HomeMy WebLinkAboutElevation Certificate
.
e
.
- ./
Aug 03 99
R::Ian
Engineering,
Inc.
~"-v-- ~ . 3
.JiJ(th LJj(Jd Pcl
612-947-0117
11:38a
V.,). .&...' '00
liLLI, 4..... oJ..J
"."'\.'1.
U.l..,....'1...,'"
/0031
ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does not provide a waiver ot the flood insurance purchase requirement. This lorm is used only to
provide elevB\lon Inlormation necessary to en5Ure compliance with applicable community lloodp/ain management ordinances, to
dlllermlne the proper insurance premium rate, and/ollo support a request for a Letter 01 Map Amendmenl or Revision (LOMA or LOMRl.
Instrucllons tor completing thl8 form can be found on the tollowlng pagelS.
O.M.B. NO 3067.0077
E.pjrr:jMilyJr.I993
SECTION A PROPERTY INFORMATION
FOR INSURANCE COIoIPAN'I' USE
POLICY NU10laEA
8UIlDING OWNER'9 NAME.
~
STREET ADOFlESS (InctlolCllrog ApI.. UI'IiI, Sulto andlor Siel;. Number) OR P.O. ROuTE AND BOX NUMeER
ell; 03 CJ /l/OICTll f1/00D
on~eR OESCRIPTION (lo! ""d Block N~. IIr.U / / f ;f/ ot:1fIt.~ A.oAi -
CrN U'b7Z- ~ ~;:J
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
eOMP.N'I' ",.IC NUM8ER
ZIP CODE
Provide the following Irom the proper FIRM (See Instructions):
,. COMMUNITY NUMBER
2. PANEL NUtoA8.ER
3. SUFFI X
.. OATE Of flAM INDEX
5. FIRM ZONE
6. BASE FLOOD ELEVATION
(in AO Ion.... UN oac>!II)
;2 70432.-
;Jt>>. /1/ !?J7 , ;4E
'101- 7
7. Indlcats Ihe elellatlon datum system used on the FIRM fOf Base Flood Elevations (6FE): (saNGVD '29 0 Other (describe on beck)
B, Fer Zones A or V, wnere no BFnided on the FIRM. and the community has est.ed a BFE lor this building she, indicate
the community's BFE: I I I~,,~. leet NGVD (or other FlAM datum-see Section B, Item 7l.
000 3
c
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions, indlcate)he diagram number from the diagrams found on Pages 5 and 6 that besl
describes lt1e subject b"g's reference level I.
2(a). FIRM ZoneG Al-A30,~ AH, and A (with BFE). The top of the refanmce lellel floor from 1M selec1ed diagram i$ al an elevation
of I I (11 [121 .li;f13et NGVD (or othe( FIRM datum-see Section 8, Item 7),
(b). FlAM Zone, V1-V30, VE, and V (with BFE). The bonom of the lowest horizontal Slructural member 01 the reterence level from
the selected diagram, Is al an elellatlon of I I I I J I.U leet NGVO (or other FIRM datum-see SectJon B, Ilem 7).
(c). FIRM Zone A (wit/loUI BFE), The 1I00r used as Ihe relerence lellel trom the selected diagram is LU. U teel aboue 0 or
below 0 (check one) the highe" grade adjacent 10 the building. .
(d). FIRM Zone AO, Thelloor used as the referencalevel from the selectsd diagram is LU.U leet aOOve 0 or belOW 0 (check
one) !he highest grade adjscanl to the building. If no flood depth number is available. is the building's lowest lloor (reference
level) elevated in accordancs with the community's fioodpleln management ordinance? 0 Yes 0 No 0 Unknown
3. Indicate the elevation datum system used in determining the above reterence level 8levation5# NGVD '29 0 Other (~escribe
under CommonUi on Pago 2). (NOTE: If Ihe e/i!va/ion dB rum usBd in m99suring /he elevations Is dmerent than that used on
the FIRM (see Sac1ion B, lIem 7]. then converr the iitava/lons to the datum system used on the FIRM and show !he conversion
equation lJnd8r Comments on PSQe 2.) .
4. Elevalion reference mark used awaars on FIRM: 0 Yes r;1NO (See In8tructions on Page 4)
5. The referenca level elevation is based on:d actual construction 0 construdion drawings
(NOTE: Use of construction drllwlngsls ar{!~Slid if the building do's not yel have /fie reference IfJVfiJI floor In plac8. in which
CdS9 this certificate will only be v.lld for the building du,ing the course of construction. A post-construction Elevation Certificate
will b6 r>>qulmd oncs construction Is completB.) A.
