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Home My WebLink AboutE-ELEVATION CERTIFICATE - 130 NORTH MACK STREET - OLD TOWN (3) .S_ DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE Federal Emergency Managernerd Ago" Nil Flood Insurance Program Important: Read the iftAructions on pages 1-8. OMB No. 1660-0008 Expires February 28 2009 SECTION A - PROPERTY INFORMATION 1 For tnsaance Company Use. AZ Bmldrg Street Address (mcludog Apt., UnJL Shute, anWor Bklg. No.) or P.O. Rode and Box No. I Company NA1C Number Mack I 130 MaStreet City Fat Collins Stage CO ZIP Code 80521 A& Properly Description (Lot and Block Numbers, Tax Parcel Number, Legal Desulption, etc.) Lot 3o, Mager -Smith Addition to Fort Coffins A4. Buiding Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RTestdential Addition A5. Latdude/Larglude: Let. _ Long. 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. A7. &uacting Diagram Number 5 A8. For a building with a crawl space or endosure(s), provide A9. For a building with an attached garage, provide: a) Square Wage of crawl space or enclosure(s) Q sq ft a) Square footage of attached garage 0 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 aoicerd grade Q walls within 1.0 font above adlacerd grade 0 c) Total net area of flood openings in A8.b Q sq in c) Total net area of flood openings in A9.b 0 sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFIP Community Name & Community Number B2. Coady Name B i State City of Fat Coins 080102 Larimer CO BC Ma ftnel Number B5, Suffok B6. FIRM Index B7. FIRM Parcel B& Flood B9r Base Flood Elevation(s) (Zorn Date EffectivelRevised Date I Zone(s) I AO, use base flood depth) 08M02003rstheet5 c 3R8I96 3-18.960-16-05 xN00yew 501&5 110_ the source of the Base Flood Elevation (BFE) data or base flood depth entered in Itan B9. ❑ FIS Profile ❑ FIRM O Corranunity Determined ® Other (Describe) Old Tatum Master Plan B11. trhdkxte elevation datum used for BFE in Poem B9: ® NGVD 19M ❑ NAVD 1988 O Other (Describe) B12. Is the buildxg located in a Coasted Barrier Resources System (CBRS) area or Otherwise Protected Area O (OPArt Yes ®No Designation Date ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Bhaldng elevations are based orc ❑ construction Drawings- ❑ Buldirg Urdu Co structiat` ® Finished Construction •A new Elevation Certificate will be required when construction of the building is complete. C2. Bevaiias—Zones A14M. AE, AH. A (with BFE), VE, V1430, V (with BFE). AR. ARIA, ARIAS, ARIA14130, ARIAH, ARIAO. Complete lions C2a-g below acoondag to the building diagram specified in Poem A7_ Benchmark UNzed City of Fat Coons ACBM Vertical Datum NGVD 1929 Check the measu mment used. a) Tap of bottom floor (mclu ohg basement, an space, orenclosure floc - SM &7 ® feet ❑ meters (Puerto Rico ody) b) Tap of the nod higher floor 5027.7 ® feet ❑met, rs (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones oily) Nor._ ❑ feet ❑ rnetehs (Puerto Rica duly) d) Attached garage (top of slab) Nor._ ❑ feet ❑ meters (Puerto Rico only) e) Lowest elevation of madhmery or equ pnerd servicing the building 50Z_7-Z ® feet Ornate (Puerto Rico only) (Describe type of equipment in Comments) - n Lowest adacerd Push grade (LAG) 5016.5 IR feet ❑ meters (Puerto Rico ady) g) Highest adjacent (finished) grade (HAG) 5017.1 ® feet ❑ meters (Puerto Rico ordy) 1 SECTION D - SURVEYOR ENGINEER, OR ARCHITECT CERTIFICATION f This ONWICatIM Is to be signed and seated by a lard surveyor, engineer, or amnaect autnaMed by raw to dxmry elevation eitannahm l amdjr that floe hdauna6on on this Certificate represents my best et►oAs to hiterprat The daft a►allable. I tumderdand Brat any false statement any be pwasfnailde by lime orbnfrisonment under 18 U.S. Code, Section 1001. ® Check here B dwrn metns we provided an back of form. Certi W% Name Franklin D. Blake Incense Number 7839 IMPORTANT: in these spaces, copy the corresponding information from Section A. I For insurance Company Use: I Bbg. No.) or 13011 1 Street City Fort Collins State CO ZIP Code 80521 SECTION D -SURVEYOR, ENGINEER,, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1)fff - agerdkorhpany, and (3) btuildog owner - Comments Furnace and heater in crawl space under ' duo work et 5027.7 Elevation of benchmark is 5020.48 m 4 i,n: 11C. ..' 0 SECTION E - BUILDING ELEVATION INFORMAI�'V`f 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. El. Prmride elevation ukfomkabork for the k9mirg 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 (mcludrg 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 bulfiikg 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 bulling is — _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only: If no flood depth number is avaflable, is the top of the bottom flow 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 sin hare. The sWemeras in Sections A, A and E are correct to the bast of my knowledge. Property Owner's or Owners Authorized Representative's Name Address City State ZIP Code Signature Date Telephone ❑ Check here ifatadmnerts SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordnance to administer the co mmunito f oodplain mi nagemernt ordinance can complete Sectorhs 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 fic P se skaveyor. ergineer, or ancMlect 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 oM J; I completed Section E for a buildirg located in Zone A (without a FEMA-issued or community -issued BFE) or Zone AO. G3. I< The follow g information (items G4.-G9.) is provided for community floodplain management purposes. G8. Date_CRktfiote Of % G7- This per,, has been issued for ErNew Construction ❑ Sut>slmw Inkprovemerd G8 Elevation of as-0m7t lowest boor Cmdu*q basemeM of the bulling: 519.Z _tWteet ❑meters(PR) Datum 6V 19a9 G9- BFE or (n Zone AO) depth of flooding at the building site: kU 6. G- Wleet ❑ meters (PR) Datum &IC11 D I a Ai Local Official's Name The 1 /1d� i �.5 �� ii0.i(Sbw. �'i-1 /►2eS-�o�O6 ✓L�ov, �ooCJOlct e n h` Community Name p • Telephone Q/ 7D - a - 6 70 c� Signature 11 e _ n A CZ Date Commends l�L� (.�l -rl/L ; n Check here if altar r ends