HomeMy WebLinkAboutElevation Certificate - BLD Permit / Conditions - 6/20/2019 U.S. DEPARTMENT OF HOMELAND SECURITY OMB Control No.1660-0008
Federal Emergency Management Agency Expiration Date:06/30/2026
National Flood Insurance Program
ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGES 1-11
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: SMITH FAMILY CABIN 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:
112 E MASON LAKE DRIVE SOUTH
City: GRAPEVIEW State: WA ZIP Code: 98546
A3. Property Description(e.g., Lot and Block Numbers or Legal Description)and/or Tax Parcel Number:
Tract 10 of the unrecorded plat of Manzanita Tracts TPN 22108-50-00010
A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory,etc.): RESIDENTIAL
A5. Latitude/Longitude: Lat.47.321207° Long.-122.952340' Horiz. Datum:❑ NAD 1927 ® NAD 1983 ❑ WGS 84
A6. Attach at least two and when possible four clear color photographs(one for each side)of the building (see Form pages 7 and 8).
A7. Building Diagram Number: 8
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s): 2084 sq.ft.
b) Is there at least one permanent flood opening on two different sides of each enclosed area? ® Yes ❑ No ❑ N/A
c) Enter number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade:
Non-engineered flood openings: 0 Engineered flood openings: 21
d) Total net open area of non-engineered flood openings in A8.c: 2814 sq. in.
e) Total rated area of engineered flood openings in A8.c(attach documentation-see Instructions): N/A sq.ft.
f) Sum of A8.d and A8.e rated area(if applicable-see Instructions): 2814 sq.ft.
A9. For a building with an attached garage:
a) Square footage of attached garage: 406 sq.ft.
b) Is there at least one permanent flood opening on two different sides of the attached garage? ❑Yes ® No ❑ N/A
c) Enter number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade:
Non-engineered flood openings: 0 Engineered flood openings: 0
d) Total net open area of non-engineered flood openings in A9.c: 0 sq. in.
e) Total rated area of engineered flood openings in A9.c(attach documentation-see Instructions): 0 sq.ft.
f) Sum of A9.d and A9.e rated area(if applicable-see Instructions): 0 sq.ft.
SECTION B-FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1.a. NFIP Community Name:MASON COUNTY B1.b. NFIP Community Identification Number: 530115
B2.County Name:MASON COUNTY B3. State:WA B4. Map/Panel No.: 53045CO500 B5. Suffix:E
B6. FIRM Index Date: 06/20/2019 B7. FIRM Panel Effective/Revised Date: 06/20/2019
B8. Flood Zone(s): A, X B9. Base Flood Elevation(s)(BFE)(Zone AO, use Base Flood Depth): 200.1
B10. Indicate the source of the BFE data or Base Flood Depth entered in Item B9:
❑ FIS ❑ FIRM ®Community Determined ❑Other:
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
B13. Is the building located seaward of the Limit of Moderate Wave Action (LiMWA)? ❑Yes ❑No
FEMA Form FF-206-FY-22-152(formerly 086-0-33) (8/23) Form Page 2 of 8
ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGES 1-11
Building Street Address(including Apt., Unit, Suite,and/or Bldg.No.)or P.O.Route and Box No.: FOR INSURANCE COMPANY USE
112 E MASON LAKE DRIVE SOUTH
Policy Number:
City: GRAPEVIEW State: WA ZIP Code: 98546
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,AO,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH, AR/AO,
A99.Complete Items C2.a-h below according to the Building Diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: SmartNetNA Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a)through h) below.
❑ NGVD 1929 ® NAVD 1988 ❑Other:
Datum used for building elevations must be the same as that used for the BFE. Conversion factor used? ❑ Yes ® No
If Yes, describe the source of the conversion factor in the Section D Comments area.
Check the measurement used:
a) Top of bottom floor(including basement, crawlspace,or enclosure floor): 201.3 ® feet ❑ meters
b) Top of the next higher floor(see Instructions): 206.2 ® feet ❑ meters
c) Bottom of the lowest horizontal structural member(see Instructions): 205.5 ® feet ❑ meters
d) Attached garage(top of slab): 206.2 ® feet ❑ meters
e) Lowest elevation of Machinery and Equipment(M&E)servicing the building
(describe type of M&E and location in Section D Comments area): 203.2 ® feet ❑ meters
f) Lowest Adjacent Grade(LAG) next to building: ❑ Natural ® Finished 202.0 ® feet ❑ meters
g) Highest Adjacent Grade(HAG) next to building: ❑ Natural ® Finished 205.5 ® feet ❑ meters
h) Finished LAG at lowest elevation of attached deck or stairs, including structural
support: 201.6 ® 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 state 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.
