HomeMy WebLinkAboutBLD-19-493 01xaa/ 7/nal(
ONE & TWO FAMILY ONLY- BUILDING PERMIT
• Town of Yarmouth Building Departmentni"-
1146 Route 28, South Yarmouth,MA 02664-4492 h64
508-398-2231 ext. 1261 Fax 508-398-0836
Massachusetts State Building Code,780 CMR
Building Permit Application To Construct, Repair, Renovate Or Demolish
a One-or Thvo-Family Dwelling
This Section For Official Use Only '
Building PermitNuntber.$/J)'/q (�72)'• Date Applied: .
. I sr^ Se..... ..• . c.:7-.12.(.., .. • . .. • D-11-.7.),F
•
Building Official(Print Name) • Signature,. .. . . , Date
' j rYlgmete,) 61 , .SECTION 1:SITE INFORMATION . .
1.1 Proortybeat. ddress: goo_ w es 9Ornvidi7 1.2 Assessors Map&Parcel Numbers_
/erg
Mats this an accepte treet?yes y no • Map Number Parcel Number
1.3 XonimInformatio • 1.4 o e imensions:
- .S , `�izr - mi/y jr P 90
Zoning District Propo Use Lot Area(sq ft) Frontage(ft).
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
30. b e9 / al. 6
1.6 Waty Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public LQ Private❑ Zone: lig Outside Flood Zone? Municipal❑ On site disposal system lll•
Check if yes❑
' . SECTION 21 PROPERTYOWNERSHIPt '
2.1 wnernafRecord p�G Walpole in") . 020R/
-�Y}HY) J�iS► •
Name(Print) City,State,ZIP /
1/4S0 treah ,Sfi- &#ia93-ypo3 &7tho4jC,Dis'1P/o. Com
No.and Street Telephone Email ess
SEFTION 3:DESCRIPTION OF FROPOSED WORK(check.all that apply)
New Construction 6 I Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition 0 I Accessory Bldg.0 Number of Units_ Other 0 Specify: .
BriefDesyiiption of Proposed Work'': /VO4) s 1O le i° I j//q 3 bed m770 h'1
Ofht • v �J
. . • SECTION'4iBST-MATED CONSTRUCTION COSTS. ;. .'.'
Item Estimated Casts: ` - • ; . •
(Labor and Materials) _ Official lTse Only, .,
1.Building CO .1:Budding Penitit Fee:•$\ of Indicate how feels determined:
$ • . IJ �.
2.Electrical • $ I n CDS•
Standard City/Town Application Fee :.. :, ' '•' 'r.; .
/ ❑To•tal Project•Cost3 tem_6)x multiplier... . .x -
3.Plumbing $ /h/ �j,so 2: Other Fees: $ • czi . . —T
4.Mechanical / /r71 1 List '
(HVAC) $ J ✓w "''
5.Mechanical (Fire
Suppression) $ TotalAIlFeesi$ , .
QC -m'Check • • Check Amount: CashAmmmt_
6.Total Project Cost $3/0J Oa 0 C p PaidPull . .. Piszatstanding 3al2nca�bud: roptc.Ic 0
- tC-1/4‘ L).
JUL 2 3 2018
Bt 1 'i if EPA -
lir.
SECTIONS:.CONSTRUCTION SERVICES .
.i 5.1 Construction Supervisor License(CSL)
4 . License Number Expiration Date .
Name of CSL Holder
List CSL Type(see below)
No.and Street : Type . Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted I&l Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Bunting Appliances
I Insulation
Telephone Email address D Demolition
. 5.2 Registered Home Improvement Contractor(MC)
BIC Company Name or BIC Registrant Name BIC Registration Number Expirarion Date
No,and Street Email address .
City/Town,State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(L4LG.L.c.152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
• this affidavit will result in the denial of the Issuance of the building permit
Signed Affidavit Attached? Yes ❑ No ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHFN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT .
I,as Owner of the subject property,hereby authorize
to act on my behalf;in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Sigtature) Date
• • SECTION 7b; OWNER'OR AuTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
con ' ed in this application is true and accurate to the best of my knowledge and understanding.
Print Own 's or Authorize/Agent's Name(Electronic Signature) • Date
• • NOTES:
I. An Owner who obtains a building permit to do hisiher own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(MC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A Other important information on the HIC Program can be found at
www.mass.zov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dns
2. When substantial work' la ned,provide the information below:
Total floor area(sq.ft) ( (including garage,finished basement/attics,decks or porch)
Gross living area(sq.R) Habitable room count 7
Number of fireplaces (3 Number of bedrooms 3
Number of bathrooms DS Number of half/baths /
Type of heating system owl Number of decks/porches a
Type of cooling system a Enclosed Open 2.
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
- 1=67 Department oflndustrialAccidents
• E•_v�`Y 1 Congress Street,Suite 100
. Boston, MA 02114-2017
%• .4�.a www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrtclans/Plumbers.
TO BE FILED WITH THE FERMI i i LNG AUTHORITY.
Applicant Information Please Print Legibly
(�
Name (Business/Organization/Individual): \ \ k\c
Address: S i b ‘\d c\N, 1
City/State/Zip:\A%,\ (\\'-t V\ (Y),n%\Phone ti: Q:•V\ --1O% — _- ___( %--
Are you an employer?Cheek the appropriate box:
Type of project(required):
1.01 am a employer with employees(full and/or part-time).
7. 9 New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in
any capacity.[No workers'comp.insurance required.] $. ❑ Remodeling
3. I am a homeowner doing all work myself.[No workers'comp.insurance requhed.]r 9. ❑Demolition
4. I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition
ensure that all contractor either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 12.0 Plumbing repairs or additions
These sub-contactors have employees and have workers'comp.insurance.: 13.❑Roof repairs
ur
6.9 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box*1 must also hll out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing ell work and then hire outside contractors must submit a new affidavit indicating such.
?Contactors that check this box must attached an additional sheet showing the name Of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
/am an employer that is providing workers'compensation insurance jor my employees. Below is the policy and job site
information.
Insurance Company Name: '
Policy#or Self-ins.Lic.4: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby c:tfy tinder the pains and penalties of perjury that the information provided above is true and correct
Sisnature— Date: t%\\QI
Phone#:
Official use only. Do not write in this area, to be completed by city or town officiaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone m:
04 Y TOWN OF YARMOUTH
r . •
BUILDING DEPARTMENT
^^ ? 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261
•
• HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE: 123120I •
� 2 r
JOB LOCATION: NAME f S TET
S SECTION OF TOWN
"HOMEOWNER" fiVlth011`1 Do P i() on-2,9 3 - 9z Sante
NAME HO r PHONE WORK PHONE
PRESENT MAILING ADDRESS 1) A 0 I J .
Qb P . 144 21)
CITY OR TO �3TATE COD
The current exemption for 'Homeowner' was extended to include owner—occupied dwellings of one or two units
and to allow such homeowners to engage an individual for hire who does not possess a license,provided that such
homeowner shall act as supervisor. (State Building Code Section 110 R5.1.3.1)
Definition of Homeowner.
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is or is intended to
be, a one or two fn roily attached or detached sR acture assessory to such use and/or farm structures. A person who
constructs more than one home in a two-year period shall not be considered a homeowner,such"homeowner'shall
submit to the building official,on a form acceptable to the building official,that he/she shall be responsible for all
such work performed under the building permit. (Section 110 R5.1.3.1)
The undersigned 'homeowner' assumes responsibility for compliance with the State Building Code and other
applicable codes,by-laws,rules and regulations.
The undersigned 'homeowner' certifies that he / she understands the Town of Yarmouth Building Department
minimum inspection procedures and requirements and that he / she will comply with said procedures and
requirements.
HOMEOWNER"S SIGNATURE �i\�
APPROVAL OF BUILDING OFFICIAL
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL
Ch.142. Yes No
If you have checked vesplease indicate the type coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity Bond
OWNER'S INSURANCE WAIVER.: I am aware that the licensee does not have the insurance coverage requiredby
Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement
Check one:
Signature of Owner or Owner's Agent Owner Agent
h:homeownrlicexemp
•
• Information and Instructions ' .
