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Home My WebLink AboutElevation CertificateDEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency ELEVATION CERTIFICATE IMPORTANT: FOLLOW THE INSTRUCTIONS ON PAGES 9-16 OMB Control Number: 1660-0008 Expiration: 11)30/2018 Copy all pages of this Elevation Certificate and all attachments for(1) communityolllelal, (2) insurance agonticompany, and (21 building owner. SECTION A - PROPERTY INFORMATION FORM INSURANCE COMPANY USE Al. Building Owner's Name Jerred S Merriam Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 70 Winchester Company NAIC Number. City Rifle State CO Zip Code 81650 A3. Property Description Rifle Village South lot 2 A4. Building Use (e.g., Residential, A5 Latitude/Longitude: A6. Attach at least 2 photographs A7. Building Diagram Number AB. For a building with a a) Square footage of b) Number of permanent crawlspace or enclosure(s) above adjacent grade c) Total net area of flood d) Engineered flood (Lot and Block Numbers, Tax Parcel Number, Legal Description, block 1 Parcel Number 2177-202-09-011 Non -Residential, Addition, Accessory, etc -)Residential Lat 39-30-48 N Long.107-48-00 W Horizontal Daum: etc.) r NAD 1927 insurance, building with an attached footage of attached garage of permanent flood openings garage within grade area of flood openings flood openings? t? NAD 1983 garage: sq ft of the building if the Certificate is being used to obtain flood 1A crawlspace crawispace flood openings within openings openings? or enclosure(s): A9. For a or enclosure(s)NA sq ft a) Square in the None b) Number 1.0 foot in the attached above adjacent 1.0 foot in A8.b sq in c) Total net in A9.b sq in C Yes (i' No d) Engineered C Yes C No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION El. NFIP Community Name & Community Number 085078 Rifle 52. County Name 1B3. State CO Garfield B4. Map/Panel Number 1353 B5. Suffix D B6. FIRM Index Date Jun 15, 1973 B7. FIRM Panel Effective/ Revised DateAO Jan 3, 1986 58. Hood Zone(s) B9. Base Flood Elevation(s) (Zone AO, use base flood depth 1 foot B10. Indicate the source of the Base Flood Elevation (BFE) data or C FIS Profile q FIRM C Community Determined C Other/Source: 811. Indicate elevation datum used for BFE In Item 69: C NGVD '512. Is the building located in a Coastal Barrier Resources System Designation Date: C CBRS C OPA base flood depth entered in Item 59: 1929 (: NAVD 1988 C Other/Source: (CBRS) area or Otherwise Protected Area (CPA)? C Yes (i No SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: C Construction Drawings' C Building Under Construction' C Finished Construction 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- ' A new Elevation Certificate will be required when construction of the building Is complete. Benchmark Utilized: NGS Winchester Vertical Datum: 5305.76 Indicate elevation datum used for the C Other/Source: Datum used for building elevations must a) Top of bottom floor (including basement, b) Top of the next higher floor c) Bottom of the lowest horizontal structural d) Attached garage (top of slab) a) Lowest elevation of machinery or equipment (Describe type of equipment and location t) Lowest adjacent (finished) grade next g) Highest adjacent (finished) grade h) Lowest adjacent grade at lowest elevation structural support elevations in items a) through h) below. C NGVD 1929 (Z. NAVD 1988 Check the measurement used. (:-feet C meters C feet C meters C feet C meters C feet C- meters C feet C- meters r feet C meters ('-feet C meters {' feet C meters be the same as that used crawispace, or enclosure member (V Zones only) servicing the building in Comments) to building (LAG) next to building (HAG) of deck or stairs, including for the BFE. floor) 5375 - .0 NA - NA - NA - NA 5374 - .6 5377 - - .6 NA - FEMA Form 086-0-33 (7/15) Replaces all previous editions. Page 3 of 15 70 Winchester ELEVATION CERTIFICATE Rifle OMB Control Number: 1660-0008 Expiration: 11/30/2018 CO 81650 SECTION 0 -SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed end sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify .[hat the information on this Certificate represents my best efforts to interpret the data available. I 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 ❑ Check here if attachments. provided by a licensed land surveyor? (? Yes (— No • Certifiers Name Michael Langhorne License Number PLS 36572 ,. -� ,`.e yy '�...:7,,c,4,--/e: - w WSJ ,;7... �^ Title President Company Name Bookcliff SurveyServices Inc X nw `v:w •, a i a 4 4 • 'S► Address 136 East Third St City R'rfle State CO Zip Code 81650 s`t k "v.,� ad 1 '' avaaa. ,.. J'cf#v4 A'-. si Signature f L. V / r{al Date Feb 2, 2017 Telephone +1 (970) 625-1330 ‘4 ` Copy bothVVVsides of this Elevation Certificate for 1) community official, (2 insurance agent/company, and (3) building owner. Comments (including type of equipment and location , per C2(e), if applicable)" - r• Signature . � 44."7 (1/ — Date 2-4211// SECTION E - BUILDING ELEVATifIN I RMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOU SPE) For Zones AO and A (without BFE), complete Items El -ES. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, Band C. For Items El -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. El. 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, - C feat C meters ❑ above or ❑ below the HAG. or enclosure) is b) Top of bottom floor (including basement, crawlspace, - (feet r meters ❑above or ❑below the LAG. or enclosure) is 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 - C feet C meters ❑ above or ❑ below the HAG, E3. Attached garage (top of slab) is - r feet C meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and /or equipment servicing the building is- C feet C meters ❑ above or ❑ below the HAG. ES. 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? C Yes C No C' 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 or Owner's Authorized Representative's Name: Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Page 4 of 15 ELEVATION CERTIFICATE, page 3 BUILDING PHOTOGRAPHS See Instructions for Item A6. 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 P0. Route and Box No. 70 Wrn 4 - Policy Number: City State to ZIP Code 81fo ja Company NAIC Number: 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 flt on this page, use the Continuation Page. llllih.p lII1111111. it1; FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 4 BUILDING PHOTOGRAPHS Continuation Page 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. -70 /Air/KA es City State 60 ZIP Code B/6 Policy Number: Company NAIC Number: If submitting more photographs than will fit on the preceding page, affix the additional photographs below. 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. FEMA Form 086-0-33 (7/12) Replaces all previous editions.