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HomeMy WebLinkAboutE-ELEVATION CERTIFICATE - 1409 WEST ELIZABETH STREET - CANAL IMPORTATION (3)U.S. DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY ELEVATION CERTIFICATE OMB No. 1660-0008 Notional Flood Insumncr Pro9mm IMPORTANT: Follow the instructions on pages 1-9. Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name 1409 Elizabeth LLC Policy Number: A2. Buildin2 Street Address (includin Apt.iUnit. Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number: 4 Xnn %A1__1 rc__�_.' a ._-- g• ' "y Fort Collins State CO ZIP Code 80528 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 2, Fairview Shopping Center Filing Four A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential A5. A6. Latitude/Longitude: Lat. 400.1d'97 15"N Long. 1050 616-Q311W Horizontal Datum: ❑ NAD 1927 ❑x NAD 1983 Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 1R 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 It b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 0 b) Number of permanent flood openings in the attached garage c) Total net area of flood openings in A8.b 0 sq in c) within 1.0 foot above adjacent grade Q Total net area of flood openings in A9.b Q sq in d) Engineered flood openings? ❑ Yes ®Nc d) Engineered flood openings? ❑ Yes ®No SECTION B — FLOOD INSURANCE RATE MAP (FIRM1 INFnRMATinN B1. NFlP Community Name & Community Number h 82. County Name 63. State City of Fort Collins 080102 Larimer Colorado 84. Map/Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel Effective/ B8. Flood Zone(s) B9. Base Flood Elevation(s) (Zone 0801020978/Plate 5 G 02/O6/2013 B10 I d' Revised Date p WIZ-1 AO, use base flood depth) X/100 year 5035.0 n cate t e source of the Base Flood Elevation (BFE) data or base flood depth enter d in Item 89: ❑ FIS Profile ❑ FIRM ❑ Community Determined ® Other/Source: Canal Importation 68Sin - See Comm nt Section 811.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 REOUIREDI 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. In Puerto Rico only, enter meters. Benchmark Utilized: City of Fort Collins Benchmark 20-97 Vertical Datum: NGVD 1929 Indicate elevation datum used for the elevations in items a) through h) below. (R 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) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support Check the measurement used. 5036 . 57 ® feet ❑ meters 5047 , 30 ® feet ❑ meters n/a ❑ feet ❑ meters n/a ❑ feet ❑ meters 5044 , 47 ® feet ❑ meters 5035 , 30 ® feet ❑ meters 5037 • 1 ® feet ❑ meters --I*. _ : 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. l 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. 0 ❑x Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ® Check here if attachments. licensed land surveyor? ❑ Yes ®No I 3 ; o� O�.AL Certiner's Name Chad Washburn License Number CO PLS 37963 Title Principal Company Name I Washburn Land Surve in , LLC Address 3621 Muskrat Creek Drive Signature City Fort Collins State ZIP Code' CO 80528 Date Telephone LANDS 06/12/2013 970 232-9645 FEMA Form 086-0-33 (Revised 7/12) See reverse side for continuation. Replaces all previous editions. 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. I Policy Number: City State ZIP Code Company NAIC Number: Fort Collins CO 80528 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 B10 - "Hydraulic Evaluation and Floodplain Mapping Update for Canal Importation Basin" from Anderson Consulting Engineers, June 10, 2005. Floodplain Waiver allowing the -use of this study is attarCity of Fort ins enc ma - .e t e owes[ a ovation o achmery is a fan coil unit mounts on e first floor ceiling. Within this building exists an elevator the lowest elevation of the elevator pit is 5031 57 The elevator installed in the building is a traction type elevator. All associated elevator controls are located on the 3rd floor adjacent to the elevator shaft. In the event of an emergency on tat floor the car is programmed to go to upper floors and Signature �// Date O6/12/2013 SECTIOWE - 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 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 E] meters El 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 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 38-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 AD. G3. The following information (Items G4-G10) is provided for community floodplain management purposes. 34. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued up 111% ,26 -2.012- 1 - ZDi3 37. This permit has been issued for: , New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: S,0_3r, . 5­7 14 feet ❑ meters Datum rd 6,VD 2 09. BFE or (in Zone AO) depth of flooding at the building site: S'd3 S 00 ❑ feet ❑ meters Datum �� Z G10. Community's design flood elevation: S6,1U. ..9'0 ,feet ❑ meters Datum V 2i Local Official's Name 1 p(� Title F-/eo4gH& Community Name V �y� Telephone ,IAG - ? 21 O c - Signature Date ,, n �1 �2jG nzm�3 �f � �+ / Comments i I n Aj -CW t AA — f'a6Id I�VI f'A"4WWAt 01n. 7w o- /+ e� - ,r �. (a N» f u. C S 101 L d� �. (:54A ,_hrMsteG"Q cf1IWO_ WW!Ilw txu" + wo-I-Me, ar ey g4.1 y ,p(J�l;0L Check here if attachments. FEMA Form 086-0-33 (Revised 7/12) 7 Replaces all previous editions. 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 PO. Route and Box No. Policy Number: 1409 West Elizabeth Street City State ZIP Code Company NAIC Number: Fort Collins CO 80528 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 A8. If submitting more photographs than will fit on this page, use the Continuation Page. Front View FEMA Form 086.0.33 (Revised 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 P0. Route and Box No. Policy Number: 1409 West Elizabeth Street City State ZIP Code Company NAIC Number: Fort Collins CO 80528 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. Left Side View r — :f - �t ,rrrltlSlrnl� FEMA Form 086-0.33 (Revised 7/12) Replaces all previous editions.