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Home My WebLink AboutE-ELEVATION CERTIFICATE - 432 12TH STREET - POUDRE RIVER (3)FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION B43 2 STREET I Z 4-A ADDR C+SS (IncWdin Apl., Unit, Suite. and/or Bldg. No.) OR P.O. ROUTE AND BO% NO. ve. - yr IT uc O`-FnY I IUN (Lot and BUILDING USE (e.y., Raeidenual, No NoA1- IFvD )r/ LATITUDEILONGITUOE (OPTIONAL; 1 04' - trip - "#.Y.N'f. • or pM11 31, NFIP COMMUNITY NAME 3 CON Glw of Foci etu B4.MAP AND PANEL BS.SUF NUMBER 0R1)t a2 f)mcl C Accessary, etc. Uan a Canments area, —t NAD 1927 1-1 NAD 1983 SOURCE: 1_1 CPS (Type): — I —I USGS Quad Map SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION O.M.B. No.30fi7-0077 Expires December 31, 2005 roolnsurance Company Use:;. Policy Number ,Pi. , Company NAIC Number.::+r.: Other _. (Zane AO, use depth of nodding) B f 0. Indicate the source of the Base Flood Elevation (BFE) data or base Rood depth entered in B9. 4 1_1 PIS Profile 1X1 FIRM Li Community Determined Bi 1. Indicate the elevation datum used for the BFE in 69: LX.1 NGVD 1929 1-1 1-1 Other (1988 1-1 Other (Describe): e): 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otthherwise Protected Area (OPA)? Designation Date: "` oa. I-LUUi GATE EFFECTNE/REVISED DATE ZONE(S) 1—I Yes I -XI No SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) CI Budding elevations are based on:. L1Construction Drawings' I_1Building Under Construction' 'A new Elevation Certificate will be required when construction of the building is complete. IZilFinished Construction 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, V1430, V (with BFE), AR, ARIA, ARIAE. 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 O or Section G. as appropriate, to document the datum conversion. DatumA/GVD 29 COnverslonlComments _ IV 1) re Elevation reference mark use0_l G Cn 7 Does the elevation reference mart used appear on the FIRM? ��C1 No ❑ a) Top of bottom Root (including basement or enclosure) ¢ q'; ¢ 1_1 Yes ❑ b) Top of next higher floor ' iz R.(m) " ❑ c) Bottom of lowest horizontal structural member (V zones only)At. a CI d) Attached garage (top of slab) /-•..,, ❑ e) Lowest elevation of machinery and/or equipment )VIA. — IL(m) W 5 Uf servicing the building (Degrade in a Comments area.) L R8 3 r ❑ Lowest adjacent (finished) grade (LAG) .(m) Ix! Y 49 s 1 9 E * It 9 G/zo R 43 ❑ g) Highest adjacent (finished) grade (HAG) 4'7 R. m z . ,c ❑ h) No. of permanent openings (Rood vents) within 1 above adjacent grade �_ It. ❑ i) Total area of all permanent openings (Rood vents) in C3.h Q sq. (� 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 ceetificate represents my bet efforts to interpret the data available. understands 1that any false statement may be punishable by fin. ��;......:......___. _ FENIA Farm 61-31, January !UU3 See reverse side for continuation. RepIdCP•—..11 Or —onus a 11, IMPORTANT: In these spaces, copy the corresponding information from Section A For Insurance Company Use: BL, DING STRE T ADDRESS (Including Apt., Unit, Suite, andor Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number 3Z TTtuec. FT ST. CITY STATE - ZIP CODE Company NAIC Number . FORT Lty CO 805 '` SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenVcompany, and (3) building owner. VV � rHE LyATBif'_ HEArea Is AT El-ev. 4938 LS, TN FucivAC E AATh THE AIP GOAJDITdb.Uez Are AN TlNB 12deP ,A:r E7Ey 4.949 13 THE B6AJCN MAEk IS Ali S IP-4Q1F�Fy4T7r7A1= 4-939.0.3 1_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 Et. through E5. 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 Moor (including basement or enclosure) of the building is 1-1_1 R. (m) 1__L1 in. (cm) L-1 above or L1 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 Moor or elevated floor (elevation b) of the building is 1-1_1 R. (m) 1-1—tin. (cm) above the highest adjacent grade. Complete Items C3.h and C3.i on front of form. E4. The top of the platform of machinery and/or equipment servicing the building is 1-1-1 ft. (m) 1-1-1 in. (cm) 1-1 above or 1-1 below (check one) the highest adjacent grade. (Use natural grade, if available.) E5. 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 floodvinin management ordinanrel 1 1 Yes 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, 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 COMMENTS 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. 11 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. L1 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 G4-Gg) is provided for community floodplain management purposes. G7. This permit has been issued for. 12�(New Construction 1-1 Subst G8. Elevation of as -built lowest floor (including basement) of the building is: Gg. BFE or (in Zone AO) depth of flooding at the building site is: . G6. DATE CERTIF ISSUED S 4g34 R. (m) Datum: N(A ie \C4r` ft. (m) Datum: wut•J D l 1171 /Skye fl�ItMei- K06i c.40�M ...__ F(peckdlai.r� p�0.wtirLutra�or COMMUNITY NAME /I •� e l- YDf+ tolll�S ColotQQO TELEPHONE ��ll t 9-70- IeT 02 COMMENTS I j Check here H attachments FEMA Form 81.31. January 2003 Replaces all previous drlions vM1w",o,, ctks if3/^y