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Home My WebLink AboutE-ELEVATION CERTIFICATE - 2500 EAST PROSPECT ROAD - POUDRE RIVER (15)U.S. DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY ELEVATION CERTIFICATE 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 A1 . Building Owner's Name Orthopaedic Center of the Rockies Policy Number. A2. Building Street Address (including Apt., Unit. Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number 2500 East Prospect Road C1ty Fort Collins State CO ZIP Code 80525 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Parcel No. 87173-10-001, Tract 1, Seven Lakes PUD PH II Subdivision A4. Building Use (e.g., Residential , Non-Residential, Addition, Accessory, etc.) Non-Residential Building Addition AS. Latitude/Longitude: Lat. 40d 34m 04s Long. 105d 01m 53s Horizontal Datum: 0 NAD 1927 181 NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 1fi 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) Q sq ft a} Square footage of attached garage Q sq ft b) Number of penn anent flood openings in the crawlspace b) Number of pennanent flood openings in the attached garage or enclosure{s) within 1.0 foot above adjacent grade Q within 1.0 foot above adjacent grade Q c) Total net area of flood openings in A8.b Q sq in c) Total net area of flood openings in A9.b Q sq in d) Engineered flood openings? 0 Yes 181 No d) Engineered flood openings? 0 Yes 181 No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B 1. NFIP Community Name & Community Number I B2. County Name I B3. State City of Fort Collins 080102 Larimer County Colorado B4. Map/Panel Number BS. Suffix B6. FIRM Index Date B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 08069C0983 H 02-06-2013 Effective/Revised Date Zone(s} AO, use base flood depth) 05-02-2012 AE 4904.02 B 10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. 181 FIS Profile 0 FIRM 0 Community Determined 0 Other/Source: __ 811 . Indicate elevation datum used for BFE in Item B9: 0 NGVD 1929 ~ NAVD 1988 0 Other/Source: __ 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes 181 No Designation Date: __ 0 CBRS 0 OPA SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1 . Building elevations are based on: 0 Construction Drawings* 0 Building Under Construction* 181 Finished Construction "A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations -Zones A1-A30, AE, AH, A (with BFE), VE, V1 - V30, V (with BFE), AR, ARIA, ARIAE, ARIA1-A30, ARIAH, ARIAO. Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized. BM 3-07 Vertical Datum: NGVD 1929 Indicate elevation datum used for the elevations in items a} through h) below. 0 NGVD 1929 181 NAVD 1988 0 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) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 4904.~ N/A. __ ~-- N/A. __ 4912.§2 4904.33 ~.42 N/A. __ Check the measurement used. 181 feet 0 meters ELEVATION CERTIFICATE, page 2 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 2500 East Prospect Road City Fort Collins State CO ZIP Code 80525 Company NAIC Number SECTION 0 - 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 BM 3-07 Elevation :: 4915.95' For Fort Collins there is 0 ft con · n between NGVD 1929 and the NAVD 1988 that is used on the FIRM's. {NGVD 29 +3.0' = NAVD 88) Equpment servici g o the of. Date 04-04-13 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. E 1. 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 --·-- 0 feet 0 meters 0 above or 0 below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is --·-- 0 feet 0 meters 0 above or 0 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 --·-- 0 feet 0 meters 0 above or []below the HAG. E3. Attached garage (top of slab} is __ .__ D feet [] meters 0 above or D below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is --·-- 0 feet 0 meters D above or 0 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? D Yes 0 No 0 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 -------------------------------------------------------------[]Checkhereifattachmenw. 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. G 1. 0 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. 0 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-G10) is provided for community floodplain management purposes. G4. Permit Number F"PLtP ~ G7. This permit has been issued for: • New Construction 0 Substantial Improvement G8. Elevation of as-built lowest floor (including basement} of the building: 'fj~L~ • feet G9. BFE or (in Zone AO} depth of flooding at the building site: 49~ . t>2- • feet G10. Community's design flood elevation: ~. S'2. • feet Local Official's Name Signature 0 meters D meters 0 meters Datum NflVJ) ... 'BS Datum ~-9B Datum NMJ>·S S ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6. 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. Polley Number: 2500 East Prospect Road City Fort Collins State CO ZIP Code 80525 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 A6. 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. If submitting more photographs than will fit on this page, use the Continuation Page. North side of building looking east. (Date: 02-20-13) North side of building. (Date: 02-20-13) -'--:r-: North side of building. (Date: 02-20-13) Front view (west side) of building looking east. (Date: 02-20-13) 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: 2500 East Prospect Road City Fort Collins State CO ZIP Code 80525 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.p When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section AS. Front view (west side) of building looking northeast. (Date: 02-20-13) FEMA Form 086-0-33 (7/12) Replaces all previous editions. 0 feet 0 meters 0 feet 0 meters 0 feet 0 meters 181 feet 0 meters £81 feet 181 feet 0 feet 0 meters 0 meters 0 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 infonnation. 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. 181 Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a 0 Check here if attachments. licensed land surveyor? 0 Yes 181 No Signature FEMA Form 086-0-33 (7/12) See reverse side for continuation. Replaces all previous editions.