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
• Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire,
express or implied,oral or written!'
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§250(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contact for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary, supply sub-contractors)name(s),address(es) and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are hot required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
• Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant
. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (cry or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit
•
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, NLA 02114-2017
Tel. r 617-7274900 ext. 7406 or 1-877-NLASS AFE
Fax t 617-727-7749
Revised 02-23-15 tiwvw.mass.gov/dia
° TOWN OF YARMOUTH
t ° BUILDING DEPARTMENT
F � � € 1146 Route 28,South Yarmouth,MA 02664
sieg. 508-398-2231 ext. 1261 Fax 508-398-0836
•
•
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 1113,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at bOWcstd . We(h rn
wo Ad
Is to be disposed of at the following location: , 1.. \\\\PCI.NSNK
.
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
\ \* 1\1\.-1)1\S
Signature of Application Date
Permit No.
v\
of_Vgk TOWN OF YARMOUTH
.-
3E;s "' 'c HEALTH DEPARTMENT
o s *lei
•
�\altPERMIT APPLICATION SIGN�, 1OFF TRANSMITTAL SHEET
To be completed by Applicant: (17 / ,k lin 9/- �,xl�S�)
Building Site Location: :taghr/7 _^Pczt7, ILJe S* Mr'/ tuft?
Proposed Improvement: A ' A ✓_ .� / 7 �s 1 5 di f
home' 4
Applicant: An on3 //,DiSip"Q / Tel.No.: �/ o?93 '- 9cROS
Address: 53O NoI' / cS% . , �i(,(�/P�Q m/9 Cflh ate Filed: �/0R,3/o�Urnf—
**Ifyou would like e-maile- notification of sign off please provide e-mail address: am-hony e.. svio n CQ
Owner Name: Anyhow 4 .D/•si�/Q `J
VV`` � 7tner
Owner Address: 530 /Vt-'k ,0- TeL No.:6l 7-49-3_7a25
25
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
Note:Floor plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: A U al (XJil DATE: 7--21-70
PLEASE NOTE _ •
COM1y1ENTS/CONDITI0 ecaf -(€ Mehl/
; e 14a
feu' ' L� `tt-
LLS. DEPARTMENT OF HOMELAND SECURITY OMB No.1660-0008
Federal Emergency Management Agency Expiration Date:November 30,2018
National Flood Insurance Program
ELEVATION CERTIFICATE
Important Follow the Instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for(1)community official,(2)insurance agent/company,and(3)building owner.
SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name Policy Number.
Anthony Dislplo
A2. Building Street Address(Including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Company NAIC Number.
Box No.
47 Franklin St Ext
City State ZIP Code
West Yarmouth Massachusetts 02673 '
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Map 22 Parcel 215.2
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) Residential
A5. Latitude/Longitude: Let. 41'38'35.42" Long. 70°14'38.30" Horizontal Datum: 0 NAD 1927 ❑x 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 crawlspace or enclosure(s):
a) Square footage of crawlspace or enciosure(s) 1,080 sq ft
b) Number of permanent flood openings In the crawlspace or enclosure(s)within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b sq In
d) Engineered flood openings? 0 Yes 0 No
A9.For a building with an attached garage:
a) Square footage of attached garage sq ft
b) Number of permanent flood openings In the attached garage within 1.0 foot above adjacent grade
c) Total net area of flood openings In A9.b sq In
d) Engineered flood openings? 0 Yes 0 No
SECTION B—FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP Community Name&Community Number 82.County Name B3. State
Yarmouth 250015 Bamstable Massachusetts
B4.Map/Panel 85.Suffix B8. FIRM Index B7.FIRM Panel B8.Flood Zone(s) B9.Base Flood Elevation(s)
Number Date Effective/ (Zone AO,use Base
Revised Date Flood Depth)
25001C0588J J 07/16/2014 07/16/2014 AE EL 11
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered In Item 89:
0 FIS Profile ❑x FIRM 0 Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item 139: 0 NGVD 1929 ❑x NAVD 1988 ❑ Other/Source:
B12. Is the building located In a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? 0 Yes 0 No
Designation Date: 0 CBRS 0 OPA
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 1 of 6
ELEVATION CERTIFICATE OMB No.1660-0008
Expiration Date:November 30,2018
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.
47 Franklin St Ext
City • State ZIP Code Company NAIC Number
West Yarmouth Massachusetts 02673
SECTION C—BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
Cl. Building elevations are based on: ❑x Construction Drawings* ❑Building Under Construction• 0 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,ARAE,AR/A1—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: RTK GPS PER MTS NETWORK Vertical Datum:NAVD 88
Indicate elevation datum used for the elevations In items a)through h)below.
❑ NGVD 1929 ❑x NAVD 1988 0 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) 13,5 ❑x feet 0 meters
b) Top of the next higher floor 23 5 ❑x feet
❑ meters
c) Bottom of the lowest horizontal structural member(V Zones only) N/A ❑x feet 0 meters
d) Attached garage(top of slab) N/A ❑x feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 13. 5 ❑x feet ❑ meters
(Describe type of equipment and location In Comments)
f) Lowest adjacent(finished)grade next to building(LAG) 12,0 ( feet 0 meters
g) Highest adjacent(finished)grade next to building(HAG) 12,7 ❑x feet 0 meters
h) Lowest adjacent grade at lowest elevation of deck or stairs,Including 12 0 ID feet 0 meters
structural support
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 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 U.S.Code, Section 1001.
Were latitude and longitude In Section A provided by a licensed land surveyor? 0 Yes 0 No 0 Check here if attachments.
Certfier's Name License Number
Daniel A.Ojala 40980
Title ��,tH of du
Prof.CMI Engineer,Prof.Land Surveyor DANIEL
Company Name § PIacSt "
Down Cape Engineering Inc. ALA w
Address E0980 w
939 Main Street \ i o�Ess%o`'
\o SURVct
City State ZIP Code
Yarmouthport Massachusetts 02675
SignatureDate Telephone
1 �� 1."(„y— 17 (508)382-4541
Copy all pa its Elevation Certificate and aliiattachments for(1)community official,(2)Insurance agent/company,and(3)building owner.
Comments(Including type of equipment and location,per C2(e),if applicable)
Vertical datum is NAVD88 from MTS RTK GPS.All machinery and equipment Is to be located at or above the first floor at elevation 13.5
SAA., s,s. P'.,., .044 r-.v. -1./ti,/1 G by D cc,tr+c.. i 0%.it 13-184
FEMA Form 088-0-33(7/15) Replaces all previous editions. Form Page 2 of 8
ELEVATION CERTIFICATE OMB No.1660-0008
Expiration Date:November 30,2018
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.
47 Franklin St Ext
City State ZIP Code Company NAIC Number
West Yarmouth Massachusetts 02673
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 El—E5.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,or enclosure)is ❑feet ❑meters ❑above or 0 below the HAG.
b) Top of bottom floor(including basement,
crawlspace,or enclosure)Is •
0 feet 0 meters 0 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 1-2 of Instructions),
the next higher floor(elevation C2.b In
the diagrams)of the building Is 0 feet 0 meters 0 above or 0 below the HAG.
E3. Attached garage(top of slab)is ❑feet 0 meters 0 above or ❑below the HAG.
E4. Top of platform of machinery and/or equipment
servicing the building Is •
0 feet 0 meters 0 above or 0 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? 0 Yes ❑ No 0 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
•
0 Check here if attachments.
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 3 of 6
ELEVATION CERTIFICATE OMB No.1 ate:Nob
Expiration Date:November 30,2018
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.
47 Franklin St Ext
City State ZIP Code Company NAIC Number
West Yarmouth Massachusetts 02673
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The 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 of this Elevation Certificate.Complete the applicable kem(s)and sign below.Check the measurement
used in Items G8-G10.In Puerto Rico only,enter meters.
