HomeMy WebLinkAboutElevation CertificateU.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Federai Emergency Management Agency ExDires FebruBrv 28. 2009
National Flood Insurance Program Important: Read the instructions on pages 1-8.
SECTION A- PROPERTY INFORMATION For Insurance Company Use:
A1. Building Owners Name Matt Tofanelli Policy Number
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. I Company NAIC Number I
15731 West Avenue SE
City Prior Lake State MN ZIP Code 55372
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Lots 1, 2 and 3, POINT BEAUTIFUL, Scott County, Minnesota. (PID#250410010)
A4. Building Use (e.g., Residential, Non-Residential, AddRion, Accessory, etc.) Residential
A5. Latitude/Longitude: Lat. 44.431516 Long. 93.255000 Horizontal Datum: ^ NAD 1927 x NAD 1983
A6. Attach at least 2 photographs of the building if the Cert~cate is being used to obtain flood insurance.
A7. Building Diagram Number 3
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) wafls within 1.0 foot above adjacent grade wa!!s 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 sq in
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name 8~ Commu~ity Number 62. County Name 63. State
Prior Lake 270432 Scott Minnesota
B4. Map/Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel 68. Flood 69. Base Flood Elevation(s) (Zone
Date Effective/Revised Date Zone(s) AO, use base flood depth)
270432 0004 C 12/20l74 11/19/97 AE ~ X500 909.9
610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69.
^ FIS Profile ^ FIRM X Community Determined ^ Other (Describe)
B11. Indicate elevation datum used for BFE in Item 69: X NGVD 1929 ^ NAVD 1988 ^ Other (Describe)
612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ^Yes X No
Designation Date ^ CBRS ^ OPA
SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C7. Building elevations are based on: X Construction Drawings" X Building Under Construdion* Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations - Zo.^.es A1-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-g
below according to the building diagram specified in Item A7.
Benchmark Utilized ' Vertical Datum NGVD 1929
Conversion/Comments
Chedc the measurement used.
a) Top of bottom floor (including basement, crawl space, or enclosure floor)_ 909.9 X feet ^ meters (Puerto Rico only)
b) Top of the next higher floor 912.9 X feet ^ meters (Puerto Rico only)
c) Bottom of the lowest horizontal structural member (V Zones only) ^ feet ^ meters (Puerto Rico only)
d) Attached garage (top of slab) 923.4 X feet ^ meters (Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building ^ feet ^ meters (Puerto Rico only)
(Describe type of equipment in Comments)
~ Lowest adjacent (fnished) grade (LAG) feet ^ meters (Puerto Rico only)
g) Highest adjacent (finished) grade (HAG) feet 0 meters (PueRo Rico only)
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
infortnation. I cefify that the infom-ation on this Certificate nspresents my best efl'orts to inteipiet the data available.
l understand that any false statement may be punishab/e by fine or imprisonment under 18 U. S. Code, Section 1001. I
X Check here 'rf comments are provided on badc of form.
Certifier's Name Scott M. Swanson License Number
Title PrBSident Company Name Valley Sunreying Co., P.A.
Address 16670 Franklin Trail SE Cily Prior Lake State MN ZIP Code 55372
Signature
Date 03/76/09 Tel@phOne (952] 447-Z570