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Home My WebLink AboutE-ELEVATION CERTIFICATE - 1015 LAPORTE AVENUE - OLD TOWN (3)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 Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number:- 1015 Laporte Avenue City Fort Collins State CO ZIP Code 80521 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 6, Morger Smith Subdivision A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Garaoe A5. Latitude/Longitude: Lat. 40.58867 Long.-105.09483 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 It a) Square footage of attached garage 0 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 0 within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.1b 0 sq in c) Total net area of flood openings in A9.1b 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 Latimer CO B4. Map/Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) one 08069C/0978 G 2/06/2013 Effective/Revised Date Zone(s) AO, use base flood depth) 5/02/2012-7/15/2013 X/100-year 5018.3 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 Master Plan B 11. 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: 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, ARIA, AR/AE, AR/A1-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: Fort Collins ACBM 31-97 Vertical Datum: NGVD 1929 Indicate elevation datum used for the elevations in items a) through h) below. ® NGVD 1929 ❑ NAVD 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) f) Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) p h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support Check the measurement used. 5018.8 ® feet ❑ meters N/A. ❑ feet ❑ meters N/A. ❑ feet ❑ meters N/A. ❑ feet ❑ meters N/A. ❑ feet ❑ meters 5018.3 ® feet ❑ meters 5018.3 ® 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. - O�,p0 U ® Check here if comments are provided on back of forth. Were latitude and longitude in Section A provided by a ❑ Check here if attachments. licensed land surveyor? ❑ Yes ® No v '� O•'., Certifier's Name Dennis H. Koch License Number PLS 23503 Title Land Surveyor Company Name Stewart & Associates - •{t�,�'/�� I rA�� Address 204 . ink Lane, Unit A-8 City Fort Collins State CO ZIP Code 80524 • •• N ••••••••'•. SJ`� Signature /1 0 ,_ - .,(.,/ % / Date 3/7/2014 Telephone 970-482-9331 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: 1015 Laporte Avenue 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 City of Fort Collins ACBM 31-97 Elev.= 5020.48(NGVD 1929) Datum. This certificate pertains to a detached garage only. Signature lwm r/ Date 3/7/2014 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 El-E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items Ei-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 Owners 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 GS-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. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued 'l `I 3 . kk - 2.0 111) G7. This permit has been issued for: New Construction ❑ Substantial Improvement ..ff��``��'' G8. Elevation of as -built lowest floor (including basement) of the building: 50\1'a_ feet [I meters Datum rvar'7 G9. BFE or (in Zone AO) depth of flooding at the building site: Q0 g.feet ❑ meters Datum All �q G10. Community's design flood elevation: 501$. $ feet ❑ meters Datum a9 Local Officials Name - G Sa�tp�wt Title C.l_ A 1 1 f1 ��F�I1 Cr (1MV O rba il>n Community Name �o A1t�1 Telephone r o. Signature - Date 3� _ -.-rGS- r r\Ew CrA Comments S tX uc. rim' tQ AU-a'r 4�fc 4N wi t ❑ Check here if attachments. 17 -tN C.�wD��6Uce. FEMA Form 086-0-33 (7/12) ~ Replaces all previous editions.