01. ❑ 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.)
02. 0 A community official completed Section E for a building located In Zone A(without a FEMA-issued or community-Issued BFE)
or Zone AO.
G3. ❑ The following Information(Items 04-G10)Is provided for community floodplain management purposes.
34. Permit Number 05. Date Permit Issued 06. Date Certificate of
Compllance/Occupancy Issued
G7. This permit has been Issued for. ❑New Construction ❑Substantial Improvement
G8. Elevation of as-built lowest floor(Including basement)
of the building: ❑feet ❑ meters Datum
G9. BFE or(in Zone AO)depth of flooding at the building site: 0 feet ❑ meters Datum
G10. Community's design flood elevation: ❑feet ❑ meters Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments(including type of equipment and location,per C2(e),if applicable)
0 Check here If attachments.
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 4 of 8
BUILDING PHOTOGRAPHS OMB No.1660-0008
ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date:November 30,2018
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.
47 Franklin St Ext
City State ZIP Code Company NAIC Number
West Yarmouth Massachusetts 02673
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.
•
Photo One
Photo Ore
Photo One Caption
•
Photo Two
Photo TVs
Photo Two Caption
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 5 of 6
• BUILDING PHOTOGRAPHS OMB No.1660-0008
ELEVATION CERTIFICATE Continuation Page Expiration Date:November 30,2018
• 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:
47 Franklin St Ext
City State ZIP Code Company NATO Number
West Yarmouth Massachusetts 02873
•
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 M.
Photo One
Photo On
Photo One Caption
Photo Two
Phoiowa
Photo Two Caption
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 8 of 6
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FEMA
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
AND
INSTRUCTIONS
2015 EDITION
OMB No. 1660-0008
Expiration Date:November 30,2018
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE AND INSTRUCTIONS
Paperwork Reduction Act Notice
Public reporting burden for this data collection is estimated to average 3.75 hours per response.The burden estimate includes the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
submitting this form. You are not required to respond to this collection of information unless a valid OMB control number is
displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the
burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency,
1800 South Bell Street, Arlington, VA 20598-3005, Paperwork Reduction Project (1660-0008). NOTE: Do not send your
completed form to this address.
Privacy Act Statement
Authority:Title 44 CFR§61.7 and 61.8.
Principal Purpose(s):This information Is being collected for the primary purpose of estimating the risMpremium rates necessary
to provide flood insurance for new or substantially improved structures in designated Special Flood Hazard Areas.
Routine Use(s):The Information on this form may be disclosed as generally permitted under 5 U.S.C.§552a(b)of the Privacy Act
of 1974, as amended. This includes using this Information as necessary and authorized by the routine uses published In DHS/
FEMA-003—National Flood Insurance Program Files System or Records Notice 73 Fed. Reg. 77747(December 19,2008); DHS/
FEMA/NFIP/LOMA-1 —National Flood Insurance Program (NFIP) Letter of Map Amendment(LOMA)System of Records Notice 71
Fed.Reg.7990(February 15,2006);and upon written request,written consent,by agreement,or as required by law.
Disclosure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may
result in the inability to obtain flood insurance through the National Flood Insurance Program or the applicant may be subject to
higher premium rates for flood Insurance.Information will only be released as permitted by law.
Purpose of the Elevation Certificate
The Elevation Certificate Is an important administrative tool of the National Flood insurance Program (NFIP). It is to be used to
provide elevation Information necessary to ensure compliance with community floodplain management ordinances, to determine•
the proper insurance premium rate, and to support a request for a Letter of Map Amendment(LOMA) or Letter of Map Revision
based on fill(LOMR-F).
The Elevation Certificate is required in order to properly rate Post-FIRM buildings,which are buildings constructed after publication
of the Flood Insurance Rate Map (FIRM), located in flood Insurance Zones A1—A30,AE,AH,A(with BFE), VE,V1—V30, V(with
BFE),AR,AR/A,ARAE,AR/A1—A30,AR/AH, and AR/A0. The Elevation Certificate is not required for Pre-FIRM buildings unless
the building is being rated under the optional Post-FIRM flood insurance rules.
As part of the agreement for making flood Insurance available In a community,the NFIP requires the community to adopt floodplain
management regulations that specify minimum requirements for reducing flood losses. One such requirement Is for the community
to obtain the elevation of the lowest floor (including basement) of all new and substantially improved buildings, and maintain a
record of such information.The Elevation Certificate provides a way for a community to document compliance with the community's
floodplain management ordinance.
Use of this certificate does not provide a waiver of the flood Insurance purchase requirement Only a LOMA or LOMR-F from the
Federal Emergency Management Agency(FEMA) can amend the FIRM and remove the Federal mandate for a lending institution
to require the purchase of flood Insurance. However, the lending institution has the option of requiring flood Insurance even if a
LOMA/LOMR-F has been issued by FEMA.The Elevation Certificate may be used to support a LOMA or LOMR-F request. Lowest
floor and lowest adjacent grade elevations certified by a surveyor or engineer will be required if the certificate is used to support a
LOMA or LOMR-F request. A LOMA or LOMR-F request must be submitted with either a completed FEMA MT-EZ or MT-1
package,whichever Is appropriate.
This certificate is used only to certify building elevations.A separate certificate is required for floodproofing. Under the NFIP, non-'
residential buildings can be floodproofed up to or above the Base Flood Elevation (BFE).A floodproofed building is a building that
has been designed and constructed to be watertight (substantially impermeable to floodwaters) below the BFE. Floodproofing of
residential buildings is not permitted under the NFIP unless FEMA has granted the community an exception for residential
floodproofed basements. The community must adopt standards for design and construction of floodproofed basements before
FEMA will grant a basement exception. For both floodproofed non-residential buildings and residential floodproofed,basements in
communities that have been granted an exception by FEMA,a floodproofing certificate Is required.
Additional guidance can be found in FEMA Publication 467-1, Floodplain Management Bulletin: Elevation Certificate, available on
FEMA's website at tittps://www fema.gov/media-library/assets/documents/3539?id=1727
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...,�,.. VI I NJIVILLflh\U VLVVIV I OMB No. 1660-0008
Federal Emergency Management Agency Expiration Date:November 30,20181
National Flood Insurance Program
ELEVATION CERTIFICATE
• Important: Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for(1)community official,(2)insurance agent/company,and(3)building owner.
SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owners Name Policy Number.
A2. Building Street Address(including Apt.,Unit, Suite,and/or Bldg. No.)or P.O.Route and
Box No. Company NAIL Number
City State ZIP Code
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory,etc.)
A5. Latitude/Longitude: Lat. Long. Horizontal Datum: ® NAD 1927 ® 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
A8. For a building with a crawlspace or enclosure(s): .
a) Square footage of crawlspace or enclosure(s) sq ft
b) Number of permanent flood openings In the crawlspace or enclosure(s)within 1.0 foot above adjacent grade
c) Total net area of flood openings in A6.b sq in
d) Engineered flood openings? a Yes a No
A9. For a building with an attached garage:
a) Square footage of attached garage sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade
c) Total net area of flood openings in A9.b sq in
d) Engineered flood openings? D Yes a No
SECTION B—FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
131.NFIP Community Name&Community Number 62.County Name B3. State
84.Map/Panel B5.Suffix B6. FIRM Index 67.FIRM Panel 68.Flood Zone(s) B9. Base Flood Elevation(s)
Number Date Effective/ (Zone A0,use Base
Revised Date Flood Depth)
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69:
a FIS Profile a FIRM ®Community Determined ® Other/Source:
811. Indicate elevation datum used for BFE in Item 69: ® NGVD 1929 a NAVD 1988 a Other/Source:
612. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? a Yes ® No
Designation Date: ® CBRS a OPA
ELEVATION CERTIFICATE VMb No. lebU-000a
Expiration Date:November 30,2018
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:
City State ZIP Code Company NAIC Number
SECTION C—BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
Cl. 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,ARAE,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.
