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Home My WebLink AboutElevation Certificate - BLD Permit / Conditions - 10/1/2012 U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency Management Agency I Expires March 31,2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION For Insurance Company Use: Al. Building Owner's Name Elizabeth Watson Policy Number A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number 2482 NE Old Belfair Highway City Belfair State WA ZIP Code 98528 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Tract B of Mason County Short Plat No. 1230 Parcel No. 12316-23-90010 A4. Building Use(e.g., Residential,Non-Residential,Addition,Accessory,etc.)Residential A5. Latitude/Longitude: Lat.47.48711' Long. 122.82007' 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. AT Building Diagram Number 8 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 900 sq ft a) Square footage of attached garage 980 sq ft b) No.of permanent flood openings in the crawlspace or b) No.of permanent flood openings in the attached garage enclosure(s)within 1.0 foot above adjacent grade 3 within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b 121 sq in c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes ® No SECTION B- FLOOD INSURANCE RATE MAP(FIRM)INFORMATION Bl.NFIP Community Name&Community Number B2.County Name 63-State MASON COUNTY,WASHINGTON 530115 1 MASON COUNTY WASHINGTON B4. Map/Panel Number B5.Suffix B6.FIRM Index B7. FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone 0070 C Date Effective/Revised Date Zone(s) AO,use base flood depth) 12-8-98 5-17-88 C 88A 310. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other(Describe) 311. Indicate elevation datum used for BFE in Item B9: 123 NGVD 1929 ❑ NAVD 1988 ❑ Other(Describe) 312. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes ® No Designation Date ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) ;1. 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. ,2. Elevations-Zones Al-A30,AE,AH,A(with BFE),VE,Vi-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 AT Use the same datum as the BFE. Benchmark Utilized PC3N Vertical Datum NAVD 1988 Conversion/Comments NGVD 1929=NAVD 1988-3.44 Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosure floor)87.8 ®feet ❑meters(Puerto Rico only) b) Top of the next higher floor 91.5 ®feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) N/A. ❑feet ❑meters(Puerto Rico only) d) Attached garage(top of slab) 89.9 ❑feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 88.9 ®feet ❑meters(Puerto Rica only) (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 88.5 ®feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 90.9 ®feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs,including 88.8 0 feet ❑meters(Puerto Rico only) structural support 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. I certify that the information on this Certificate represents my best efforts to interpret the data available. �';e0v SfU,�•,tj' I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a P ly- licensed land surveyor? ® Yes ❑ No -o= S .- A: O Certifier's Name Daniel B.Johnson License Number 28408 �rs••'RFofstttrt��Q:�<v Title Managing Director Company Name Aspen Land Surveying LLC ��•• . ••'SJ n Address P.O x 124 City Vaughn State WA ZIP Code 98394 NFL LAty Signature D e 10-1-12 Telephone 253-303-0270 FMA Fnrnn R1-31 Mart1Q CPP raw-rea eirlo fnr r•nn}innatinn Renlorne�11 nroviniic nAiti- 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 2482 NE Old Belfair Highway City Belfair State WA ZIP Code 98528 Company NAIC Number SECTION D -SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner. Comments Residence is(just barely)above Base Flood Elevation and outside of Flood Zone B. C2.e): Heat Signature 1 Date 10-1-12 ❑ Check here if attachments SECTION E-BUILD G ELEVATION INFORMATION(SURVEY NOT 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 El-E4,use natural grade,if available. Check the measurement used. In Puerto Rico only, enter meters. Ell. 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 ❑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 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams)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 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. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments -- ^— - ❑Check here if attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) ne 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), id G of this Elevation Certificate. Complete the applicable item(s)and sign below. Check the measurement used in Items G8 and G9. 1.❑ 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.) 2.❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. 3.❑ The following information(Items G4-G9)is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued 7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement 8. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑meters(PR)Datum 9. BFE or(in Zone AO)depth of flooding at the building site: ❑ feet ❑meters(PR)Datum 10.Community's design flood elevation ❑feet ❑meters(PR)Datum -oval Official's Name Title community Name Telephone Signature Date comments ❑Check here if attachments GRAA P—m 91211 11Aor no Ranlaroc all nrAvini m ariifinnc Building Photographs Building Street Address: 2482 NE Old Belfair Highway, Belfair, WA 98528 a yam,� � �,,g� ..�, •`�.r�i o-� - 7. w "" ;I?�-;,.�.7k..�F:?.::t..i.r-1M.+�":•�+F�+i�r+.,'�:-•^ri'ww"'" _ • `�' "S`+P�t�4. :fr�i-S:.iM.•"'�+r:.''�,- r�.�w.� '��^`'A;gst SOUTH & EAST SIDES 10-1-12 ir. •• ' . 7 WEST SIDE 10-1-12 Building Photographs continued Building Street Address: 2482 NE Old Belfair Highway, Belfair, WA 98528 WEST SIDE 10-1-12 411 I` .i EAST SIDE & UNION RIVER 10-1-12