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Home My WebLink AboutE-ELEVATION CERTIFICATE - 1275 EAST MAGNOLIA STREET - POUDRE RIVER (3)FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE O.M.B. No. 3067-0077 Expires July 31, 2002 Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number G...Vnnflcnry BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. I Company NAIC. Number ( ##°-##'-##.##"'or ##.#R###°) 1_1 NAD 1927 �-j NAD 1983 L—i USGS Quad Map )—i Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD LEVATION(S) NUMBER I DATE I EFFECTIVEIREVISED DATE I ZONES) (Zone AO, use depth of flooding) 0801407 04 Cmmej M A cy X 500 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. ]__I FIS Profile 1__1 FIRM __1 Community Determined jX-j Other (Describe):—L.0M8._F_ltr1..-413 nZ__ B11. Indicate the elevation datum used for the BFE in B9:1.K1 NGVD 1929 1__I NAVD 1988 1_1 Other (Desc(be): ________________ B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? I—J Yes KI No Designation Date: _-___-___�_________ SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: 1__lConslruction Drawings' 1__IBuilding Under Construction' 1XIFinished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number__J-_ (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, V1-V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-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 Jir V o Conversion/Comments Elevation reference mark used_,Jj` ¢QZ______ Does the elevation reference mark used al; ❑ a) Top of bottom floor (including basement or enclosure) __4J3y____ .Q_ ft.(m) ❑ b) Top of next higher floor .V. O c) Bottom of lowest horizontal structural member (V zones only) ---- • __ ft.(m) a 0 d) Attached garage (top of slab) ___A A__ . ft.(m) a O e) Lowest elevation of machinery and/or equipment m servicing the building (Describe in a Comments area.) -0_ ft.(m) E p f) Lowest adjacent (finished) grade (LAG) ___ 4-4-a-_ . -0 ft.(m) 2 ❑ g) Highest adjacent (finished) grade (HAG) �Jy O h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade-- 0 ❑ i) Total area of all permanent openings (flood vents) in C3.h _-Q_ sq. in. (sq. cm) 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 FFMA Fnrm R'1-.'1'1 .II II nn RFr RF\/FRRF RIf1F Fr1R r:r1NTINI IATION RFPI ACFR Al 1 PRF\/I(li LR FfJjTln NR D-i IMPORTANT: In these spaces, copy the corresponding information from Section A. ror Insurance company use: BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number - T CITY STATE ZIP CODE Company NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. UUMMI=N I f tT6 HAA L( Mk F/1-L 4-LIzooz 3.M. 2-4.0Z E1_Ey.=4939.03 /4VAC 3' r O.tl 7-i1E eooP AT THeWAT6e. NEATEe ILifLI, B6�USTALLE� 83 , TE.vAUT FsA/IStI AT E4-C—V. 493G.12 SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) 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-v (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__I--I ft.(m) I—I--Iin.(cm) I__j above or I_I 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 I—I__I ft.(m) I--I__Iin.(cm) above the highest adjacent grade. Complete Items C3.h and C3.1 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? I Yes I I No I I 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 beRf PROPEY mWWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE I__I 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. I__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 and date of the elevation data in the Comments area below.) G2. I__I 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. N The following information (Items G4-Gg) is provided for community floodplain management purposes. G7. This permit has been issued for: ]'New Construction I__I Substantial Improvement p G8. Elevation of as -built lowest floor (including basement) of the building is: __ L7L6_ • 0_ ft.(m) Datum: ------ _--__ G9. BFE or (in Zone AO) depth of flooding at the building site is: _,..� . S2_ ft.(m)Datum: _&LGy D //tl��(S>>��::�fr/1%i.17�tiUl�1 i.Tlll�t[�[sv1)AIL�A'i>•:rr�ur...r�r■4,a-i�� COMMUNITY NAME TELEPHONE r i ray � o O'I'll� II.1I�Ii1<�D�LT t .II n nn t/yI /q5 t/y/) ew- RFPI ACFF AT 1 PRF\/InI IR FnITIr)NR