HomeMy WebLinkAboutE-ELEVATION CERTIFICATE - 114 South Loomis Avenue - OLD TOWNFOR INSURANCE COMPANY USE
Policy Number:
Company NAIC Number:
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.:
City: State:ZIP Code:
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Section A, B, C, E, G, or H of this Elevation Certificate. Complete the applicable item(s) and sign below when:
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 state law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.)
G2.a.A local official completed Section E for a building located in Zone A (without a BFE), Zone AO, or Zone AR/AO, or when item
E5 is completed for a building located in Zone AO.
G2.b.A local official completed Section H for insurance purposes.
G3.In the Comments area of Section G, the local official describes specific corrections to the information in Sections A, B, E and H.
G4.The following information (Items G5–G11) is provided for community floodplain management purposes.
Permit Number:
G8. This permit has been issued for:New Construction Substantial Improvement
G9.a. Elevation of as-built lowest floor (including basement) of the
building:Datum:metersfeet
G9.b. Elevation of bottom of as-built lowest horizontal structural
member:Datum:
G10.a. BFE (or depth in Zone AO) of flooding at the building site:Datum:
G10.b.
Datum:
Community's minimum elevation (or depth in Zone AO)
requirement for the lowest floor or lowest horizontal structural
member:
G11. Variance issued?Yes No If yes, attach documentation and describe in the Comments area.
The local official who provides information in Section G must sign here. I have completed the information in Section G and certify that it is
correct to the best of my knowledge. If applicable, I have also provided specific corrections in the Comments area of this section.
NFIP Community Name:
Local Official's Name:Title:
Comments (including type of equipment and location, per C2.e; description of any attachments; and corrections to specific information in
Sections A, B, D, E, or H):
SECTION G – COMMUNITY INFORMATION (RECOMMENDED FOR COMMUNITY OFFICIAL COMPLETION)
G6. Date Permit Issued:
Date Certificate of Compliance/Occupancy Issued:
G5.
G7.
metersfeet
metersfeet
metersfeet
Address:
City:State:ZIP Code:
Ext.:Email:Telephone:
Signature:Date:
FEMA Form FF-206-FY-22-152 (formerly 086-0-33) (10/22)Page 5 of 19
ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON PAGES 9-19
Fort Collins
1010 W. Mountain Ave.
CO 80524