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HomeMy WebLinkAboutE-ELEVATION CERTIFICATE - 321 SOUTH WHITCOMB STREET - OLD TOWN (22)U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 National flood Insurance Program Important: Read the instructions on pages 1-9. Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name JOHN G. AND TAYLOR S. MORRIS Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No, Company NAIC Number: 321 S. WHITCOMB STREET City FORT COLLINS State CO ZIP Code 80521 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 12, LESS WEST 1 OFT., BLOCK 268, LOOMIS ADDITION A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) DETACHED GARAGE A5. Latitude/Longitude: Lat. N40 34 57.8 Long. W105 05 09.1 Horizontal Datum: ❑ NAD 1927 ® NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. AT Building Diagram Number 1A A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) N/A sq fit a) Square footage of attached garage NIA sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade NIA within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b NIA sq in d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes IR No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name 8 Community Number B2. County Name B3. State CITY OF FORT COLLINS 080102 LARIMER COLORADO B4. Map/Panel Number 85. Suffix Be FIRM Index Date B7. FIRM Panel B8. Flood 89. Base Flood Elevations) (Zone 08069C 0979 H 2-6-2013 Effective/Revised Date Zone(s) A0, use base flood depth) 5-2-2012/7-15-2003 X/100 YEAR 5003.78 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile ❑ FIRM ❑ Community Determined ® Other/Source: OLD TOWN BASIN MASTER PLAN B11. Indicate elevation datum used for BFE in Item B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date: _ ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' ® Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations -Zones Al-A30, AE, AH, A (with BFE), VE, VI-V30, V (with BFE), AR, ARIA, AR/AE, AR/Al-A30, ARIAH, AR/AO. Complete Items C2.a-h below according to the building diagram specified in Item AT In Puerto Rico only, enter meters. Benchmark Utilized: FT. COLLINS BM 1-11 Vertical Datum: NGVD 1929 UNADJUSTED Indicate elevation datum used for the elevations in items a) through h) below. ® NGVD 1929 ❑ NAVE) 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) I) Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support Check the measurement used. 5004.37 ® feet ❑ meters NIA._ ❑ feet ❑ meters NIA.- ❑ feet ❑ meters hm.- ❑ feet ❑ meters N/A._ ❑ feet ❑ meters ¢003.7 ® feet ❑ meters 5004.3 ® feet ❑ meters NIA._ ❑ feet ❑ meters 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 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. 9,N? 0 L /� ® Check here if comments are provided on back of form. Were latitude and longitude In Section A provided by a p...... ❑ Check here if attachments. licensed land surveyor? ® Yes ❑ No Certifier's Name STEVEN PARKS License Number 38348 �eiSto Title PROJECT MANAGER Company Name KING SURVEYORS, INC. Address 650 E. GARDEN DRIVE City WINDSOR State CO ZIP Code 80550 Signature ��- Date 4-18.2013 Telephone 970-686-5011 FEMA Form 086-0-33 (7/12) See reverse side for continuation. Replaces all previous editions. IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No, Policy Number: 321 S. WHITCOMB STREET City FORT COLLINS State CO ZIP Code 80521 Company NAIC Number 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 Entire property at 321 S. Whitcomb Stis within the 100-yr City Designated Old Town Basin Floodplain and must comply with floodplain requirements of Chapter 10, City Code. Refer Floodplain Use Permit*11153. mo O%IA sfST Lt Foe 1-0 is Bwuo,+ 4 815s141,+Ae'L 8µ )-I( LUYAVVA)z 5CP50-. A)44D Z9 Signature �� .Date it �q. Zo )3 SECTION E - BUILD NG ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items El-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is _ _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is _._ ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is _ _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is _ _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is —_ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. 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? ❑ Yes ❑ No ❑ 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. The statements in Sections A, B, 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 Comments ❑ 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 C of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8-G10. In Puerto Rico only, enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by 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. 0 The following information (Items G4—G10) is provided for community floodplain management purposes. G4. Pe 4 Number F&O ++11153 G5. Date Permit ssue la t1 2o1Z G6. Date Cert' to Cam Iiance/Occupancy Issued 19 aa1 G7. This permit has been issued for. r New Construction ❑ Substantial Improvement Ga. Elevation of as -built lowest floor (including basement) of the building: 5404.'b-I 0 feet ❑ meters Datum r16VD t'tZ-J G9. BFE or (in Zone AO) depth of flooding at the building site: L. -tB ■ feet ❑ meters Datum N&VD 1gL11 G10. Community's design flood elevation: 5»� 7% 0 feet ❑ meters Datum r.)�VD 14WIT Local Official's Name ,,ryry 11 Title nv1y� G, saM�lry SIB+ r..,�r w.9. r 1..�.1a� frn4rmrm Mr�n,, Community Name C ��, UWu 6 Telephone — Signature C_ S Date n ,� Comments •*6nK 0c-rNi '1C4, 1 a-0-\0 *\I q*� Ce, sbr,.cc �w o gaK�E, `pt 45F� � "'j. \e.n.T cov C- t �ti Ca, Y' Ck1aO�inr � 0 'C C- LI& fl Check here if attachments. C�Wkirrl9 �rl -rh G.s �-Z�<�l fi FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6. IMPORTANT: In these spaces, copy the information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 321 S. WHITCOMB STREET City FORT COLLINS State CO ZIP Code 80521 Company NAIC Number: If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item AS. Identify all photographs with date taken; "Front VIe%W' and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section AS. If submitting more photographs than will fit on this page, use the Continuation Page. LOOKING NORTH FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page Building Photographs Continuation Page IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 321 S. WHITCOMB STREET City FORT COLLINS State CO ZIP Code 80521 Company NAIC Number: If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section AS. FEMA Form 086-0-33 (7/12) Replaces all previous editions U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 National Flood7nsarance Program Important: Read the instructions on pages 1-9. Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Buildina Owner's Name JOHN G. AND TAYLOR S. MORRIS I Policv Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. I Company NAIC Number: 321 S. WHITCOMB STREET A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 12, LESS WEST LOFT., BLOCK 268, LOOMIS ADDITION A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. N40 34 57.8 Long. W105 05 09.1 Horizontal Datum: ❑ NAD 1927 ® NAD 1983 AS. Attach at least 2 photographs of the building 9 the Certificate is being used to obtain flood insurance. AT Building Diagram Number 1A AS. For a building with a crawlspace or enclosure(s): AS, For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) N/A sq ft a) Square footage of attached garage N/A sq It b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade N/A within 1.0 foot above adjacent grade NIA c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes ® No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Bt. NFIP Community Name 8 Community Number B2. County Name 83. State CITY OF FORT COLLINS 080102 LARIMER COLORADO B4. Map/Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 08069CO979 H 2-6-2013 Effective/Revised Date Zone(s) AO, use base flood depth) 1 54Fgr 1 5-2-201217-15.2003 X/100 YEAR 5001.6+2=5003.6 BID. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile ❑ FIRM ❑ Community Determined ® Other/Source: OLD TOWN BASIN MASTERPLAN B11. Indicate elevation datum used for BFE in Item B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date: _ ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' I@ Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations -Zones At-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 C2.a-h below according to the building diagram specified in Item AT In Puerto Rico only, enter meters. Benchmark Utilized: FT. COLLINS BM 1-11 Vertical Datum: NGVD 1929 UNADJUSTED Indicate elevation datum used for the elevations in items a) through h) below. ® NGVO 1929 ❑ NAVD 1988 17 Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure Floor) b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 5005.25 ® feet ❑ meters N/A._ ❑ feet ❑ meters N/A._ ❑ feet ❑ meters NIA._ ❑ feet ❑ meters 5005.25 ® feet ❑ meters 5002.7 ® feet ❑ meters 5003.7 ® feet ❑ meters N/A._ ❑ feet ❑ meters 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 on this Certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. ® Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a Qlp� O L / XRO Check here if attachments. licensed land surveyor? ® Yes [INo �;•;;� Certifier's Name STEVEN PARKS License Number 38348 , Title PROJECT MANAGER Company Name KING SURVEYORS, INC. Address 650E. GARDEN_QWE City WINDSOR State CO ZIP Code 80550 Date 4-18.2013 Telephone 970-686-5011 s8348 FEMA Form 086-0-33 (7/12) See reverse side for continuation. Replaces all previous � ... ....,."ray.. IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 321 S. WHITCOMB STREET City FORT COLLINS State CO ZIP Code 80521 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. Comments Entire property at 321 S. Whitcomb Stis within the 100-yr City Designated Old Town Basin Floodplain and must comply with floodplain requirements of Chapter 10, City Code. Refer Floodplain Use Permit #11152. F,4A14GE GT p,"„ST)ED 1=LoeR.. 3b>GNuA2K Zino I - It E&VtrT1alu-Sao5Hy N6t4 z9 Date Z,//'•7013 SECTION E - BUILQXG ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items El-E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items E1-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. Et. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is —_ ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is _ _ ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is _ _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is _ _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. 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? []Yes ❑ No ❑ 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. The statements in Sections A, B, 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 Comments ❑ 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. Check the measurement used in Items G8-G10. In Puerto Rico only, enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by 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 434-G70) is provided for community floodplain management purposes. G4. Pannd Number G5. Date Permit Issued G6. Date Certcate f Compliance/Occupancy Issued u �111'SZ 10 11 2- g t9 Zo13 G7. This permit has been issued for: 0 New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: _ree2j.10 a feet ❑ meters Datum N4�D 1429 G9. BFE or (in Zone AO) depth of flooding at the building site: Oeo3. 1� 1, feet ❑ meters Datum JkaV D 192i G10. Community's design flood elevation: $rt03.1 2 feet ❑ meters ( Datum A%VD "Zy Local Official's Name K � : l C - S� M e1 Title �1 .1 rr aj f • 1 I 1 P(2 ply M i8,aa.Y Community Namec% •` r-t . S 1 Telephone tv 9wyaTV _ Z� it✓/a6,1.OdZ ��� Signature k P C Date I` 3 2 n Comments EN �S �-`A� VM5 k /YL. • r'C3' -n cC.1 b E�..v1 .i ctrvtitr� cow ' CG 0 L. ❑Check here B attachments. LA6 . 'i6w 'r 'C,, v '?- MCC. FEMA Form 086-0-33 (7112) 1 Replaces all previous editions. ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6. IMPORTANT: In these spaces, copy the information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. I Policy Number: 321 S. WHITCOMB STREET City FORT COLLINS State CO ZIP Code 80521 1 Company NAIC Number: I If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View" and 'Rear Vieth"; and, if required, 'Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. LOOKING NORTH FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 4 Building Photographs Continuation Page IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 321 S. WHITCOMB STREET City FORT COLLINS State CO ZIP Code 80521 Company NAIC Number: If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; 'Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. LOOKING EAST FEMA Form 086-0-33 (7112) Replaces all previous editions.