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HomeMy WebLinkAboutE-ELEVATION CERTIFICATE - 920 EAST MULBERRY STREET - POUDRE RIVER (19)FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE O.M.B. No. 3067-0077 Expires July 31, 2002 Pe r rw, A- -,If 10 ago SECTION A - PROPERTY OWNER INFORMATION I For Insurance Company Use: I olicy Number: BUILDINb STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. I Company NAIC'Number I G.Ze) 1= %AA ..1 In vvr -V i a <T L1 NAD 1927 1-1 NAD 1983 STATE SOURCE: LI GPS (Type): LI USGS Quad Map 1_1 Other: SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION M ELEVATIU NUMBERANEL I B5. SUFFIX I B6. FDATE DEX B7. FIRM PANEL B8.I EFFECTIVEIREV SED DATE I ZONE(S)D I (Zone AD, u Bg. BASE eOdepth of flood ng)) 310. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. lJ FIS Profile JK J FIRM lJ Community Determined iJ Other (Describe): 311. Indicate the elevation datum used for the BFE in 89: Q41 NGVD 1929 1J NAVD 1988 1J Other (Describe): 312. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? L_i Yes LJ No Designation Date: SECTION C - BUILDING ;1. Building elevations are based on: [_[Construction Drawings* lJBuilding Under Construction* [[Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. ,2. Building Diagram Number 3 (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.) :3. 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 C3a-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 sj)ace provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum ✓t7 ).q Conversion/Comments Elevation reference mark used 30-R 7- Does the elevation reference mark used ap ❑ a) Top of bottom floor (including basement or enclosure) IK36 .9—ft.(m) ❑ b) Top of next higher floor 19434 ❑ c) Bottom of lowest horizontal structural member (V zones only) �N ft.(m) ❑ d) Attached garage (top of slab) E ❑ e) Lowest elevation of machinery and/or equipment w servicing the building 1/93�1 . ft.(m) E ❑ f) Lowest adjacent grade (LAG) w 936 . S IL(m) 2 ❑ g) Highest adjacent grade (HAG) y93$ . 7- fL(m) ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade K ❑ i) Total area of all permanent openings (flood vents) in C3h 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. 1 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 Dunishable by fine or imprisonment under 18 U.S. Code. Section 1001. 2S�t! "` Poem"C/P/+L- E.NG/NEE/2 VV r�1 " %`1©�% (strllE2Y /,.//rTSd'J ADDRESSY//O/ 17� -Sr, <i4lre 60D CITY 7iEiVVE2 STATE co ZIP CODE PU202 303-382-5-000 EMA Form 81-31. AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In these spaces, copy the corresponding information from Section A. I For Insurance Company Use: I i ron4y: INUFT10C1_ ) S TE ZIP CODE Company NAIC Number T� 1 IXA c- �i� CZAoi a SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agentloompany, and (3) building owner. 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 E3. 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 L L l Mai) LLlin.(cm) 1_I above or LI below (check one) the highest adjacent grade. E3. 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? 1-1 Yes 1-1 No 1-1 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, and E for Zone A (without a FEMA-issued or community -issued BFE) or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE 1-1 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. 1_1 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. IXI The following information (Items G4-G9) is provided for community floodplain management purposes. ISSUED G7. This permit has been issued for: New Construction I I Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: 4 4 3 6 °L ft.(m) Datum: k)6 V.D 19c29 G9. BFE or (in Zone AO) depth of flooding at the building site is: ` 173 5- . _a, ft.(m) Datum: NIGV b 19DO r' r/IlE�://;!/Irl�!���'��hl�_a^i.��IQca�a • Check here if attachments FEMA Form 81-31, AUG 99 REPLACES ALL PREVIOUS EDITIONS STORMWATER RECEIVED - O.M.B. NO. 3067.0077 ELEVATION CERTIFICATE Expires May 31,1996 FEB 14 1996 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM TTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to provide elevation information necessary to ensure compliance with applicable community flcodplain management ordinances, to determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR). Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION I FOR INSURANCE COMPANY USE I (Including Al�., Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER 1 I COMPANY NAIC NUMBER OTHER DESCRIPTION (Lot end Block Numbers, etc.) - (,vw v-P ) CI SATE ZIP CODE o Zr Cal l Ll S © SO ! SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM (See Instructions): 1. COMMUNITY NUMBER 2. PANEL NUMBER 3. SUFFIX 4. DATE OF FIRM INDEX 5. FIRM ZONE 6. BASE ROOD ELEVATION �ob0 0-u (i 0 0 L a"b, 15 1 VnV16 (in AO zones, use depth) 9g3b-r 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): 2NGVD'29 ❑ Other (describe on back) 8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate the community's BFE:1 14613141.tsj feet NGVD (or other FIRM datum -see Section 8, Item 7). SECTION C BUILDING ELEVATION INFORMATION Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level _ . 2(a). FIRM Zones Al-A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation of 11 419141c) Ad feet NGVD (or other FIRM datum -see Section B, Item 7). (b). FIRM Zones Vt-V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from The selected diagram, is at an elevation oil 1 1 1 1 1.LJ feet NGVD (or other FIRM datum -see Section B, Item 7). (c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is L1J.L1 feet above ❑ or below ❑ (check one) the highest grade adjacent to the building. (d). FIRM Zone AO. The floor used as the reference level from the selected diagram is L.LJ .LJ feet above ❑ or below ❑ (check one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference level) elevated in accordance with the community's floodpiain management ordinance? ❑ Yes ❑ No ❑ Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations: C� NGVD '29 ❑ Other (describe under Comments on Page 2). (NOTE: if the elevation datum used in measuring the elevations is different than that used on the FIRM (see Section B, Item 77, then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) 4. Elevation reference mark used appears on FIRM: ❑ Yes ® No (See Instructions on Page 4) 5. The reference level elevation is based on: U actual construction ❑ construction drawings (NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which case this certificate will only be valid for the building during the course of construction. A post -construction Elevation Certificate will be required once construction is complete.) 6. The elevation of the lowest grade immediately adjacent to the building is:1 16 .0 feet NGVD (or other FIRM datum -see Section B, Item 7). SECTION D COMMUNITY INFORMATION If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1 is not the "lowest floor" as defined in the community's flocdplain management ordinance, the elevation of the building's "lowest floor" as defined by the ordinance is: I I I I I . LJ feet NGVD (or other FIRM datum -see Section B, Item 7). 2. Date of the start of construction or substantial improvement gJ6t'7 FEMA Form 81.31, MAY 93 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION SECTION E CERTIFICATION This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation A& Information when the elevation information for Zones At-A30, AE, AH, A (with 8FE),V1 V30,VE, and V (with BFE) is required. Xf Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the certification. In the case of Zones AO and A (without a FEMA or community issued BFE), a building official, a property owner, or an owner's representative may also sign the certification. Reference level diagrams 6, 7 and 8 - Distinguishing Features -If the certifier is unable to certify to breakaway/non-breakaway wall, enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not included in the certification under Comments below. The diagram number, Section C, Item 1, must still be entered. 1 Certify that the information in Sections 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. C.'� -2,8 S 1 CERTIFIERS NAME �,E COMPANY NAME' /0065 E. 4 2,o( ADORFSS CITY STATE ZIP /5-H6 3v3-69S-'fO30 DATE PHONE Copies should be made of this Certificate for., 1) community official, 2) insurance agent/company, and 3) building owner. COMMENTS: ON SLAB A v ZONES ZONES WITH 13ASEMEW ON Pass, PIERS, OR COLUMNS A The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones. Elevations for all A Zones should be measured at the top of the reference level floor. Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member. Page 2 ELEVATION CERTIFICATE O.M.B.May3l, Expires o306 1993 r993 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR). Instructions for completing this form can be found on the following pages. SECTION PROPERTY INFORMATION FOR INSURANCE COMPANY USE BUILDING OWNER'S NAME POLICY NUMBER 9 R ADDRESS (Including Apt, Unit, Suite andior Bldg,Number) OR P.O. