building site is: _ `f y_4 . _]_ ft.(m) Datum: jJ LOCAL OFFICIAL'S NAME 11 \u,r� TITLE Tt1�W�C2S—: IASDVI �lomc9P�rr-a.� �c�.Uvnv1`lC�-fo�-or COMMUNITY NAME TELEPHONE G�-q r , I 1 " A 1t 9-70 Ui.N C L_Vtn-a�d__� '_?A, , �— d 1­. �7- `-i ,-Q_ AA--� c Li�L�c x Acy IZ-(o© �.G I use Q zuwvt� alas issued -fir-. Qr,5\r\a4 Lk4ase Loos oci-,9 4 V 1 1 Check here if attachments FFNAA Fnrrn Al-11 .11II nn RFPI Af:FC Al I PRF/Irll I.0 F:nITION.0 -K f ATTACHMENT Legal Description Of Properly: Beginning at a point on the North line of Lincoln Avenue which bears N8900710011W 1808.00 feet and again N00°53'00"E 70.00 feet from the East 1/4 corner of Section 12, Township 7 North, Range 69 West of the 6th P.M., City of Fort Collins, County of Latimer, State of Colorado and runs thence N00053'00"E 151.80 feet; thence N89°07'00"W 52.00 feet; thence S00053'00"W 151.80 feet to a point on the North line of Lincoln Avenue; thence S89°07'00"E 52.00 feet to the point of beginning. SECIIONI2769 Li"cMwe a[hmt&c