No preview available
HomeMy WebLinkAboutElevation CertificateU.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008 Federal Emergency Management Agency Expiration Date: November 30, 2022 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 anent/cnmnmny anri (ql hi dlrlin SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE A1. Building Owner's Name Policy Number: Nathan and Karyn Simmons A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number: 16661 Highway 82 Access Road City State ZIP Code Carbondale Colorado 81623 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 2, Second Amended Plat Englund Moore Subdivision A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential A5. Latitude/Longitude: Lat. 39°24'13.04" Long. 107'08'17.24" 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. A7. Building Diagram Number 2A A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) 1995.00 sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b N/A sq in d) Engineered flood openings? ❑ Yes ❑X No A9. For a building with an attached garage: a) Square footage of attached garage 809.00 sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes FX� No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name B3. State 080205 Garfield Colorado B4. Map/Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) Date Effective/ Zone(s) (Zone AO, use Base Flood Depth) Revised Date 1880 B 12-15-1977 01-03-1986 A 6215 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 139: ❑ FIS Profile © FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 Z NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes R No Designation Date: ❑ CBRS ❑ OPA r-mvim corm 066-0-33 (i2ii9) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No 16661 Highway 82 Access Road Carbondale State ZIP Code Colorado 81623 OMB No. 1660-0008 Expiration Date: November 30, 2022 FOR INSURANCE COMP Policy Number: Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* Z 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, ARIA, AR/AE, AR/A1—A30, AR/AH, AR/AO. Complete Items C2.a—h below according to the building diagram specified in Item AT In Puerto Rico only, enter meters. Benchmark Utilized: Weishaar ((AC8638) Vertical Datum: 6205.3 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 Q NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support Check the measurement used. 6317.2 © feet ❑ meters 6323.2 © feet ❑ meters ❑ feet ❑ meters 6322.0 © feet ❑ meters 6317.2 feet ❑ meters 6321.2 feet ❑ meters 6323.6 © feet ❑ meters 6323.0 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. I certify that the information on this Certificate represents my best efforts to interpret the data available. l 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. ICertifier's Name License Number Jeffrey A Tuttle 33638 Owner Company Name Tuttle Surveying Services Address P.O. Box 983 Glenwood Springs Copy of f�agr oft 's Comments (incl ding In regards to Item-Aa State ZIP Code Colorado 81602 Date Telephone Ext. 08-30-2022 (970)928-9708 LE,� sit F LL� 33638 C oNq t L ANC and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. of equipment and location, per C2(e), if applicable) B are both interior drains in the crawlspace and exterior drains outside the crawlspace. FEMA Form 086-0-33 (12119) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHSSee Instructions for Item A6. OMB No. 1660-0008 Expiration Date: November 30, 2022 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: 16661 Highway 82 Access Road city State ZIP Code Company NAIC Number Carbondale Colorado 81623 If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken, "Front View" and 'Rear View' ,- and, if required, 'Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. is Photo One Caption � T e C% 2.z__ Clear Photo One r.. ,tr +is'n rY _ Cb Photo Two Caption FEMA Form 086-0-33 (12/19) Replaces all previous editions. Clear Photo Two Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS OMB No. 1660-0008 Continuation Pane --, • � — k .« I Vj Neplaces all previous editions. Form Page 6 of 6