HomeMy WebLinkAboutElevation Certificate U.S. DEPARTMENT OF HOMELAND SECURITY Bc,PMtk SoYCoq 27 SS
Federal,Fmergency Management Agency Bo2N CTE r E piirrationl660-000
Dae: November 30,2018
National'Abod 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:
DEBORN ENTERPRISES,INC
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Company NAIC Number:
Box No.
282 SOUTH SEA AVENUE
City • State ZIP Code
WEST YARMOUTH Massachusetts 02673
A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.)
ASSESSORS MAP 14, PARCELS 106.3.4 - DEED BOOK 27814,PAGE 53
A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory,etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat.41.63515 Long.-70-23629 Horizontal Datum: ❑ 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 8
A8. For a building with a crawlspace or endosure(s):
a) Square footage of crawlspace or enclosure(s) 1440.00 sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade 8
c) Total net area of flood openings in A8.b 1904 sq in
d) Engineered flood openings? ❑x Yes 0 No
A9. For a building with an attached garage:
a) Square footage of attached garage 576.00 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? ❑x Yes 0 No
SECTION B—FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61. NFIP Community Name&Community Number 62.County Name 83. State
YARMOUTH 250015 BARNSTABLE Massachusetts
B4.Map/Panel 65.Suffix 66. FIRM Index 67.FIRM Panel 68.Flood B9. Base Flood Elevation(s)
Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth)
Revised Date
2500100588 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 69:
❑ FIS Profile ❑x FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item 69: 0 NGVD 1929 ❑x NAVD 1988 ❑ Other/Source:
612. Is the building located in a Coastal Barrier Resources System(CBRS)area or OttIe f sEleecedIAVa EV)? ❑Yes x❑ No
Designation Date: 0 CBRS 0 OPA
NOV 02 2018
FEMA Form 086-0-33(7/15) Replaces all previous editions. BUILDING DEPARTMENT Form Page 1 of 6
By' --
OMB No. 1660-0008
ELEVATION CERTIFICATE 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:
282 SOUTH SEA AVENUE
City State ZIP Code Company NAIC Number
WEST YARMOUTH Massachusetts 02673
SECTION C—BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
Cl. Building elevations are based on: 0 Construction Drawings* 0 Building Under Construction* ❑x 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/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: GPS RECEIVER Vertical Datum:NAVD-1988
Indicate elevation datum used for the elevations in items a)through h)below.
❑ NGVD 1929 ❑x 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) 8.10 ❑x feet 0 meters
b) Top of the next higher floor 13.20 ❑x feet ❑ meters
c) Bottom of the lowest horizontal structural member(V Zones only) ❑ feet 0 meters
d) Attached garage(top of slab) 11.10 ❑x feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building x feet
(Describe type of equipment and location in Comments) 11.10 ❑ 0 meters
0 Lowest adjacent(finished)grade next to building(LAG) 8.00 ❑x feet 0 meters
g) Highest adjacent(finished)grade next to building(HAG) 11.00 0 feet 0 meters
h) Lowest adjacent grade at lowest elevation of deck or stairs,including 0
feet❑7.70 xmeters
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 maybe 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.
Certifier's Name License Number
KIERAN J. HEALY 48135
Title E7jH OF MggS4e
SURVEY MANAGER o1' yoTr,
Company Name pERrNJ.
BSC GROUP INC. u HEM.?
NO.13t33
Address
349 ROUTE 28,UNIT D "FS Rfcisa�oo�,t
City State ZIP Code Si°NqL�nNo s
WEST YARMO H Massachusetts 02673
Signajur Date Telephone Ext.
10-31-2018 (508)778-8919 4586
Co a I pages o is El-va'on C= . cats 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)
THE LOWEST MACHINERY LISTED IN C2-e IS THE DUCT WORKING HANGING FROM THE UNDERSIDE OF THE FIRST FLOOR.
MECHANICAL FLOOD VENTS USE ARE"COOKE VENTS"WITH A RATING OF 238 S.F.PER UNIT.
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 2 of 6
OMB No. 1660-0008
ELEVAJION CERTIFICATE 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:
282 SOUTH SEA AVENUE
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, 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 0 feet 0 meters 0 above or 0 below the HAG.
b) Top of bottom floor(including basement,
crawlspace,or enclosure)is 0 feet 0 meters 0 above or 0 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 0 feet 0 meters 0 above or 0 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 0 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
OMB No. 1660-0008
ELEVATION CERTIFICATE 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:
282 SOUTH SEA AVENUE
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 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 ❑ 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 05. Date Permit Issued 06. Date Certificate of
Compliance/Occupancy Issued
G7. This permit has been issued for. ❑ New Construction 0 Substantial Improvement
G8. Elevation of as-built lowest floor(including basement)
of the building: 0 feet 0 meters Datum
G9. BFE or(in Zone AO)depth of flooding at the building site: 0 feet 0 meters Datum
G10. Community's design flood elevation: ❑ feet 0 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 6
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.
282 SOUTH SEA AVENUE
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, 'd 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.