Were latitude and longitude in Section A provided by a licensed land surveyor? ®Yes ❑No
❑Check here if attachments and describe in the Comments area.
Certifier's Name: Daniel B. Johnson License Number:28408
Title: Managing Director �~ < °F •+sH,N��s
Company Name: Aspen Land Surveying LLC
Address: 15510 92nd Street NW
�.n 28408
City: Gig Harbor State: WA ZIP Code: 98329 Fss Recrsreae°" ,
-40,v L L AT1D 5
Telephone: (253) 303-0270 Ext.: Email:danjohnson@aspenland.com
Diyiea%sig-d by Dani el B.Jabnson
DN.cW-18.Job—o�As —S—yiny LLC.ou•Aspen
r�� dSN� «C... d-1.b.,o.@-p-.��m.��s Place Seal Here
Signature: Wt.2024 .2t 0831 01-07� Date: 03/14/2024
Copy all pages of this Elevation Certificate and all attachments for(1)community official, (2)insurance agent/company, and(3)building owner.
Comments(including source of conversion factor in C2;type of equipment and location per C2.e; and description of any attachments):
C2.e: Heat Pump
FEMA Form FF-206-FY-22-152 (formerly 086-0-33) (8/23) Form Page 3 of 8
ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGES 1-11
Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No.: FOR INSURANCE COMPANY USE
112 E MASON LAKE DRIVE SOUTH
Policy Number:
City: GRAPEVIEW State: WA ZIP Code: 98546
Company NAIC Number:
SECTION E—BUILDING MEASUREMENT INFORMATION (SURVEY NOT REQUIRED)
FOR ZONE AO,ZONE AR/AO, AND ZONE A (WITHOUT BFE)
For Zones AO,AR/AO, and A(without BFE),complete Items El—E5. For Items El—E4, use natural grade, if available. If the Certificate is
intended to support a Letter of Map Change request, complete Sections A, B, and C. Check the measurement used. In Puerto Rico only,
enter meters.
Building measurements are based on: ❑Construction Drawings* ❑ Building Under Construction* ❑ Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
El. Provide measurements(C.2.a in applicable Building Diagram)for the following and check the appropriate boxes to show whether the
measurement is above or below the natural HAG and the LAG.
a) Top of bottom floor(including basement,
crawlspace, or enclosure)is: ❑ feet ❑ meters ❑ above or ❑ below the HAG.
b) Top of bottom floor(including basement,
crawlspace, or enclosure)is: ❑ feet ❑ meters ❑ above or ❑ 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(C2.b in applicable
Building Diagram)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 AUTHORIZED REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A(without BFE)or Zone AO must
sign here. The statements in Sections A, B, and E are correct to the best of my knowledge
❑ Check here if attachments and describe in the Comments area.
Property Owner or Owner's Authorized Representative Name:
Address:
City: State: ZIP Code:
Telephone: Ext.: Email:
Signature: Date:
Comments:
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(8/23) Form Page 4 of 8
ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGES 1-11
Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No.: FOR INSURANCE COMPANY USE
112 E MASON LAKE DRIVE SOUTH
Policy Number:
City: GRAPEVIEW State: WA ZIP Code: 98546
Company NAIL Number:
SECTION G—COMMUNITY INFORMATION (RECOMMENDED FOR COMMUNITY OFFICIAL COMPLETION)
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.
G5. Permit Number: G6. Date Permit Issued:
G7. Date Certificate of Compliance/Occupancy Issued:
G8. This permit has been issued for: ❑New Construction ❑ Substantial Improvement
G9.a. Elevation of as-built lowest floor(including basement) of the
building: ❑ feet ❑ meters Datum:
G9.b. Elevation of bottom of as-built lowest horizontal structural
member: ❑ feet ❑ meters Datum:
G10.a. BFE(or depth in Zone AO)of flooding at the building site: ❑feet ❑ meters Datum:
G10.b. Community's minimum elevation (or depth in Zone AO)
requirement for the lowest floor or lowest horizontal structural
member: ❑ feet ❑ meters Datum:
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.