Benchmark Utilized: Vertical Datum:
Indicate elevation datum used for the elevations In items a)through h)below.
® NGVD 1929 a 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) ® feet a meters
b) Top of the next higher floor a feet D meters
c) Bottom of the lowest horizontal structural member(V Zones only) a feet a meters
d) Attached garage(top of slab) a feet ® meters
e) Lowest elevation of machinery or equipment servicing the building a feet ® meters
(Describe type of equipment and location In Comments)
f) Lowest adjacent(finished)grade next to building(LAG) ® feet ® meters
g) Highest adjacent(finished)grade next to building(HAG) ® feet a meters
h) Lowest adjacent grade at lowest elevation of deck or stairs,Including ® feet a meters
structural support
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 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 imprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? ®Yes a No 0 Check here if attachments.
Certifiers Name License Number
Title
Company Name Place
Seal
Address Here
City State ZIP Code
Signature Date Telephone
Copy allpagesof this Elevation Certificate and all attachments for(1)community official,(2)insurance agent/company,and(3)building owner.
Comments(including type of equipment and location, per C2(e),if applicable)
ELEVATION CERTIFICATE UMC NO. 10U04)uua
Expiration Date:November 30,2018
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.
City State ZIP Code Company NAIC Number
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,B,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 a meters
®above or ®below the HAG.
b) Top of bottom floor(including basement,
crawlspace,or enclosure)Is ®feet a meters
•
a above or a below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 1-2 of Instructions),
the next higher floor(elevation C2.b In
the diagrams)of the building is •
®feet ®meters a above or a below the HAG.
E3. Attached garage(top of slab)is . a feet a meters a above or a below the HAG.
E4. Top of platform of machinery and/or equipment
servicing the building is . a feet a meters a above or
a 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? a Yes a 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 or Owners Authorized Representative's Name
Address City State ZIP Code
ignature Date Telephone
Comments
❑Check here if attachments.
ELEVATION CERTIFICATE UMC No. atwuots
Date:Date:November 30,2018
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.
City State ZIP Code Company NAIC Number •
SECTION G—COMMUNITY INFORMATION(OPTIONAL)
The 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 of this Elevation Certificate.Complete the applicable item(s)and sign below.Check the measurement
used in Items G8—G10. In Puerto Rico only,enter meters.
01. 0 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.)
G2 0 A community official completed Section E for a building located In Zone A(without a FEMA-Issued or community-Issued BFE)
or Zone AO.
G3. 0 The following information(Items G4—G10)is provided for community floodplain management purposes.
G4. Permit Number G5. Date Permit Issued GB. Date Certificate of
Compliance/Occupancy Issued
G7. This permit has been issued for: ®New Construction ® Substantial Improvement
G8. Elevation of as-built lowest floor(including basement)
of the building: ®feet a meters Datum
G9. BFE or(in Zone AO)depth of flooding at the building site: D feet ® meters Datum
G10. Community's design flood elevation: ®feet a meters Datum
Local Official's Name Title
Community Name Telephone
Si nature Date
Comments(including type of equipment and location,per C2(e),if applicable)
0 Check here if attachments.
UMIb NO. 1bbU-0005
ELEVATION CERTIFICATE Continuation Page Expiration Date:November 30,2018
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.
City State ZIP Code 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.
Photo One
Photo One
Photo One Caption
Photo Two
Photo Two
Photo Two Caption
U.S. DEPARTMENT OF HOMELAND SECURITY OMB No.1660-0008
Federal Emergency Management Agency Expiration Date: November 30,2018
National Flood Insurance Program
Instructions for Completing the Elevation Certificate
The Elevation Certificate is to be completed by a land surveyor, engineer, or architect who is authorized by law to certify
elevation information when elevation information is required for Zones A1-A30, AE,AH,A(with BFE), VE, V1 V30, V
(with BFE), AR, AR/A, AR/AE, AR/Al-MO, AR/AH, or AR/A0. Community officials who are authorized by law or
ordinance to provide floodplain management Information may also complete this form. For Zones AO and A (without
BFE), a community official, a property owner, or an owner's representative may provide Information on this certificate,
unless the elevations are intended for use in supporting a request for a LOMA or LOMR-F. Certified elevations must be
included if the purpose of completing the Elevation Certificate is to obtain a LOMA or LOMR-F.
The property owner, the owner's representative, or local official who Is authorized by law to administer the community
floodplain ordinance can complete Section A and Section B.The partially completed form can then be given to the land
surveyor, engineer, or architect to complete Section C. The land surveyor, engineer, or architect should verify the
information provided by the property owner or owner's representative to ensure that this certificate is complete.
In Puerto Rico only, elevations for building information and flood hazard Information may be entered In meters.
SECTION A-PROPERTY INFORMATION
Items A1-A4.This section identifies the building, its location, and its owner. Enter the name(s) of the building owner(s),
the building's complete street address, and the lot and block numbers. If the building's address Is different from the
owner's address, enter the address of the building being certified. If the address is a rural route or a Post Office box
number, enter the lot and block numbers, the tax parcel number, the legal description, or an abbreviated location
description based on distance and direction from a fixed point of reference. For the purposes of this certificate, "building"
means both a building and a manufactured(mobile)home.
A map may be attached to this certificate to show the location of the building on the property. A tax map, FIRM, or
detailed community map is appropriate. If no map is available, provide a sketch of the property location, and the location
of the building on the property. Include appropriate landmarks such as nearby roads, intersections, and bodies of water.
For building use, indicate whether the building is residential, non-residential,an addition to an existing residential or non-
residential building, an accessory building (e.g., garage), or other type of structure. Use the Comments area of the
appropriate section if needed,or attach additional comments.
Item A5.Provide latitude and longitude coordinates for the center of the front of the building. Use either decimal degrees
(e.g., 39.5043°, -110.7585°) or degrees, minutes, seconds (e.g., 39° 30' 15.5", -110° 45' 30.7") format. If decimal '
degrees are used, provide coordinates to at least 5 decimal places or better. When using degrees, minutes, seconds,
provide seconds to at least 1 decimal place or better.The latitude and longitude coordinates must be accurate within 66
feet. When the latitude and longitude are provided by a surveyor, check the 'Yes" box in Section D and Indicate the
method used to determine the latitude and longitude in the Comments area of Section D. If the Elevation Certificate Is
being certified by other than a licensed surveyor, engineer, or architect, this information Is not required. Provide the type
of datum used to obtain the latitude and longitude. FEMA prefers the use of NAD 1983.
Item A6.If the Elevation Certificate is being used to obtain flood insurance through the NFIP,the certifier must provide at
least 2 photographs showing the front and rear of the building taken within 90 days from the date of certification. The
photographs must be taken with views confirming the building description and diagram number provided in Section A.To
the extent possible, these photographs should show the entire building including foundation. If the building has split-level
or multi-level areas, provide at least 2 additional photographs showing side views of the building. In addition, when
applicable, provide a photograph of the foundation showing a representative example of the flood openings or vents.All
photographs must be in color and measure at least 3"x 3". Digital photographs are acceptable.
Item A7. Select the diagram on pages 7-9 that best represents the building. Then enter the diagram number and use
the diagram to Identify and determine the appropriate elevations requested in Items C2.a-h. If you are unsure of the
correct diagram, select the diagram that most closely resembles the building being certified.
Item A8.a. Provide the square footage of the crawlspace or enclosure(s) below the lowest elevated floor of an elevated
building with or without permanent flood openings. Take the measurement from the outside of the crawlspace or
enclosure(s). Examples of elevated buildings constructed with crawlspace and enclosure(s)are shown in Diagrams 6-0
AMID riavafinn ra.4ifineta tnWn'Minn.— Dn.n I of n
Instructions for Completing the Elevation Certificate(continued)
on.pages 8-9. Diagrams 2A, 2B,4, and 9 should be used for a building constructed with a crawlspace floor that is below
the exterior grade on all sides.