I . . ., ' � ,,isk t,0. : y,..%-.1/4,0:"-^.-4,,'„.,„" „.w,y+ .. ,
c�r A 1 a{ 'F, d k 4"Y"1n , , f S.'r.� +" yr
r V
Fill 1Tr1LIr
lair
•
gi � . C�.iw.:-e ++r .+?r`•7JV.w . . _ ��i —+.' 'rMV+ ."'
mow,.:T
'!",:... --":;;„;;712,
k '- ; m aY : ..;' tCWtCw 's. fw:,.74::',"!•:34174 ° '"' a_ -„.-c- ”-t ' "MW�/,kpi"*. "P "`WX ,,,, ,-:'q' `""rt 'r"L4...1a."7,-S ' aa" 'wAt C. « ar , $"& FA ' aXY ,, te0.4 ry J ; y w 4w � F : < Xr ..i-ry; SsLLit ;.
Photo On.
Photo One Caption FRONT/STREET VIEW Clear Photo One• I I \t
A
�Iilll li dill f'!! IT-- Q
a '.`
-4 x ,�x,�
a
''''L.
7711'.V a' + Ys .a a, I. r-°`.-.nom 'n'�.. ':^!:4•'''
. " .r.... .5'4 Sake ^-. ""R:h l.'SNn,.'
y t .gay
.,4,µ�piw 4 `F'K S_.- t l.8r *1- , ,t,,.•4" `"'" '1,‘,"'"1 3
w i
ixf.�'a.1T:: .w..... }.. •�. 1 -1,'lr.k:.y �' j:r:.. nle4d',U' "N ;',i.: ''. *. ..f.' ra. %?.
Photo Two
Photo Two Caption REAR/BACK VIEW Clear Photo Two
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:
282 SOUTH SEA AVENUE
City State ZIP Code Company NAIC Number
WEST YARMOUTH Massachusetts 02673
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.
---— —
r r ,y'
` l 7 , .
p
i
" + •'
r ,•`._ 0- -.:14),(144•4.P. i 1•+tS; .CJs ':1
441.
rid. T, t C . r
,I '1t �, ' 6a i� • mo ' of
„4.4,
t`°4
'�
_ SF
T7 ;,v ' ” L `tettw .
tein t �4 �- ,
• .. *� _
eds. vffe.!La- Strsr14_01.41:011 � + j v �! •
!N0 re -Cr". f �. G` s - 7• 1,.!."• " awtAt tN.
Photo Throe
Photo Three Caption "COOKE FLOOD VENT" Clear Photo Three
Photo Four
Photo Four Caption Clear Photo Four
--
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 6 of 6
r
Engineered Flood Openings Certificate
To satisfy requirements of the National Flood Insurance Program
This certification must be submitted to,and kept on me by,the local jurisdiction's permit
authority.A copy should be retained by the owner to demonstrate compliance in order to receive
flood insurance rating.
The Cooke Vent 01 is certified as meeting the flood openings requirements for engineering openings as set forth in the
Federal Emergency Management Agency's National Flood Insurance Program regulations(44CFR 60.3(c)(5))and ASCE
24-14,-provided it Is installed accord-ng to the references,as summarized below. Flood openings are required in
enclosures below elevated buildings,attached and detached garages,and accessory structures that meet the limitations.
I do hereby certify that the Cooke Flood Vent 01 is designed for installation in buildings,allow for the automatic I
equalizing of hydrostatic flood forces on exterior walls by allowing for the automatic entry and exit of flood water
during floods up to and including base(100-year)flood.One Cooke Vent for every 238 Sq.ft.of enclosed area will
provide sufficient hydrostatic pressure equalization during a flood provided the Installation limitations and
instructions are followed as listed below.To calculate the required number of Cooke Vents,divide the Square Feet of
enclosed area by 238.
'Required Fields ----•
Signature:
Signature: ��� September 8, 2016 �a�n of uts�
Antonio Ancona, P.E. Date ts'�� ANTONIO
Title: Consulting Engineer2 ANCONA IA
Type of License Professional Fnzineer 3 CML a
I License Number:MA PE 52785 AS
No-52785
es Ga
"Project Name:
+
•Project Address:
`Date Submitted: Professional Seal
.
Installation Limitations and Instructions
1. The bottom of The vent shall be no higher the-Far from finished grade.
2. There shall be appropriate number of vents per foundation as needed to supply 1 square inch of net free space
for 2.424 soft of enclosed space for maximum rate of rise and fall of Sftlhr or less.The flood protection area per
inch of opening can be increased,per engineering calculation,for rate of rise and fall less than 5ftlhr,and the
flood area per inch of opening shall be reduced,per engineering calculations,if the rate of rise and fall is greater
than 5ft/hr.
3. The flood vents shall not be used for crawl space ventilation.
4. And,the vents shall not be restricted as to the operation of the drop out panel,this panel must be
able to drop out freely at all times.A vent visual is to be performed after the initial installation of the
vents,after completion of all building work or site grading done after the installation of the vents to ensure that
the vent panel is free to drop out.
5. The flood vent openings are designed to automatically equalize hydrostatic flood loads on exterior walls by
allowing entry and exit of flood waters in accordance with Engineered openings.
6. Note that Ancona and Associates,Inc.,its employees,and any Ancona and Associates, Inc.associates do not
assume any risk or liability for the flood vent or the vent installation,and makes no warranty of any kind,express
or implied,with regard to the vents,or installation of the vents,unless Ancona and Associates,Inc.
representative inspects and approves the vent Installation.