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Home My WebLink AboutE-ELEVATION CERTIFICATE - 621 WEST MAGNOLIA STREET - OLD TOWN (7)U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE Federal Emergency Management Agency National Flood Insurance Program important: Read the instructions on pages 1-8. OMB No. 1660-0008 Expires February 28, 2009 SECTION A - PROPERTY INFORMATION I;For Insurance Company Use Al. Building Owner's Name Copper River Land & Cattle, LLC. Policy Number A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company:NAIC Number 621 W. Magnolia Street City Fort Collins State CO ZIP Code 80521 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 1, Magnolia West Subdivision A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Addition A5. Latftude/Longitude: Lat. 40434'58"N Long. 105A05"I S 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 5 A8. For a building with a crawl space or enclosure(s), provide A9. For a building with an attached garage, provide: a) Square footage of crawl space or enclosure(s) n/a sq It a) Square footage of attached garage Na sq ft b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage enclosure(s) walls within 1.0 foot above adjacent grade n/a walls within 1.0 foot above adjacent grade n/a c) Total net area of flood openings in A8.b n/a sq in c) Total net area of flood openings in A9.b n1a sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Bi. NFIP Community Name & Community Number B2. County Name B3. State City of Fort Collins 080102 1 Larimer I Colorado B4. Map/Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone Date Effective/Revised Date Zone(s) AO, use base flood depth) 06069CO979/Sheet 3 G 06/17/08 06/17/08 7/15/03 X / 100-yr 5004.3 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 (Describe) Old Town Master Plan 1311. 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-g below according to the building diagram specified in Item AT Benchmark Utilized City of Fort Collins ACBM Vertical Datum NGVD1929 Conversion/Comments Benchmark ACBM #28-97 Elevation 6005.58 Check the measurement used. 600(..E a) Top of bottom floor (including basement, crawl space, or enclosure floor)- 5994 @ ® feet ❑ meters (Puerto Rico only) "�/ b) Top of the next higher floor 99 =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 5005.3 ® feet ❑ meters (Puerto Rico only) (Describe type of equipment in Comments) f) Lowest adjacent (finished) grade (LAG) 5004.6 ® feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade (HAG) 5004.8 ® feet ❑ meters (Puerto Rico only) 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. REG/S, pno ® Check here if comments are provided on back of form. PLACFs ?l 0: Certifier's Name Kevin E. Forbes License Number 35265 Title Professional Engineer Company Name Stewart & Associates, Inc. ; Address 103 S. Meldrum Street City Fort Collins State CO ZIP Code 80521 d '• Signature Date 03/18/09 Telephone (970)482-9331 <aN " c• FEM Form 81-31, February 2006 See reverse side for continuation. Replaces all revious editions -UVLZ 3/1?109 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 621 W. Magnolia Street City Fort Collins State CO ZIP Code 80521 £ompany 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 `Benchmark used was City of Ft. Colins ACBW28-97 Elevation = 5005.58. The addition is built on pillars and the area under the addition is open with lattice covering the opening. The addition is 96 sf. The addition's HVAC is at elevation 5005. Signature Date 03/18/09 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 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, crawl space, or enclosure) is ._ ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawl space, or enclosure) is — ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9 (see page 8 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 El 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 items) 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 1073 Q G5. Date Permit Issued dz /ZI /0 G6. Date Certificate f Co pliance/Occupancy Issued / ( 9 G7. This permit has been issued for: IXNew Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building:S004. 4 -® feet ❑ meters (PR) Datum r 4 •r 2, f G9. BFE or (in Zone AO) depth of flooding at the building site: I 5boq. 3 ❑ feet ❑ meters (PR) Datum A&VD 29 Local Official's Name Z p 4 .(/ _ _ /) Q _ Title Community Name c�7ry Y /TXJ'Oe Telephone o�f sr Co g Signature Date Comments /gyp r`> % i0k a.U/'wC: •oiQ,`D_ �F�� Su..+, �_ �i�%r� . /7T eq bvr�w0*r� 4'E-0 ,, 4Tret�/� L✓�%ch �7 lar p�/0�� ! � I S '� t'P.wM.}�. O� . ❑ Check here if attachments FEMA Form 81-31, February 2006 Replaces all previous editions Building Photographs See Instructions for Item A6. For Insurance Company Use: Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number 621 W. Magnolia 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 two 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." If submitting more photographs than will fit on this page, use the Continuation Page, following. IE Building Photographs rnnfinnatinn Pane. For Insurance Company Use: Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. policy Number 621 W. Magnolia Street City Fort Collins State co ZIP Code B0521 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." 3l18�r09 _