Items A8.b—d. Enter in Item A8.b the number of permanent flood openings in the crawlspace or enclosure(s) that are
no higher than 1.0 foot above the higher of the exterior or interior grade or floor immediately below the opening. (A
permanent flood opening is a flood vent or other opening that allows the free passage of water automatically in both
directions without human intervention.) If the interior grade elevation is used, note this in the Comments area of
Section D. Estimate the total net area of all such permanent flood openings in square inches, excluding any bars,
louvers, or other covers of the permanent flood openings, and enter the total in Item A8.c. If the net area cannot be
reasonably estimated, provide the size of the flood openings without consideration of any covers and indicate in the
Comments area the type of cover that exists in the flood openings. Indicate in Item A8.d whether the flood openings
are engineered. If applicable, attach a copy of the Individual Engineered Flood Openings Certification or an
Evaluation Report issued by the International Code Council Evaluation Service (ICC ES), if you have it. If the ,
crawlspace or enclosure(s) have no permanent flood openings, or if the openings are not within 1.0 foot above
adjacent grade, enter"0"(zero) in Items A8.b—c.
Item A9.a. Provide the square footage of the attached garage with or without permanent flood openings. Take the
measurement from the outside of the garage.
Items A9.b—d. Enter in Item A9.b the number of permanent flood openings in the attached garage that are no higher
than 1.0 foot above the higher of the exterior or interior grade or floor immediately below the opening. (A permanent
flood opening is a flood vent or other opening that allows the free passage of water automatically in both directions
without human intervention.) If the interior grade elevation is used, note this in the Comments area of Section D. This
includes any openings that are in the garage door that are no higher than 1.0 foot above the adjacent grade. Estimate
the total net area of all such permanent flood openings in square inches and enter the total in Item A9.c. If the net
area cannot be reasonably estimated, provide the size of the flood openings without consideration of any covers and
indicate in the Comments area the type of cover that exists in the flood openings. Indicate in Item A9.d whether the
flood openings are engineered. If applicable, attach a copy of the Individual Engineered Flood Openings Certification
or an Evaluation Report issued by the International Code Council Evaluation Service (ICC ES), if you have it. If the
garage has no permanent flood openings, or if the openings are not within 1.0 foot above adjacent grade, enter
"0"(zero) in Items A9.b—c.
SECTION B—FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
Complete the Elevation Certificate on the basis of the FIRM in effect at the time of the certification.
The information for Section B is obtained by reviewing the FIRM panel that includes the building's location. Information
about the current FIRM is available from the Federal Emergency Management Agency (FEMA) by calling
1-800-358-9616. If a Letter of Map Amendment(LOMA)or Letter of Map Revision (LOMR-F)has been issued by FEMA,
please provide the letter date and case number in the Comments area of Section D or Section G, as appropriate.
For a building in an area that has been annexed by one community but is shown on another community's FIRM, enter
the community name and 6-digit number of the annexing community in Item 61, the name of the county or new county, if
necessary, in Item B2, and the FIRM index date for the annexing community in Item 66. Enter information from the
actual FIRM panel that shows the building location, even if it is the FIRM for the previous jurisdiction, in Items B4, 65,
67, 68, and 69.
If the map in effect at the time of the building's construction was other than the current FIRM, and you have the past map
information pertaining to the building, provide the information in the Comments area of Section D.
Item 61. NFIP Community Name & Community Number. Enter the complete name of the community in which the
building is located and the associated 6-digit community number. For a newly incorporated community, use the name
and 6-digit number of the new community. Under the NFIP, a "community" is any State or area or political subdivision
thereof, or any Indian tribe or authorized native organization, that has authority to adopt and enforce floodplain
management regulations for the areas within its jurisdiction. To determine the current community number, see the
NFIP Community Status Book, available on FEMA's web site at https://www.fema.gov/national-flood-insurance-
program/national-flood-insurance-orogram-community-status-book, or call 1-800-358-9616.
AMID Cla..eHHnn rat-Mir...'.win'.ai....e_ Panw 2 of g
Instructions for Completing the Elevation Certificate(continued)
Item B2. County Name. Enter the name of the county or counties in which the community is located. For an
unincorporated area of a county, enter"unincorporated area." For an independent city, enter"independent city."
Item B3. State. Enter the 2-letter state abbreviation (for example, VA,TX, CA). •
Items B4—B5. Map/Panel Number and Suffix. Enter the 10-character"Map Number' or"Community Panel Number"
shown on the FIRM where the building or manufactured (mobile) home is located. For maps in a county-wide format,
the sixth character of the "Map Number' is the letter"C"followed by a 4-digit map number. For maps not in a county-
wide format, enter the"Community Panel Number shown on the FIRM.
Item B6. FIRM Index Date. Enter the effective date or the map revised date shown on the FIRM Index.
Item B7. FIRM Panel Effective/Revised Date. Enter the map effective date or the map revised date shown on the
FIRM panel. This will be the latest of all dates shown on the map. The current FIRM panel effective date can be
determined by calling 1-800-358-9616.
Item B8. Flood Zone(s). Enter the flood zone, or flood zones, in which the building is located. All flood zones
containing the letter "A" or"V" are considered Special Flood Hazard Areas. The flood zones are A, AE, A1—A30, V,
VE, V1—V30,AH,AO,AR,AR/A,AR/AE,AR/A1—A30,AR/AH, and AR/AO. Each flood zone is defined in the legend of
the FIRM panel on which it appears.
Item B9. Base Flood Elevation(s). Using the appropriate Flood Insurance Study (FIS) Profile, Floodway Data Table, or
FIRM panel, locate the property and enter the BFE (or base flood depth) of the building site. If the building is located
in more than 1 flood zone in Item 68, list all appropriate BFEs in Item 69. BFEs are shown on a FIRM or FIS Profile
for ZonesAl—A30,AE,AH,V1—V30,VE,AR,AR/A,AR/AE,AR/A1—A30,AR/AH, and AR/AO; flood depth numbers are
shown for Zone AO. Use the AR BFE if the building is located in any of Zones AR/A,AR/AE,AR/A1—A30, AR/AH, or
AR/AO. In A or V zones where BFEs are not provided on the FIRM, BFEs may be available from another source. For
example, the community may have established BFEs or obtained BFE data from other sources for the building site.
For subdivisions and other developments of more than 50 lots or 5 acres, establishment of BFEs is required by the
community's floodplain management ordinance. If a BFE is obtained from another source, enter the BFE in Item 69.
In an A Zone where BFEs are not available, complete Section E and enter N/A for Section B, Item B9. Enter the BFE
to the nearest tenth of a foot(nearest tenth of a meter, in Puerto Rico).
Item B10. Indicate the source of the BFE that you entered in Item B9. If the BFE is from a source other than FIS
Profile, FIRM, or community, describe the source of the BFE.
Item B11. Indicate the elevation datum to which the elevations on the applicable FIRM are referenced as shown on
the map legend.The vertical datum is shown in the Map Legend and/or the Notes to Users on the FIRM.
Item B12. Indicate whether the building is located in a Coastal Barrier Resources System (CBRS) area or Otherwise
Protected Area (OPA). (OPAs are portions of coastal barriers that are owned by Federal, State, or local governments
or by certain non-profit organizations and used primarily for natural resources protection.) Federal flood insurance is
prohibited in designated CBRS areas or OPAs for buildings or manufactured (mobile) homes built or substantially
improved after the date of the CBRS or OPA designation. For the first CBRS designations, that date is October 1,
1983. Information about CBRS areas and OPAs may be obtained on the FEMA web site at https://www.fema.gov/
national-flood-insurance-orog ram/coastal-barrier-resources-systern•
SECTION C—BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Complete Section C if the building is located in any of Zones A1—A30, AE, AH, A (with BFE), VE, V1—V30, V (with
BFE),AR, AR/A, ARAE, AR/A1—A30, AR/AH, orAR/AO, or if this certificate is being used to support a request for a
LOMA or LOMR-F. If the building is located in Zone AO or Zone A (without BFE), complete Section E instead. To
ensure that all required elevations are obtained, it may be necessary to enter the building (for instance, if the building
has a basement or sunken living room, split-level construction, or machinery and equipment).
