The URL can be used to link to this page

Home My WebLink AboutELEVATION CERT - BLD Permit / Conditions - 5/9/2018 TO BF KEPT IN THE U S. DEPARTMENT OF HOMELAND SECURITY pA k k'-'*E L FILE OMB No. 1660-0008 Federal Emergency Management Agency Expiration Date: November 30, 2018 National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. Copy all pages of this Elevation Certificate and all attachments for(1)community official, (2) insurance agent/company, and(3)building owner. SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Policy Number: Janelle Twiss A2. Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Company NAIC Number: Box No. 101 West River Bend Road City State ZIP Code Shelton Washington 98584 A3. Property Description(Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Parcel Number 52112-31-00252 A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory, etc.) Residential A5. Latitude/Longitude: Lat. 47.321402 Long. -123.261261 Horizontal Datum: ❑ NAD 1927 ❑x NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insuranc� UIL DA7. Building Diagram Number 2A (, 'N A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) 1,216 sq ft Rkj�i b) Number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot abc, &V Y c) Total net area of flood openings in A8.b 1,371 sq in �'/ Y O d) Engineered flood openings? ❑x Yes [INo 9 ?0�8 A9. For a building with an attached garage: 6',1' Aid., a) Square footage of attached garage sq ft Street b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? ❑Yes ❑ No SECTION B—FLOOD INSURANCE RATE MAP(FIRM) INFORMATION A B1. NFIP Community Name&Community Number B2. County Name B3. State B4. Map/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth) Revised Date 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: B11. indicate elevation datum used for BFE in Item 139: ❑ 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 FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 1 of 6 s 1 OMB No. 1660-0008 ELEVATION CERTIFICATE Expiration Date: November 30, 2018 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: City State ZIP Code Company NAIC Number SECTION C—BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. 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: Vertical Datum: 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) ❑ feet ❑ meters b) Top of the next higher floor ❑ feet ❑ meters c) Bottom of the lowest horizontal structural member(V Zones only) ❑ feet ❑meters d) Attached garage(top of slab) ❑ feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building(Describe type of equipment and location in Comments) feet ❑ meters f) Lowest adjacent(finished)grade next to building(LAG) ❑ feet ❑ meters g) Highest adjacent(finished)grade next to building (HAG) ❑ feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support ❑ 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. /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. Were latitude and longitude in Section A provided by a licensed land surveyor? ❑Yes ❑No ❑Check here if attachments. Certifier's Name License Number �Q►1• Mu EA JoSHNAV T P't1;- GGti 53755- o sH/cF� Title �. + -AJ&=,vEE Company Name M. C S q K A R- z N C . al Address 1235- G t"- AVM s t Ic sSfONAt V1Via City State ZIP Code oL Prp VJA (0, Sign at Date Telephone Ext. of/t5711 360- 75'�-�359 Comments(including type of equipment and location, per C2(e), if applicable) FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 2 of 6 OMB No. 1660-0008 ELEVATION CERTIFICATE Expiration Date: November 30, 2018 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: City State ZIP Code Company NAIC Number 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 El—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 1-7 ❑x feet ❑meters ❑above or ❑x below the HAG. b) Top of bottom floor(including basement, crawlspace, or enclosure)is 1.7 ❑x feet [—]meters ❑above or ❑x below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 1-2 of Instructions), the next higher floor(elevation C2.b in 2.3 x feet x above or below the HAG. the diagrams)of the building is ❑ ❑ ❑ ❑ 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. Joshua T. Mergens, P.E. Address City State ZIP Code 1235 East 4th Avenue Olympia Washington 98506 Signature Date Telephone O !s" 360-754-9339 Corn .7 ❑Check here if attachments. FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 3 of 6 r � OMB No. 1660-0008 ELEVATION CERTIFICATE Expiration Date: November 30, 2018 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: City State ZIP Code Company NAIC Number 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 G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-built lowest floor(including basement) of the building: ❑ feet ❑ meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑ feet ❑ meters Datum G10. Community's design flood elevation: ❑ feet ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments(including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 4 of 6