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Home My WebLink AboutE-ELEVATION CERTIFICATE - 412 WEST OLIVE STREET LOT 5 BLOCK 82 - OLD TOWN (3)U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency Management Agency Expires March 31, 2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION For Insurance Company Use: Al. Building Owner's Name Jacqueline Fields PolicysWu tber A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number 412 W. Olive Street City Fort Collins State CO ZIP Code 80521 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 5 of subdivision of Lot 1, Block 82, City of Fort Collins A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Addition A5. Latitude/Longitude: Lat. 40.58445 Long.-105.08333 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 1 B 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) 0 sq ft a) Square footage of attached garage 0 sq ft b) No. of permanent flood openings in the crawlspace or b) No. of permanent flood openings in the attached garage enclosure(s) within 1.0 foot above adjacent grade 0 within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b 0 sq in d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes ® No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name B3. State City of Fort Collins 080102 1 Larimer Colorado B4. Map/Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 08069C0979/Sheet 4 G Date Effective/Revised Date Zone(s) AO, use base flood depth) June 17, 2008 06/17/08 / 7/15/03 X/100-year 5000.2 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 (Describe) Old Town Master Plan B11 . Indicate elevation datum used for BFE in Item 139: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date n/a ❑ 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, V1-V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized FC ACBM 28-97 Vertical Datum ELEV. = 5005.58 1929 NGVD Conversion/Comments Benchmark AC BM #28-97 Elevation 5005.58 Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 5001.7 ® feet ❑ meters (Puerto Rico only) b) Top of the next higher floor n/a ❑ feet ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) n/a ❑ feet ❑ meters (Puerto Rico only) d) Attached garage (top of slab) n/a ❑ feet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building n/a ❑ feet ❑ meters (Puerto Rico only) (Describe type of equipment and location in Comments) 0 Lowest adjacent (finished) grade next to building (LAG) 5000.2 E feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade next to building (HAG) 5000.3 ® feet ❑ meters (Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs, including 5000.3 ® feet ❑ meters (Puerto Rico only) structural support 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 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 licensed land surveyor? ❑ Yes ® No Certifier's Name Dennis H. Koch License Number 23503 Title Licensed Surveyor Company Name Stewart & Associates, Inc. Address 102-Meldrum Street City Fort Collins State CO ZIP Code 80521 Signature , // / Date 12/06/11 Telephone (970) 482-9331 FEMA Form81-31. Mar 09 See reverse side for continuation. Replaces all previous editions r1 IMPORTANT: In these spaces, copy the corresponding information from Section A. gr.13Ct prartm 0 �aY.E35� Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. # oh y t i:.... .. 412 W. Olive Street City Fort Collins State CO ZIP Code 80521 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 'Benchmark used was City of Ft. Colins ACBM#28-97 Elevation = 5005.58 ft 1929 Datum. Sign a Date 12/06/11 ❑ Check here if attachments SECTION E - BUILDING 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 E1-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. E1 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 and G9. 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 G4-G9) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Is ued G6. Date Certificate Of Compliance/Occupancy Issued l O 9 O't O $�OZ/ZO I o G7. This permit has been issued for: ® New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: 00 .�_ M feet ❑ meters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site: r000 a feet ❑ meters (PR) Datum G10. Community's design flood elevation Sbay . - IN feet ❑ meters (PR) Datum Local Official's Name nn Title Community Name / Telephone D or. Cc'� S (o Z Z( Signature nDate n Comments -- `rs `f o arcCor' 4o rX o GO�✓Jf� G —r Wfvt 44- a s ��s .(v of FL/V&wv, G6e Q a� �o s aAr,-- air-6- u j-v-" G ❑ Check here if attachments FEMA Form 81-31, Mar 09 Replaces all previous editions