6, The elevation ot the lowest grade immediately adlacent to the building is: 1'1 A III ~. t1j feet NGVD (or other FlAM datum-sse
Sadion B, lIem 7).
SECTION 0 COMMUNITY INFORMATION
1. IItne community oHicial responsible for verifying building elevallons &pecifies thallhe reference level indicated In Sllctlon C. Itllm 1
is not Ihe "loweSI f1cor' as dehned in the community's floodplain management ordinance, the elevation of the building's "lowest
floor" as defined by t/le ordlnence is: I I I I I I. U feel NGVD (or other FIRM datum-see Seclion 6, Item 7).
2. Date oltMe start of construction or 5ubs1antlal improvement
HMA Fa.... .,-:1', MAY 90
REPLACES ALL PREVIOU~ EDITIONS
SEE REVERSE SIDE FOR CONTINU.&TION
.
e
.
-~ "
Aug 03 99 f1:38a
R::Ian Engineering, Inc.
05/12/99 WED 14:53 FAX 6124474245
~..
CITY OF PRIOR LAKE
SECTION E CERTIFICATION
612-947-0117
F.2
Il1J UUq
This certificalion is 10 bg signed by a land surveyor, engineer, or archilecl who is authorized by slale or local law 10 cel1ily elevation
inlormation when Ihllelevation information for Zones A1-A30, AE, AH, A (with BFE),V1-V30,VE, and V (with BFE) is required.
Community officials: who are authorized by local law or ordinance to provide floodplain management Information, may Blso 6ign Ihe
car1ll1calion. In Ihe case 01 Zone5 AO and A (without a FEMA or community issued BFE), a building oNlcial, a property owner, or an
ownor':; representative may al$o sign the certification.
Reference level diagrams 6, 7 and 8 . Di$tlngulshing Fealures-If the caroller is unable 10 certily to breakawaylnon-breakaway wall.
enclosure size, location of servicing equipmenl, area use, wall openings, or unlinished area Fealure(s), then Iisllhe Fealure(s) nol
included in the certillcatlon under Comments below. The (jlagram number, Section C, IIem 1, must sfill be 8ntered.
I c8rtify mat the informaCion in S9Ctions Band C on Itlis c9rtificBte represents my best Bltorts to Interprer the data availablB.
I un~d thaT sny lalse statement may be punishable by fins or imcrisonmf1nr under 18 U. S. CIXf9, Section 100 ,.
ret'fl1 M-l2-t~ ~.t: M,N -ZZo7(
CERTIFIER'S N~ . ~ ^ ) -r=-tICENSE NUMBER (or Am. ~al'rJ
r12e-S +-'1 fVV 'CVlo,t\1 e.('r ~k-C; / f;rj-..JL
TITLE lo4.Dp V:l6kj_D(L,. COMPE6~1>~~~
AOORESS -1.l!..-/t.,.Lf CITY / /
. c........ P, /7 J'37
SIGNATURE I -- DATE ", .
IU J 5-s-34tfJ
ST...TE
Ulpl. -9-'17- //t:Jt)
PHONE
ZIP
Copies should be made of this Certificate ror: 1) community officIal, 2) Insurance agent/company. and 3) building owner.
COMMENTS,
ON
'LA.
Wlni
'A5fMENT
A V
ZONe' ZONE3
&AU
"000
ru"..n()llll
r',;~_ ~. "<",
.1 ~~;
FlOOO ?~~;;~~:.
k(w.1"1QH fiit"Eii",~~ ~NT
I LlVR , ORAD(
;:::::.;'!:.i;i';: ./:;;
.....Cl' :,:' CR.'.....""'.'
OA-oC " "'~~L
~ '
Ifj~,~l..~
ON PilES,
PlUOS. OM COlU....S
V
gONES
IRf~~h ' '.....RE"".l
' ~ \ I.fYEL
~; -~/
~Lr~ \\,~
\ '\ n...''''''
~I\ '\
~};':::' t j:I;....',.,.. ',;, ,\ ~""."t'"
. 't't' "'.; ,..;:~\:~:. :....~., l.~,'.,' ':'f:(~.~
i:i:!i~:!(!W?N:~:'~i(}i~!f,i,~n;'~~:,:;
..
lONES
The dIagrams Bbove Illustrate the points at which the elevations should be measured in A Zones and V Zones.
Elevations lor all A Zones should be measured at ltle lop of the reference lellelfloor.
Elevalions tor aU V Zones should be measurod at tho bottom 01 thlll IQwest horfzontal structural member,
Pig. 2