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Home My WebLink AboutE-ELEVATION CERTIFICATE - 1281 EAST MAGNOLIA STREET - POUDRE RIVER (3),-� t1#' - ##.##"' or FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE hnnortant: Read the instructions on oaaes 1 - 7. 1_1NAD and/or Bldg. N^ �—1 NAD 1983 O.M.B. No.3067-0077 Expires July 31, 2002 uncy nuu wer L-1 USGS Quad Map 1_1 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 ELEVATION(S) NUMBER DATE I EFFECTIVE/REVISED DATE ZONES) (Zone AO, use depth of flooding) 66010Z 000 C Ma i %, M c /a. 111L X 500 510. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. )_) FIS Profile )__I FIRM (__( Community Determined (.j4( Other (Describe): f_61Me -F 1311. Indicate the elevation datum used for the BFE in B9: 1__1 NGVD 1929 ]__1 NAVD 1988 1__1 Other (Describe): ________......... B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? I—J Yes 1Xj No Designation Date:____________________ SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) -C1. Building elevations are based on: 1--Construction Drawings* 1__lBuilding Under Construction* IXIFinished Construction *A new Elevation Certificate will be required when construction of the building is complete. .,C2. Building Diagram Number_1— (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. lithe 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,Ll & V Q__ Conversion/Comments Elevation reference mark used`__(_ 4 0Z Does the elevation reference mark used app Q a) Top of bottom floor (including basement or enclosure) _-qur-____ .6-3— ft.(m) ❑ b) Top of next higher floor __J)-. A ___ . ___ ft.(m) O c) Bottom of lowest horizontal structural member (V zones only) �SLA- • —_ ft.(m) o 0 ❑ d) Attached garage (top of slab) ❑ e) Lowest elevation of machinery and/or equipment w servicing the building (Describe in a Comments area.) ft.(m) E A ❑ f) Lowest adjacent (finished) grade (LAG) ft.(m) z m O g) Highest adjacent (finished) grade (HAG) '4-��(�. _Q ft.(m) mN ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade... CI i) Total area of all permanent openings (flood vents) in C3.h _&_ sq. in. (sq. cm) ear on the F((iM?^•).�Yes 1__1 No 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 certifyelevation information. I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the date available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. FFMA Fnrm R1-11 .II n on CFF RF\/FRCF .oinP FOR r.ONTINI IATION RFPI Ar:FC Al I PRF\/Ifni I.0 FIIITInNC �,urOJI lk�47? IMPORTANT: In these spaces, copy the corresponding information from Section A. I For Insurance Company Use: and/or 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. wmm�ry i a f-rE 14A1> L0MP2 FILL. 41!/0T BA k RIZ CLEV - 4939n-3 IYVAC Tr oAl i LIS Poor A-1 ELemrlOJ 475-18 TAC WA7,9& Eft=ATE,_ /1iL1 f3 T,VJ'TALLE.D By TE,VAAITFiAwH A-r,9LEy. 4,1360 I__I Check here if attachments 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 E1. 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 I —I --I ft•(rn) 1—I—lin.(cm) 1-1 above or I__l 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_-1 ft.(m)1__1__1in.(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__I No 1__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 best of my knowledge PROPERTY OWNER'S OR OWNER'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__I 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. 1-1 A community official completed Section E for abuilding located in Zone A (without a FEMA-issued or community -issued BFE) or Zone AO. G3. J�gThe following information (Items G4-G9) is provided for community floodplain management purposes. ISSUED G7. This permit has been issued for: >4 New Construction __1 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: .... q.I36�__ 103 ft.(m) Datum: _—j-0 U0__ G9. BFE or (in Zone AO) depth of flooding at the building site is: __ n.331__ . SQ ft.(m)Datum: __j�%��__ DIUIVAIUKC U11hiAt,e.,_ 41n,..� ��,.:�.,.� ---- 1--93_,rI2 i FFMA Fnrm Al-511 .11II nn RFPI AC.PS Al I PRF\/I011S