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER OTHER DESCRIPTIOW(Lot and Block Numbers. etc.) STATE ZIP CODE CITYF4- cb l (;ne (41) 696sa SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM (See Instructions): 1. COMMUNITY NUMBER 2. PANEL NUMBER 3. SUFFIX 4. DATE OF FIRM INDEX S. FIRM ZONE 6. BASE FLOOD ELEVATION 090101 I O 1 ! ( C 1 l j8l 8 (0 A (in AO Zones, use depth) e1 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): y&GVD '29 ❑ Other (describe an back) 8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate the community's BFE: I I'll 31 , LD I feet NGVD (or other FIRM datum —see Section S, Item 7). SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best describes the subject building's reference level _ . 2(a). FIRM Zones A1430, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation oil I I I I .LJ feet NGVD (or other FIRM datum —see Section B, Item 7). (b). FIRM Zones V1430, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from the selected diagram, is Stan elevation of! 1 1 1 1 U feet NGVD (or other FIRM datum —see Section 8, Item 7). (c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is L_L_j . II feet above ❑ or below ❑ (check one) the highest grade adjacent to the building. (d). FIRM Zone AO. The floor used as the reference level from the Selected diagram is .LJ feet above ❑ or below ❑ (check one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations NGVD '29 ❑Other (describe under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than that used on the FIRM (see Section B, Item 77, then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) 4. Elevation reference mark used appears on FIRM: 0 Yes ❑ No (See Instructions on Page 4) 5. The reference level elevation is based on:A actual construction El construction drawings (NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which case this certificate will only be valid for the building during the course of construction. A post -construction Elevation Certificate will be required once construction is complete.) 6. The elevation of the lowest grade immediately adjacent to the building is: I i I I, LJ feet NGVD (or other FIRM datum -see Section B, Item 7). SECTION D COMMUNITY INFORMATION 1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1 is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest floor" as defined by the ordinance is: 1 1 ' 1 1 LJ feet NGVD (or other FIRM datum —see Section B, Item 7). 2. Date of the start of construction or substantial improvement FEMA Form 81.31t MAY 90 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION SECTION E CERTIFICATION This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation information when the elevation information for Zones At—A30, AE, AH, A (with BFE),V1—V30,VE, and V (with 8FE) is required. Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the certification. In the case of Zones AO and A (without a FEMA or community issued BFE), a building official, a property owner, or an owner's representative may also sign the certification. Reference level diagrams 6, 7 and 8 - Distinguishing Features —If the certifier is unable to certify to breakaway/non-breakaway wall, enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not included in the certification under Comments below. The diagram number, Section C, Item 1, must still be entered. I certify that the information in Sections 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. Robert Smith CERTIFIER'S NAME LICENSE NUMBER (or Affix Sea) _ Stormwater Utility Manager City of Fort Collins Stormwater Utility TITLE COMPANY NAME ADDRESS cm Collins DATE PHONE STATE ZIP Copies should be made of this Certificate for:1) community official, 2) Insurance agent/company, and 3) building owner. COMMENTS: This is a transfer of elevation certificate information to the FEMA form in accordance with 1990 CRS authorization. ON - - WITH ON PILES, SLAB BASEMENT PIERS, OR COLUMNS A v A A v ZONES ZONES ZONES ZONES ZONES PEFEPENCE USE LEVEL REFERENCE LEVEL PEE FENCE ELEVATION m USE 'I .•... _:. ;,' REFERENCE FL000AOJACENT:i;.•yL: OWE k LEVEL ELEVATION REFERENCE USE 11000 ELEVATON AOJACEIR LEVELGMOE:: �� The diagrams above illustrate the points at which.the elevations should be measured in A Zones and V Zones. Elevations for all A Zones should be measured at the top of the reference level floor. Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member. Page 2