HomeMy WebLinkAboutElevation Certificate
Land Surveyors
Planners
Valley Surveyin~~ Co., RA.
(952) 447-2570
Suite 230
16670 Franklin Trail S.E.
Prior Lake, Minnesota 55372
September lIlli, 2006
Don Pampuch
4295 Grainwood Circle NE
Prior Lake, MN 55372
RE: As-Built elevations
This is to certify that on September lIlli, 2006, I dlid under my direct supervision survey the
existing dwelling elevations of the residencl~ under construction located at 4295
Grainwood Circle NE, Prior Lake, Minnesota. And I further certify that the top of the
walkout foundation (house) is at elevation 913.80, the proposed lowest floor to be poured
on top with a typical thickness of 4" making the: lowest floor at elevation 914.13+\-. The
aforemention elevations being on NGVD'29 ADJ. datum.
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Scott M. Swanson, L.S.
Minnesota Registration Number 42309
File Number 9760
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FEM:A
NATIONAL FLOOD INSlIRANCE PROGRAM
ELEVATION CI~RTIFICATE
AND
INSTRUCTIONS
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE
OMS No. 1660-0008
Expires Februarv 28, 2009
Important: Read the instructions on pages 1-8.
~ SECTION A a PROPERTY INFORMATION
A1. Building Owner's Name " \
..l.)l"'I N ~~'--~
A2. Building S reet Address (i~9 Apt., Unit, SUite, andl r Bldg. No.) or P.O;l3Pute and Box No.
1.; . \.....'\,J.:)oo" ~
City f..,.~ 0 Q..... ~k ~N State ZIP Code cS?'b17
A3. p.roperty Description (Lot and BI~ck ~umbers, Tax Parcel Num er, LW' Desce~n, etc.) " I
Ll> ~-UU.I\ VV\\ '^ ~~~..
A4. Building Use (e.g~Sident~on-Resldential, Addition, Accessory, etc.) ,
A5. Latitude/Longitude: Lat. Long. Horizontal Datum: D NAD 1927 D NAD 1983
A6. Attach at least 2 photograph, of the building if the Certificate is beln!! used to obtain flood insurance.
A7. Building Diagram Number---L- ' '.
A8, For a building with a crawl space or enclosure{s), provide: A9. For a building with an attached garage, provide:
a) Square footage of crawl space or enclosure(s) __ sq ft a) Square footage of attached garage sq ft
b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage
enclosure{s) walls within 1.0 foot above adjacent grade _' walls within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b __ sq In c) Total net area of flood openings In A9.b
For Insurance Company Use:
Policy Number
Company NAIC Number
sqin
B4. Map/Panel Number
SECTION B - FLOOD INSURJ\NCE RATE MAP (FIRM) INFORMATION
I B3. State t'f\ ~
B9. Base Flood Elevation{s) (Zone
AO, use base flood depth)
B5. Suffix
l,
B10. Indicate the source of the Base Flood Elevation (BFE) data or base nood depth entered in Item B9.
o FIS Profile 0 FIRM ~mmunity Determined 0 Other (Describe)
B11. Indicate elevation datum used for BFE in Item B9: 0 NGVD 1929 0 NAVD 1988 0 Other (Describe)
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area {OPAl?
Designation Date [] CBRS DOPA
DYes
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: D Construction Drawings. uilding Under Construction. D Finished Construction
. A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations - Zones A1-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, ARIA, AR/AE, ARlA1-A30, AR/AH, ARlAO. Complete Items C2.a-g
below according to the building diagram specified in Item A7.
Benchmark Utilized
Conversion/Comments
1\ "i.~l~'~ ~~~.....t.\ c~u~~~ _ '\\~. !J~ ~e~mDurementused.
!)\"1)O!)'fatlt,a) -Top of bottom "'-or (including ba~ment, crawl space, or enclosJre floor) ~ \ ~ .a LrTeet meters (Puerto Rico only)
''" b) TOp of the next higher floor ~ 1.'1.. .LUHeE;t D meters (Puerto Rico only)
c) Bottom of the lowest horizontal structural member (V Zones onl;l) 0 feet 0 meters (Puerto Rico only)
d) Attached garage (top of slab) 0 feet 0 meters (Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building D feet D meters (Puerto Rico only)
(Describe type of equipment in Comments)
f) Lowest adjacent (finished) grade (LAG) D feet
g) Highest adjacent (finished) grade (HAG) D feet
Vertical Datum
D meters (Puerto Rico only)
D meters (Puerto Rico only)
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CI;RTIFICATION
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.
I understand that any false statement may be punishable by fine or implisonment under 18 U.S. Code, Section 1001.
o Check here If mments are provid
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Certifier's Name
'--\'-00 ~
License Number
F1!Lt\C:E
SE/.\L
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_ \ State N\~ . ZIP Code ~$~~
Date91/ /a" Telephone <\~'2- \.\~. '2.51'0
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See revl~rse side for continuation.
Replaces all previous editions