Surveyors may not be able to gain access to some crawlspaces to shoot the elevation of the crawlspace floor. If
access to the crawlspace is limited or cannot be gained, follow one of these procedures.
• Use a yardstick or tape measure to measure the height from the floor of the crawlspace to the"next higher floor,"
and then subtract the crawlspace height from the elevation of the"next higher floor." If there is no access to the
AMID Gia„afinn ra,4;f,.ala Ine+n'Minna— Dana Q of 0
Instructions for Completing the Elevation Certificate(continued)
• crawlspace, use the exterior grade next to the structure to measure the height of the crawlspace to the "next
higher floor."
•
• Contact the local floodplain administrator of the community in which the building is located.The community may have
documentation of the elevation of the crawlspace floor as part of the permit issued for the building.
• If the property owner has documentation or knows the height of the crawlspace floor to the next higher floor, try to
verify this by looking inside the crawlspace through any openings or vents.
In all 3 cases, use the Comments area of Section D to provide the elevation and a brief description of how the elevation
was obtained.
Item Cl. Indicate whether the elevations to be entered in this section are based on construction drawings, a building
under construction, or finished construction. For either of the first 2 choices, a post-construction Elevation Certificate will
be required when construction is complete. If the building is under construction, include only those elevations that can be
surveyed in Items C2.a—h. Use the Comments area of Section D to provide elevations obtained from the construction
plans or drawings. Select"Finished Construction"only when all machinery and/or equipment such as furnaces, hot water
heaters, heat pumps, air conditioners, and elevators and their associated equipment have been installed and the grading
around the building is completed.
Item C2. A field survey is required for Items C2.a—h. Most control networks will assign a unique identifier for each
benchmark. For example,the National Geodetic Survey uses the Permanent Identifier(PID). For the benchmark utilized,
provide the PID or other unique identifier assigned by the maintainer of the benchmark. For GPS survey, indicate the
benchmark used for the base station, the Continuously Operating Reference Stations (CORS) sites used for an On-line
Positioning User Service(OPUS)solution (also attach the OPUS report), or the name of the Real lime Network used.
Also provide the vertical datum for the benchmark elevation.All elevations for the certificate, including the elevations for
Items C2.a—h, must use the same datum on which the BFE is based. Show the conversion from the field survey datum
used if it differs from the datum used for the BFE entered in Item B9 and indicate the conversion software used. Show the
datum conversion, if applicable, in the Comments area of Section D.
For property experiencing ground subsidence, the most recent reference mark elevations must be used for determining
building elevations. However, when subsidence is involved, the BFE should not be adjusted. Enter elevations in Items
C2.a—h to the nearest tenth of a foot(nearest tenth of a meter, in Puerto Rico).
Items C2.a—d. Enter the building elevations (excluding the attached garage) indicated by the selected building diagram
(Item A7) in Items C2.a—c. If there is an attached garage, enter the elevation for top of attached garage slab in Item C2.d.
(Because elevation for top of attached garage slab is self-explanatory, attached garages are not illustrated in the
diagrams.)If the building is located in a V zone on the FIRM, complete Item C2.c. If the flood zone cannot be determined,
enter elevations for all of Items C2.a—h. For buildings in A zones, elevations a, b, d, and e should be measured at the top
of the floor. For buildings in V zones, elevation c must be measured at the bottom of the lowest horizontal structural
member of the floor(see drawing below). For buildings elevated on a crawlspace, Diagrams 8 and 9, enter the elevation
BUILDING ON BUILDING WITH BUILDING ON PILES,
SLAB BASEMENT PIERS,OR COLUMNS
® AZONES VZONES Ir AZONES VZONES
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/J/E A ZONES
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111)
BASE FLOOD
ELEVATION1111111111
BASE FLOOD`;'j:::
ADJACENT ELEVATION
GRADE �/�:;:;;':':•:'•:':+:.:.•
AICID CIa.,eK,.n re.Llr..eie Ine•n„Minn_ Pana d of
Instructions for Completing the Elevation Certificate(continued)
of the top of the crawlspace floor in Item C2.a, whether or not the crawlspace has permanent flood openings (flood
vents). If any item does not apply to the building, enter WA"for not applicable.
' Item C2.e. Enter the lowest platform elevation of at least 1 of the following machinery and equipment items: elevators
and their associated equipment, furnaces, hot water heaters, heat pumps, and air conditioners in an attached garage
or enclosure or on an open utility platform that provides utility services for the building. Note that elevations for these
specific machinery and equipment items are required in order to rate the building for flood insurance. Local floodplain
management officials are required to ensure that all machinery and equipment servicing the building are protected
from flooding. Thus, local officials may require that elevation information for all machinery and equipment, including
ductwork, be documented on the Elevation Certificate. If the machinery and/or equipment is mounted to a wall, pile, •
etc., enter the platform elevation of the machinery and/or equipment. Indicate machinery/equipment type and its
general location, e.g., on floor inside garage or on platform affixed to exterior wall, in the Comments area of Section D
or Section G, as appropriate. If this item does not apply to the building, enter"N/A'for not applicable.
Items C2.f-g. Enter the elevation of the ground, sidewalk, or patio slab immediately next to the building. For Zone
AO, use the natural grade elevation, if available. This measurement must be to the nearest tenth of a foot (nearest
tenth of a meter, in Puerto Rico) if this certificate is being used to support a request for a LOMA or LOMR-F.
Item C2.h. Enter the lowest grade elevation at the deck support or stairs. For Zone AO, use the natural grade
elevation, if available. This measurement must be to the nearest tenth of a foot (nearest tenth of a meter, in Puerto
Rico) if this certificate is being used to support a request for a LOMA or LOMR-F.
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION
Complete as indicated. This section of the Elevation Certificate may be signed by only a land surveyor, engineer, or
architect who is authorized by law to certify elevation information. Place your license number, your seal (as allowed by
the State licensing board),your signature, and the date in the box in Section D.You are certifying that the information on
this certificate represents your best efforts to interpret the data available and that you understand that any false •
statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Use the Comments area of
Section D to provide datum, elevation, openings, or other relevant information not specified elsewhere on the certificate.
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)
FOR ZONE AO AND ZONE A(WITHOUT BFE)
Complete Section E if the building is located in Zone AO or Zone A(without BFE). Otherwise, complete Section C instead.
Explain in the Section F Comments area if the measurement provided under Items E1-E4 is based on the"natural grade."
Items El.a and b. Enter in Item El.a the height to the nearest tenth of a foot(tenth of a meter in Puerto Rico)of the top
of the bottom floor(as indicated in the applicable diagram) above or below the highest adjacent grade (HAG). Enter in
Item E1.b the height to the nearest tenth of a foot (tenth of a meter in Puerto Rico) of the top of the bottom floor (as
indicated in the applicable diagram) above or below the lowest adjacent grade (LAG). For buildings in Zone AO, the
community's floodplain management ordinance requires the lowest floor of the building be elevated above the highest
adjacent grade at least as high as the depth number on the FIRM. Buildings in Zone A(without BFE) may qualify for a
lower insurance rate if an engineered BFE is developed at the site.
Item E2. For Building Diagrams 6-9 with permanent flood openings (see pages 8-9), enter the height to the nearest•
tenth of a foot (tenth of a meter in Puerto Rico) of the next higher floor or elevated floor(as indicated in the applicable
diagram)above or below the highest adjacent grade(HAG).
Item E3. Enter the height to the nearest tenth of a foot (tenth of a meter in Puerto Rico), in relation to the highest
adjacent grade next to the building, for the top of attached garage slab. (Because elevation for top of attached garage
slab is self-explanatory, attached garages are not illustrated in the diagrams.) If this item does not apply to the building,
enter"N/A"for not applicable.
