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Home My WebLink AboutE-ELEVATION CERTIFICATE - 321 SOUTH WHITCOMB STREET - OLD TOWN (17)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 JOHN G. AND TAYLOR S. MORRIS Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number: 321 S. WHITCOMB STREET City FORT COLLINS State CO ZIP Code 80521 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 12, LESS WEST IOFT., BLOCK 268, LOOMIS ADDITION A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. N40 34 57.8 Long. W105 05 09.1 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 1A 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) 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.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 LARIMER COLORADO B4. Map/Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 0806900979 H 2-6-2013 Effective/Revised Date Zone(s) AO, use base flood depth) 54-5_r"7 5-2-2012r7-15-: X/100 YEAR 2.0' 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 BASIN MASTERPLAN B11. 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 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. In Puerto Rico only, enter meters. Benchmark Utilized: FT. COLLINS BM 1-11 Vertical Datum: NGVD 1929 UNADJUSTED 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. Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 5005.25 ® feet ❑ meters b) Top of the next higher floor N/A. ❑ feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A. ❑ feet ❑ meters d) Attached garage (top of slab) N/A. ❑ feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 5005.25 ® feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 5002.7 ID feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 5003.7 ® feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 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. 00 f I 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 *.•[ ❑ Check here if attachments. licensed land surveyor? ® Yes ❑ No S` O v : 38348 Certifier's Name STEVEN PARKS License Number 38348 • ce �,r, yZZ Title PROJECT MANAGER Company Name KING SURVEYORS, INC. Esd! Address 650 E. GARDEN DRIVE City WINDSOR State CO ZIP Code 80550 .. lANagJ�,� Signature ate 4-22-2013 Telephone 970-686-5011 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: 321 S. WHITCOMB STREET 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 Entire property at 321 S. Whitcomb St.is within the 100-yr City Designated Old Town Basin Floodplain and must comply with floodplain requirements of Chapter 10, City Code. Refer Floodplain Use Permit #11152. T0,ZNAce" AT FLoYk, 9Jbl I-1! FLEYAO& ' = SOOSNy MIJt, Z9 b4TV. -,W£ 7Srt ma -r C >b is Z.o Prc-r 480,AE iA15 NrCNFsr £Nsrw.,, (pro c ilCv<71au C,Sw,.63 Z.O : $m3.L� 7ur 2F1 noT Ee A Maim— nG $ w A<E� kf 5f rO 5en3,L+/.5 �.5eo5.1) 4,9—,ea_ e6,5r m'rkN,.hr 4;-,a,,ZgC0 47Vp2 £tgvar)cj or -tAV {io..si 15 5mS.L5 vole-Urs Zo- Irm-Ntt ASoz -rOr F-AP_ Signature Date . Zz,Zo,3 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-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. The following information (Items G4-G10) is provided for community floodplain management purposes. G4. Permit Number � FPLAP I(t5�.. G5. Date Permit Issued eo/14�ra- G6. Date Certificate O Com liance/Occupancy Issued O'{19%zor3 G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: Soo 5'..215, 0 feet ❑ meters Datum Ml2VP? 5 G9. BFE or (in Zone AO) depth of flooding at the building site: 2.0 i feet ❑ meters Datum G10. Community's design flood elevation: 3 . Sr' 0 feet ❑ meters Datum Local Official's Name A"s�4 yarrwo�_, CX, Title F(0p !I Community Name /CC S Telephone g70- !'7talA2rtil ) Signature 6lw r Date ( Z Ww y.� -.t h �- C Ow, 5^//��Llr De/M1,6wp /�AL'cr ►0P Fi yc a��.F�n�ar.<,r .i��"Sf Commentswc 41 FPCr gS a - �P d_ 4"^Ca 'OuIti S7)fI— ,y.. �Check here R ffeattachments. ttachm en ts. . / N-Ir* %5 oou!, FEMA Form 086-0-33 (7/12) 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 P.O. Route and Box No. Policy Number: 321 S. WHITCOMB STREET City FORT COLLINS State CO ZIP Code 80521 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 A8. If submitting more photographs than will fit on this page, use the Continuation Page. LOOKING NORTH 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: 321 S WHITCOMB STREET City FORT COLLINS State CO ZIP Code 80521 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." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. LOOKING EAST FEMA Form 086-0-33 (7/12) Replaces all previous editions. RequirementsSection D: Survey Vertical Datum Conversion: NGVD2.%101t=NAVD88 (tor City of Fort Coffins Noodplain purposes) • Structure is: ®elevated ❑floodproofed ❑vented []Na • If floodproofed, describe method used: -- • Benchmark used: City of Fort Collins BM 1-11 • Elevation of benchmark: 5005.44 it NGVD29 • Lowest existing ground elevation: 5001.0 it NGVD29 • Highest existing ground elevation: 5001.6 It NGVD29 • Lowest finished ground elevation: 5003.2 it NGVD29 • Highest finished ground elevation: 5003.8 it NGVD29 • Lowest floor elevation (refer to Coy Code 10.37(dn: 5005.1 ft NGVD29 5008.1 ft NAVD88 • Elevation of garage slab: — it NGVD29 — it NAVD88 • Lowest elevation of HVAC equipment 5005.1 ft NGVD29 5008.1 ft NAVD88 • Enclosed area (not elevated or Modproofedj: • Number of vents: • Area of venting: --- ft2 _ # in2 Section• • • Requesting a variance from City Code? Oyes ®no If yes, attach variance application with additional $300 variance fee. Variance application can be obtained from Foil Collins Utilities. Variance request requires consideration by Water Board, Attached WA • Structures: Attach building plans showing foundation design, flood elevation, floor elevations, HVAC elevations • Site work: Attach site and grading plans and other relevant information. • Property In floodway: Attach No -Rise Certification and documentation. Freeboard • Poudre River Freeboard: Twenty four (24) inches above the base flood elevation. • FEMA basin AND City basin freeboard: -New construction and redevelopments: eighteen (18) inches above base flood elevation. -Additions and substantial improvements: six (6) inches above base flood elevation. -Accessory structures: six (6) inches above base flood elevation or meet venting requirements Signature of petitioner: Signature of owner: 18 # inches freeboard Date: Date:'/ 0—IV —1 Z Floodplain Use Permit: _Napproved ❑denied Permit # I Paid Date: D 1 U P1 Signature of iloodplain administrator: Date:CD I D 11 ZO/ Z Comments: ?.rw; ^rorv.4 K^. c � `ler►yt —c v`•: If you have questions or need assistance filling out forms, contact Fort Collins Utilities at: 6LCC*� 4% , i' L • S • PO Box 580, Fort Collins City of • Phone: (970) 221-6003 • Web: fcgov.com/stonwater water CO 80522 F61 Collins • TDD: (970) 224.6003 • E-mail: utilities�fcgov.com �►- • 700 Wood Street Utilities Updated November 2011 Page 2