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Home My WebLink AboutElevation Certificate - BLD Permit / Conditions - 12/8/1998 M ELEVATION CERTIFICATE M .�,,_ �$ieiXf y 6l; . FEDERAL EMERGENCY MANAGEMENT AGENCY ' NATIONAL FLOOD INSURANCE PROGRAM r r ri ATTENTION: Use of.this certificate does not provide a waiver of the flood insurance purchase requirement. T1�isr-for�rris @Wonly to provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances,to determine the proper insurance premium rate,and/or to support a request for a Letter of Map Amendm oG140(tsjoMr(Lt9J%ALgri�OMF Instructions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE B( Q U�iL�DIN9 OWNER'S NAME r POLICY NUMBER WS n � $ ITVI ilk e ayi �c �te,✓� STREET ADDRESS(Including Apt..Unit.Suite and/or Bldg.Number)OR P.O.ROUTE AND BOX NUMBER COMPANY NAIC NUMBER De- e -ffZ 0, Il— OTHER DESCRIPTION(Lot and Block Numbers.etc.) CITY W j1STATE 1�P COD 5�� T' SECTION B FLOOD INSURANCE RATE MAP(FIRM)INFORMATION Provide the following from the proper FiRM (See Instructions): 1.COMMUNITY NUMBER Z PANEL NUMBER 3 SUFFIX <.DATE OF FIRM INDEX 5.`FIRM ZONE 6.BASE FLOOD ELEVATION (in AO Zone-,use depth) 7. Indicate the elevation datum system used on the FiRM for Base Flood Elevations(BFE): NGVD'29 ❑Other(describe on back) 8.For Zones A or V,where no BFE is provided on the FiRM,and the community has established a BFE for this building site,indicate the community's BFE:; i I I I 1.�II feet NGVD(or other FIRM datum—see Section B, Item 7). SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevadact Certificate Instructions,indicate the diagram number from the diagrams found on Pages 5 and 6 that best describes the,subject building's. eference level 5 2(a). FIRM Zones A1-A30,AE.AH.and A(with BFE). The top of the reference level floor from the selected diagram is at an elevation of( I I featµ feet NGVD(or other FIRM datum—see Section 8, Item 7). (b). FiRM Zones V1~-V30,VE;-and'V(with 8FE). The bottom of the lowest horizontal structural member of the reference level from the selected diagram;Is at an elevation of ' 1 I.j___;feet NGVD(or other FIRM datum—see Section.B, Item 7). (c).FiRM Zone A(without BFE). The floor used as the reference level from the selected diagram is W.0 feet above❑ or below❑ (check one) the highest grade adjacent to the building. (d).FIRM Zone AO. The floor used as the reference level from the selected diagram is I I LU feet above❑ or below❑(check one)the highest grade adjacent to the building. If no flood depth number is available,is the building's lowest floor(reference level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations:0 NGVD'29 ❑ Other(describe under Coirihnents on.Page 2). (NOTE. If the elevation datum used in measuring the elevations is different than that used on the'FIRM (see Section 8, item 77, then convert the elevations to the datum system used on the FiRM and show the conversion equation under Comments on Page 2.) 4. Elevation reference mark used appears on FIRM: Yes ❑No (See Instructions on Page 4) 5.The reference level elevation is based on: ! actual construction NI construction drawings (NOTE.• Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which case this certificate will only be valid for the building during the course of construction. A post-construction Elevation Certificate will be required once construction is complete.) 6. The elevation of the lowest grade immediately adjacent to the building is: Q feet NGVD (or other FIRM datum-see Section B. Item 7). SECTION D COMMUNITY INFORMATION 1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C. Item 1 is not the-lowest floor"as defined in the community's floodplain management ordinance, the elevation of the building's "lowest floor"as defined by the ordinance is: _ feet NGVO (or other FIRM datum—see Section B. Item 7). 2. Date of the start of construction or substantial improvement FEMA Form 81.311 MAY 90 REPLACES ALL PREVIOUS EDiIiON) SEE REVERSE SIDE FOR CONTINUATIO: - SECTION E CERTIFICATION certification is to be signed by a land surveyor,engineer,or architect who is authorized by state or local law to certify elevation mation when the elevation information for Zones Al—A30,AE.AH,A(with 8FE),V1—V30,VE,and V(with BFE) is required. imunity officials who are authorized by local law or ordinance to provide floodplain management information,may also sign the fication. In the case of Zones AO and A(without a FEMA or community issued BFE),a building official,a property owner,or an 3r's representative may also sign the certification. rence level diagrams 6, 7 and 8-Distinguishing Features--If the certifier is unable to Certify to breakaway/non-breakaway wall, )sure size,location of servicing equipment,area use,wall openings,or unfinished area Feature(s),then list the Feature(s) not ded in the certification under Comments below. The diagram number,Section C, Item 1,must still be entered. - rift'that the information in Sections B and C on this certiricate represents my best efforts to interpret the data available. ferstand that any false statement may be punishable by fine or imprisonment under 18 U.S. Cade, Section 1001. IFIER'S NAME UCENSE NUMBER(or Affix Seal) Donald R. Bartlett Washington - 14579 COMPANY NAME Chief Engineer Washington Department of Fish and Wildlife ESS CITY STATE ZIP _ 600 Capitol Way North Olympia WA 98501-1091 kTURE �' ��1/2�9/99 ��(360�) 58�6-5884 �� es should be made of this Certificate for:1)community official,2) Insurance agenticompany,and 3) n, MENTS: '� CF At l p ON wTTH ON PILES, SLAB SASEMENT P!£RS,OR COLUMNS A V A A V ZONES ZONES ZONES ZONES ZONES REFERENCE RE -I I LEVEL w' FLO LEV£i� ELEVATION aASE SASE FLOOD .AGJACEM• .'.'.!' REFERENCE FLOOD EIEVATgN REFERENCE AcjACENr GRADE I} LEVEL ELEVATION IEVEt GRADE ~� jJ 'AD.IACENT :•!!.:_ ._...,:;:.•;.r1jj ... GRADE .. .. . ArQ: the diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones. levations for all A Zones should be measured at the top of the reference level floor. levations for all V Zones should be measured at the bottom of the lowest horizontal structural member. Page 2