Item E4. Enter the height to the nearest tenth of a foot (tenth of a meter in Puerto Rico), in relation to the highest
adjacent grade next to the building, of the platform elevation that supports the machinery and/or equipment servicing the
building. Indicate machinery/equipment type in the Comments area of Section F. If this item does not apply to the
building, enter N/A"for not applicable.
AMID Clava/inn rarliAnaIet InMn,,4inne— Dona F ni 0
Instructions for Completing the Elevation Certificate(continued)
Item ES. For those communities where this base flood depth is not available, the community will need to determine.
whether the top of the bottom floor is elevated in accordance with the community's floodplain management ordinance.
SECTION F—PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
Complete as indicated. This section is provided for certification of measurements taken by a property owner or property
owners representative when responding to Sections A, B, and E.The address entered in this section must be the actual
mailing address of the property owner or property owners representative who provided the information on the certificate.
SECTION G—COMMUNITY INFORMATION (OPTIONAL)
Complete as indicated. The community 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 of this Elevation Certificate. Section C
may be filled in by the local official as provided in the instructions below for Item G1. If the authorized community official
completes Sections C, E, or G, complete the appropriate item(s)and sign this section.
Check Item 61 if Section C is completed with elevation data 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 of the elevation data and the date obtained in the Comments area of Section G. If you are both a community
official and a licensed land surveyor, engineer, or architect authorized by law to certify elevation information, and you
performed the actual survey for a building in Zones A1—A30, AE,AH, A(with BEE), VE, V1 V30, V(with BFE), AR, AR/
A,AR/A1—A30,AR/AE,AR/AH, or AR/AO,you must also complete Section D.
Check ftem G2 if information is entered in Section E by the community for a building in Zone A(without a FEMA-issued
or community-issued BFE)or Zone AO.
Check Item G3 if the information in Items G4—G10 has been completed for community floodplain management purposes
to document the as-built lowest floor elevation of the building. Section C of the Elevation Certificate records the elevation
of various building components but does not determine the lowest floor of the building or whether the building, as
constructed, complies with the community's floodplain management ordinance. This must be done by the community.
Items G4—G10 provide a way to document these determinations.
Item G4. Permit Number. Enter the permit number or other identifier to key the Elevation Certificate to the permit issued
for the building.
Item G5.Date Permit Issued. Enter the date the permit was issued for the building.
Item G6. Date Certificate of Compliance/Occupancy Issued. Enter the date that the Certificate of Compliance or
Occupancy or similar written official documentation of as-built lowest floor elevation was issued by the community as
evidence that all work authorized by the floodplain development permit has been completed in accordance with the
community's floodplain management laws or ordinances.
Item G7. New Construction or Substantial Improvement. Check the applicable box. "Substantial Improvement' means
any reconstruction, rehabilitation, addition, or other improvement of a building, the cost of which equals or exceeds 50
percent of the market value of the building before the start of construction of the improvement. The term includes
buildings that have incurred substantial damage, regardless of the actual repair work performed.
Item 68. As-built lowest floor elevation. Enter the elevation of the lowest floor (including basement) when the
construction of the building is completed and a final inspection has been made to confirm that the building is built in
accordance with the permit, the approved plans, and the community's floodplain management laws or ordinances.
Indicate the elevation datum used.
Item G9. BFE. Using the appropriate FIRM panel, AS Profile, or other data source, locate the property and enter the
BFE(or base flood depth)of the building site. Indicate the elevation datum used.
Item G10. Community's design flood elevation. Enter the elevation (including freeboard above the BFE) to which the
community requires the lowest floor to be elevated. Indicate the elevation datum used.
Enter your name, title, and telephone number, and the name of the community. Sign and enter the date in the
appropriate blanks.
PJCID Die..aHnn fiat-Winn.°Ine,n,ri..ne— Dena A nf 0
Building Diagrams
The following diagrams illustrate various types of buildings. Compare the features of the building being certified with -
the features shown in the diagrams and select the diagram most applicable. Enter the diagram number in Item A7,
• the square footage of crawlspace or enclosure(s) and the area of flood openings in square inches in Items A8.a-c,
the square footage of attached garage and the area of flood openings in square inches in Items A9.a-c, and the
elevations in Items C2.a-h.
In A zones, the floor elevation is taken at the top finished surface of the floor indicated; in V zones, the floor elevation
is taken at the bottom of the lowest horizontal structural member(see drawing in instructions for Section C).
DIAGRAM 1A DIAGRAM 1B
All slab-on-grade single-and multiple-floor buildings All raised-slab-on-grade or slab-on-stem-wall-with-fill
(other than split-level)and high-rise buildings,either single-and multiple-floor buildings(other than split-
detached or row type(e.g.,townhouses);with or level),either detached or row type(e.g.,townhouses);
without attached garage. with or without attached garage.
Distinguishing Feature—The bottom floor is at or above Distinguishing Feature—The bottom floor is at or above
ground level(grade)on at least 1 side.* ground level(grade)on at least 1 side'
•
• C2.b
NEXT HIGHER NEXT HIGHER
I FLOOR I FLOOR
GRADE sorroMFLOOR GRADMall
E
IMEIMEMS
a ,
nei
77.
(detianine 6� ` " (daMrmlMd by ' - v
C2.f—h C2.f-h
'existing grade) exrstlng grade) t -•' • • -
DIAGRAM 2A DIAGRAM 2B
All single-and multiple-floor buildings with basement All single-and multiple-floor buildings with basement
(other than split-level)and high-rise buildings with (other than split-level)and high-rise buildings with
basement,either detached or row type basement,either detached or row type
(e.g.,townhouses);with or without attached garage. (e.g.,townhouses);with or without attached garage.
Distinguishing Feature—The bottom floor(basement Distinguishing Feature—The bottom floor(basement or
or underground garage)is below ground level(grade)on underground garage)is below ground level(grade)on all
all sides.' sides;most of the height of the walls is below ground level
® on all sides;and the door and area of egress are also
below ground level on all sides.*
C2.b
NEXT HIGHER
FLOOR CD NEXTFLOOR HIGHER
GRADE
GRADE
.a •,.,, J,,S".1 ;i s`: 1;iG. [,'��.': �� BOTTOM FLOOR �?.''•
-i6:`r C'�..`+•'t1 ::L_j;'% ...: � r. - BASEMENT
Mi v ,.Na,
C2.f-h (detrninadb9
:.. 'a>lleltng drYde)'.:;:. ..<..,.. •,.:.4: .: .;.,::;. :....,.:n:.a' •: .': ._a�_�
C2.f—s. (determined bY:.':'• !:'.:';'; ::'...':;':
•A floor that is below ground level(grade)on all sides is considered a basement even if the floor is used for living purposes,or as an office,
garage,workshop,etc.
KICID Claroeinn f oAifneln Ine/mMinns— Own.,7 of rf
Building Diagrams
• DIAGRAM 3 DIAGRAM 4
All split-level buildings that are slab-on-grade,either All split-level buildings(other than slab-on-grade),
detached or row type(e.g.,townhouses);with or without either detached or row type(e.g.,townhouses);with or
attached garage. without attached garage.
Distinguishing Feature—The bottom floor(excluding Distinguishing Feature—The bottom floor(basement
garage)is at or above ground level(grade)on at least or underground garage)is below ground level(grade)on
1 side.* all sides.`
••
r
0
0 C2.b
• r
HIGHER 0 OD HIGHER 1
FLOORS GRADE FLOORS
,, NEXT HIGHER ` , NEXT HIGHER
GRADE FLOOR \sl BOTTOM FLOOR FLOOR
1 „ (BA3^EMENU
;....
.�
L'
'.. •...� ry ? n.:.:r ..
