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HomeMy WebLinkAboutElevation Certificate 12. 1045 U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660 - 0008 National 1-7ood Insurance Program important: Read the instructions on pages 1 -9. Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Brendan O'NeiEll Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. Company NAIC Number: 15287 Fairbanks Trail NE City Prior Lake State MN ZIP Code 55372 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) portions of Lots 7 & 8, Maple Park Shore Acres (Tax Parcel ID 25- 036007 -0 & 25- 036007 -1) A4. Building Use (e.g.. Residential. Non - Residential, Addition, Accessory, etc.) residential A5. Latitude /Longitude: Lat. N 44.72780 Long. W 93.43240 Horizontal Datum: ❑ NAD 1927 0 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 1B A8. For a building with a crawtspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawtspace or enclosure(s) N/A sq ft a) Square footage of attached garage 868 sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent arade N/A within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes No d) Engineered flood openings? ❑ Yes ® No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name B3. State Prior Lake 270432 Scott Minnesota B4. Map /Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel I 88. Flood B9. Base Flood Elevation(s) (Zone 270432 -002 C November 19.1997 Effective /Revised Date i Zone(s) AO, use base flood depth) X & AE 909.43 NAVD8S B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 89. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other /Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ® NAVD 1988 ❑ Other /Source: 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date: ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings` ❑ Building Under Construction` 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, AR/A, AR /AE, AR/At -A30, AR/AH, AR/A0. Complete Items C2.a -h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: MN /DOT benchmark "Thumb" Vertical Datum: 980.795 NAVD88 Indicate elevation datum used for the elevations in items a) through h) below. 0 NGVD 1929 S. NAVD 1988 ❑ Other /Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 913.62 ® feet ❑ meters b) Top of the next higher floor 924.32 0 feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) NIA.__ ❑ feet ❑ meters d) Attached garage (top of slab) 913.09 ® feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 916.33 ® feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 912.08 LE feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 917.56 ® feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 912.54 E feet ❑ meters SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION t This certification is to be signed and sealed by a land surveyor. engineer. or architect authorized by law to certify elevation 1 information. 1 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 imprisonment under 18 US Code. Section 1001. ® Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ❑ Check here if attachments. licensed land surveyor? ® Yes ❑ No - Certifier's Name Mark D. Kemper, PLS License Number 18407 114' ryPe- Title President Company Name Kemper & Associates, Inc. ' <1 v Address 721 Old Hwy. 8 NW City New Brighton State MN ZIP Code 55112 Signature /' Date 5 -24 -2013 Telephone 651 - 631 -0351 FEMA Form 088 - -33 (7/12) See reverse side for continuation. Replaces all previous editions. '41 ELEVATION CERTIFICATE, page 2 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: 15287 Fairbanks Trail NE City Prior Lake State MN ZIP Code 55372 Company NAIC Number: SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments Lowest elevation of machinery or equipment is an electrical box near the southwest house corner, elevation of 916.33 (NAVD88). NOTE: BFE is reported to be 909.0 NGVD29 for Prior Lake. To convert to NAVD88 elevation add .43 BFE = 909.43 NAVD88 Signature Date May 24, 2013 SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE). complete Items E1 -E5. If the Certificate is intended to support a LOMA or LOMR -F request, complete Sections A,13, and C. For Items E1 -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. or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG, 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 ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and /or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. 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? ❑ Yes ❑ No ❑ 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's or Owner's Authorized Representative's Name Mark D. Kemper, PLS Kemper & Associates, Inc. Address 721 Old Hwy. 8 NW • City New Brighton State MN ZIP Code 55112 Signature '. Date May 24, 2013 Telephone 651- 631 -0351 Comments NOT : Measurement aken 15 foot east & south of the new house are above the 909.0 NGVD29 elevation required by the City (this is towards Prior Lake) ® Check here if attachments. SECTION G - COMMUNITY INFORMATION (OPTIONAL) he local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G f this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8-G 10. In Puerto Rico only, enter meters. ;1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) ;2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA- issued or community- issued BFE) or Zone AO. ;3. ❑ The following information (Items G4 -G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued 06. Date Certificate Of Compliance /Occupancy Issued 37. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement ;8. Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters Datum i9. BFE or On Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum ;10. Community's design flood elevation: ❑ feet ❑ meters Datum — - -- -- - - - - -- Local Official's Name - -- -- - - - - -- Title - - - � - -- - - -- -- - - - - -- - Community Name Telephone Signature Date Comments ❑ Check here if attachments. EMA Form 086 -0 -33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 4 Building Photographs Continuation Page I MPORTANT: 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: 15287 Fairbanks Trail NE City Prior Lake State MN ZIP Code 55372 Company NAlC 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. 4 R > . N 1 4 , . , rr r r 4 �c �! a V---i } 7-4-, ?' t: 4 . , .. A i +, . ,- ,,„;,. , . . t I �r • ... . ,a 4 _ • r .,. . • •... ,,,.• , .,, Ars i ' ■ FEMA Form 086 -0 -33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Rem 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 P.O. Route and Box No. Policy Number: 15287 Fairbanks Trail NE City Prior Lake State MN ZIP Code 55372 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 fit on this page, use the Continuation Page. r � i ;t "'d 4 or I 100/ , .,,.' - . 4-...: ' ''''' ';C *1 '?,;:.,1 ' a "r i a x , a ' ti. ,, a X ., s q wx .r r � 9 � y � u 1 4 FEMA Form 086 - - 33 (7/12) Replaces all previous editions.