HomeMy WebLinkAboutElevation Certificate - n M I . a
U.S. DEPARTMENT OF HOMELAND SECURITY JAE 0A LUTj OMB No:1660-0008
Federal Emergency Management Agency Expiration Date: November 30,2018
National Flood Insurance Program BUILDING DEPAN'I rvIEN1
ELEVA ATE
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:
Beverly A Bruno
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O. Route and Company NAIC Number:
Box No.
15 Powers Lane
City State ZIP Code
West Yarmouth Massachusetts 02673
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Map 14 Parcel 68
A4. Building Use(e.g.,Residential, Non-Residential,Addition,Accessory,etc.) Residential
A5. Latitude/Longitude: Let. 41637'59.87"N Long. 70°13'56.46"W 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 5
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) 1,060 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? ❑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 B2.County Name B3. State
Yarmouth 250015 Bamstable Massachusetts
B4.Map/Panel B5.Suffix Be. 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 VE 13&14
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9:
❑FIS Profile ❑x FIRM ❑Community Determined 0 Other/Source:
B11. Indicate elevation datum used for BFE In Item B9: 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)? o Yes ❑X No
Designation Date: ❑ CBRS ❑ OPA
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 1 of 6
II !
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:
15 Powers Lane
City State ZIP Code Company NAIC Number
West Yarmouth Massachusetts 02673
SECTION C—BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
Cl. Building elevations are based on: ❑ 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 Al—A30,AE,AH,A(with BFE),VE,Vt—V30,V(with BEE),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: RTK GPS PER MTS NETWORK Vertical Datum:NAVD 88
Indicate elevation datum used for the elevations in items a)through h)below.
❑ NGVD 1929 0 NAVD 1988 0 Other/Source:
Datum used for building elevations must be the same as that used for the BEE.
Check the measurement used.
a) Top of bottom floor(including basement,crawlspace,or enclosure floor) 19. 2 0 feet ❑ meters
b) Top of the next higher floor 28, 3 E feet ❑ meters
c) Bottom of the lowest horizontal structural member(V Zones only) 17. 2 0 feet 0 meters
d) Attached garage(top of slab) N/A. 0 feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 19.2 0 feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent(finished)grade next to building(LAG) 9. 6 ❑x feet 0 meters
g) Highest adjacent(finished)grade next to building(HAG) 10,3 0 feet 0 meters
h) Lowest adjacent grade at lowest elevation of deck or stairs,Including 9. 0 E feet ❑ 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 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? E Yes 0 No ❑Check here if attachments.
Certifiels Name License Number
Daniel A. Ojala 40980 .mr»aea
Title py" L,11-44i�.
Prof.Civil Engineer,Prof.Land Surveyor c'i DANIEL c i\
l,- Place.
Company Name �;
Down Cape Engineering Inc. Sea(AIA t.
P 9 91e0980
e
939 Main Street �q10 SUauO
City State ZIP Code +ri'
Yarmouthport Massachusetts 02675
Signature.----�---�.����y ` Date Telephone
^,--^'_>i LCD'_ ; _- y_ Qj (508)362-4541
Copy all pages of this Elevation Certificate and in 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)
Vertical datum is NAVD88 from MTS RTK GPS.All utilities located on first floor at elevation 19.2. Home is v-zone compliant foundation
on open piles,no lattice between piles.
•
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 2 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:
15 Powers Lane
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 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 ❑meters 0 above or 0 below the HAG.
b) Top of bottom floor(Including basement,
crawlspace,or enclosure)is •
❑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 •
❑feet 0 meters ❑above or 0 below the HAG.
E4. Top of platform of machinery and/or equipment
servicing the building is •
❑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 owners 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:
15 Powers Lane
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.
Di, 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 Acommunity
official completed Section E for a building located In Zone A(without a FEMA-issued or community-issued BFE)
r Zone AO
G3. 0 The following information(Items G4-G10)is provided for community floodplain management purposes.
G4. Permit Number G5. Date Permit Issued G6. 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: ❑feet ❑ meters Datum
G10. Community's design flood elevation: 0 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,andfor Bldg.No.)or P.O. Route and Box No. Policy Number:
15 Powers Lane
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.
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FEMA Form 086-0-33(7/15) Replaces all pr •
evious editions. Form Page 5 of 6
I
BUILDING PHOTOGRAPHS ' `
OMB No. 1660-0008
ELEVATION CERTIFICATE•
Continuation Page Expiration Date:November 30,2016
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:
,
15 Powers Lane
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 Vi
ew" and "Left Side View." When applicable, I
photographs must show the foundation with representative examples of the flood openings or vents,as indicated In Section A8.
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FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 6 of 6