\N.f.!1V
'ry
Yli .V.n•• w.a :r ,Vw.1. 'YC4Y:•n.i :"VI. 1.V?n• .:}.. f'V' Ioi . '
"" " I: : ` fy ,:;ori
�lde 'rke . . . C2f h �'determi^ a
,C2f—h ..exiatin0aade)"".' . .. .... ::..:; o-... .:,..: . .... existing grade)
i
DIAGRAM 5 DIAGRAM 6
All buildings elevated on piers,posts,piles,columns, All buildings elevated on piers, posts,piles,columns,
or parallel shear walls. No obstructions below the or parallel shear walls with full or partial enclosure
elevated floor. below the elevated floor.
Distinguishing Feature—For all zones,the area below the Distinguishing Feature—For all zones,the area below the
elevated floor is open,with no obstruction to flow of floodwaters elevated floor is enclosed,either partially or fully. In A Zones,the
(open lattice work and/or insect screening is permissible). partially or fully enclosed area below the elevated floor is with or
without openings"present in the walls of the enclosure. Indicate
NEXT HIGHER '
information about enclosure size and openings in Section A-
41)
Property Information.
I
NEXT ,
i FLOOR , ® i HIGHER ,
C2.a r FLOOR 6
ELEVATED
ELEVATED ,
FLOOR FLOOR
AB.a—c
\./
GRADE / \ r GRADE r,�
■,�DSURE .eternise
enclosure size 8
� openings,zany.
' Ydeiarminedbq+' • , n V
C2.(—hIdeterinined by .. . .' J`'. C2.f—h existing grade) .n, (F FV..existing grade) C24 (ForV zones only)
•
• A floor that is below ground level(grade)on all sides is considered a basement even if the floor is used for living purposes,or as an office,
garage,workshop,etc.
"An"opening"is a permanent opening that allows for the free passage of water automatically In both directions without human Intervention.
Under the NFIP,a minimum of 2 openings is required for enclosures or crawlspaces.The openings shall provide a total net area of not less than
1 square inch for every square foot of area enclosed,excluding any bars,louvers,or other covers of the opening.Alternatively,an Individual
Engineered Flood Openings Certification or an Evaluation Report issued by the International Code Council Evaluation Service(ICC ES)must be
submitted to document that the design of the openings will allow for the automatic equalization of hydrostatic flood forces on exterior walls.A
window,a door,or a garage door is not considered an opening;openings may be Installed in doors.Openings shall be on at least 2 sides of the
enclosed area.If a building has more than 1 enclosed area,each area must have openings to allow floodwater to directly enter.The bottom of
the openings must be no higher than 1.0 foot above the higher of the exterior or interior grade or floor immediately below the opening.For more
guidance on openings,see NFIP Technical Bulletin 1.
rump CIo,aHnn rap-tier.,,.Inesn,.Hinne_ Pans R of A
Building Diagrams
DIAGRAM 7 DIAGRAM 8
All buildings elevated on full-story foundation walls All buildings elevated on a crawlspace with the floor of
with a partially or fully enclosed area below the elevated the crawlspace at or above grade on at least 1 side, •
floor.This includes walkout levels,where at least 1 side with or without an attached garage.
is at or above grade.The principal use of this building is
located in the elevated floors of the building. Distinguishing Feature—For all zones,the area below the first
floor is enclosed by solid or partial perimeter walls.In all A zones,
Distinguishing Feature—For all zones,the area below the the crawlspace is with or without openings**present in the walls
elevated floor is enclosed,either partially or fully.In A Zones,the of the crawlspace. Indicate Information about crawlspace size
partially or fully enclosed area below the elevated floor is with or and openings in Section A—Property Information.
without openings"present in the walls of the enclosure.Indicate
information about enclosure size and openings in Section A—
Property Informatio42)
n. ® 1 I
1
1
CDNEXT HIGHER ® GRADE NEXT HIGHER co
FLOOR ® , FLOOR A
GRADE A
® (ELKOUT NCLOSURE)L
�(lNOL-SUR!)
9 I .. 9
I
•PENINGS OPININOI ®OPENINGS G
DIAGRAM 9
All buildings(other than split-level)elevated on a sub-
grade crawlspace,with or without attached garage.
Distinguishing Feature—The bottom(crawlspace)floor is below
ground level(grade)on all sides."(If the distance from the crawlspace
floor to the top of the next higher floor is more than 5 feet,or the
crawlspace floor is more than 2 feet below the grade[LAG]on all
sides,use Diagram 2A or 2B.)
41)1 1
1 1
GRADE NEXT HIGHER ,
® FLOOR AA
L
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OPENINGS.
* A floor that is below ground level(grade)on all sides is considered a basement even if the floor is used for living purposes,or as an office,
garage,workshop,etc.
"An"opening"is a permanent opening that allows for the free passage of water automatically In both directions without human intervention.
Under the NFIP,a minimum of 2 openings is required for enclosures or crawlspaces.The openings shall provide a total net area of not less than
1 square inch for every square foot of area enclosed,excluding any bars,louvers,or other covers of the opening.Alternatively,an Individual
Engineered Flood Openings Certification or an Evaluation Report issued by the International Code Council Evaluation Service(ICC ES)must be
submitted to document that the design of the openings will allow for the automatic equalization of hydrostatic flood forces on exterior walls.A
window,a door,or a garage door is not considered an opening;openings may be installed in doors.Openings shall be on at least 2 sides of the
enclosed area.If a building has more than 1 enclosed area,each area must have openings to allow floodwater to directly enter.The bottom of .
the openings must be no higher than 1.0 foot above the higher of the exterior or interior grade or floor immediately below the opening.For more
guidance on openings,see NFIP Technical Bulletin 1.
NICID CIa.mlinn ranIGnala Ine1n'Minne— Dana 0ni 0
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DiSipio Building Group
Lot 10 Bayberry Rd West Yarmouth MA 02673
March 8,2018
Building Specifications&HERS Rating
Area of conditioned Space 2,736
Volume of conditioned Space 25,210
Year Built 2018
Housing Type Single Family
Floors on or Above Grade 2
Number of Bedrooms 3
Thermal Boundary Location Floor
Foundation Wall Insulation Type
Foundation Wall Insulation R-Value
Slab Floor Underslab R-Value N/A
Slab Floor Perimeter R-Value N/A
Frame Floor Floor Finish Hardwood
Frame Floor Insulation Type Fiberglass
Frame Floor Insulation R-Value 38
Rim&Band Joist Insulation Type Cavity open cell
Rim&Band Joist Insulation R-Value 21
Above Grade Walls Insulation Type Cavity fiberglass
Above Grade Walls Insulation R-Value 21
Window&Doors Glass
Window U-Value 0.30
Window SHGC 0.28
Door Glass U-Value 0.32
Door Glass SHGC •
, 0.25
Door Type Varies
Door R-Value Varies
Ceiling Insulation Hot Roof Method Yes
Ceiling Insulation Type LDF
Ceiling Insulation R-Value 42 •
Skylights U Value
Skylights SHGC
'R .
Mechanical Equipment
Heating Zones 2
Heating System Type Furnace
Heating Fuel Natural Gas
Heating AFUE 95%
Cooling Zones 2
Cooling System Type Central
Cooling SEER 13
Hot Water Type Instant
Hot Water Fuel Natural Gas
• Hot Water EF 0.97
Duct Leakage CFM50(total for all systems) 108
Whole House Infiltration ACH 50 3.0
Lights&Appliances
Refrigerator kWhryr 565
Dishwasher Energy Factor 0.7
Ceiling Fan cfm/Watt Not Included
Lighting Pin Based%Fluorescent 75%
Lighting CFL 0%
•
Clothes Dryer Fuel Electric
Oven/Range Fuel Natural Gas
HERS Rating 87
This rating bda__
plans and information provided&passes 2015 IECC..
Denis Keohane
Certified HERS Rater#8329022
TOWN OF YARMOUTH BUILDING DEPARTYLNT
PLAN REVIEW &BUI DLNG PERMIT APPLICATION REVIEW
Applicant Name
Peinji_t Address 47) f rAntd;r, S) f
Review Date ) "ab — 1 g
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