Local Official's Name: Title:
NFIP Community Name:
Telephone: Ext.: Email:
Address:
City: State: ZIP Code:
Signature: Date:
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):
FEMA Form FF-206-FY-22-152(formerly 086-0-33) (8/23) Form Page 5 of 8
ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGES 1-11
Building Street Address(including Apt.,Unit, Suite,and/or Bldg. No.)or P.O. Route and Box No.: FOR INSURANCE COMPANY USE
112 E MASON LAKE DRIVE SOUTH
Policy Number:
City: GRAPEVIEW State: WA ZIP Code: 98546
Company NAIC Number:
SECTION H—BUILDING'S FIRST FLOOR HEIGHT INFORMATION FOR ALL ZONES
(SURVEY NOT REQUIRED) (FOR INSURANCE PURPOSES ONLY)
The property owner, owner's authorized representative,or local floodplain management official may complete Section H for all flood zones
to determine the building's first floor height for insurance purposes. Sections A, B, and I must also be completed. Enter heights to the
nearest tenth of a foot(nearest tenth of a meter in Puerto Rico). Reference the Foundation Type Diagrams(at the end of Section H
Instructions)and the appropriate Building Diagrams(at the end of Section 1 Instructions) to complete this section.
H1. Provide the height of the top of the floor(as indicated in Foundation Type Diagrams)above the Lowest Adjacent Grade(LAG):
a) For Building Diagrams 1A, 1 B,3, and 5-8.Top of bottom ❑ feet ❑ meters ❑ above the LAG
floor(include above-grade floors only for buildings with
crawlspaces or enclosure floors)is:
b) For Building Diagrams 2A, 26,4,and 6-9.Top of next ❑feet ❑ meters ❑ above the LAG
higher floor(i.e.,the floor above basement,crawlspace, or
enclosure floor) is:
H2. Is all Machinery and Equipment servicing the building(as listed in Item H2 instructions)elevated to or above the floor indicated by the
H2 arrow(shown in the Foundation Type Diagrams at end of Section H instructions)for the appropriate Building Diagram?
❑ Yes ❑ No
SECTION 1—PROPERTY OWNER(OR OWNER'S AUTHORIZED REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, and H must sign here. The statements in Sections
A, B, and H are correct to the best of my knowledge. Note: If the local floodplain management official completed Section H,they should
indicate in Item G2.b and sign Section G.
❑ Check here if attachments are provided(including required photos)and describe each attachment in the Comments area.
Property Owner or Owner's Authorized Representative Name:
Address:
City: State: ZIP Code:
Telephone: Ext.: Email:
Signature: Date:
Comments:
FEMA Form FF-206-FY-22-152(formerly 086-0-33)(8/23) Form Page 6 of 8
ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGES 1-11
BUILDING PHOTOGRAPHS
See Instructions for Item A6.
Building Street Address(including Apt., Unit, Suite,and/or Bldg. No.)or P.O. Route and Box No.: FOR INSURANCE COMPANY USE
112 E MASON LAKE DRIVE SOUTH
Policy Number:
City: GRAPEVIEW State: WA ZIP Code: 98546
Company NAIC Number:
Instructions: Insert below at least two and when possible four photographs showing each side of the building (for example, may only be
able to take front and back pictures of townhouses/rowhouses). Identify all photographs with the date taken and"Front View,""Rear View,"
"Right Side View,"or"Left Side View."Photographs must show the foundation.When flood openings are present, include at least one
close-up photograph of representative flood openings or vents,as indicated in Sections A8 and A9.
a
Photo One
Photo One Caption: Southeast and Northeast Sides 03-13-2024 Clear Photo
4.
Photo Two
Photo Two Caption: Southeast Side 03-13-2024 Clear Photo Two
FEMA Form FF-206-FY-22-152 (formerly 086-0-33) (8/23) Form Page 7 of 8
• ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGES 1-11
BUILDING PHOTOGRAPHS
Continuation Page
Building Street Address(including Apt.,Unit,Suite,and/or Bldg. No.)or P.O.Route and Box No.: FOR INSURANCE COMPANY USE
112 E MASON LAKE DRIVE SOUTH
Policy Number:
City: GRAPEVIEW State: WA ZIP Code: 98546
Company NAIC Number:
Insert the third and fourth photographs below. Identify all photographs with the date taken and"Front View,""Rear View," 'Right Side
View,"or"Left Side View."When flood openings are present, include at least one close-up photograph of representative flood openings or
vents,as indicated in Sections A8 and A9.
)
r
Photo Three
Photo Three Caption: Southeast and Southwest Sides 03-13-2024 Clear Photo Three
w
a
4-
Photo Four
Photo Four Caption: Northwest and Southwest Sides 03-13-2024 Clear Photo Four
FEMA Form FF-206-FY-22-152 (formerly 086-0-33) (8/23) Form Page 8 of 8