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Home My WebLink AboutFEMA Elevation CertificateU.S. DEPARTMEN丁OF HOMELAND SECURiTY Fede「al Emergency Management Agency National FIood lnsu「ance P「ogram ELEVA丁ION CERT音F菓CATE !mportant: FoIIow the inst「uctions on pages l-9 OMBNo.1660-0008 ExpirationDate:Novembe「3O,2022 Copy aii pages ofthis EIevation Ce輔cate and a= attachments for (1 ) community offlciaI, (2) insurance agent/company, and (3) buiIdjng owne「. SECTIONA-PROPERTYINFORMATION FORINSURANCECOMPANYUSE Al.Bu冊ngOwne「isName Po=cyNumbe「: RobertE.Vigneau,jr. A2.誌鴇StreetAddress(lnCludingApt.,Unit,Suite,and/OrBIdg・No)orP.ORouteand CompanyNA看CNumbe「: 12Ve「montAvenue City　　　　　　　　　　　　　　　　　　　　　　　　　　state ZIPCode WestYarmouth　　　　　　　　　　　　　　　　　　　　　Massachusetts　　　　　　　　O2673 A3.P「OPertyDesc「iption(LotandBIockNumbers,TaxPa「ceiNumbe「,LegalDesc「iption,etC.) Assesso「sMap16,Pa「ce120 A4.BuiidingUse(e・g.,Residentiai,Non-ResidentiaI,Addition,Accesso「y,etC.)　ResidentialDwei=ng A5.Latitude/Longitude‥　Lat.41.641675N　　　Long・70.248355W　　　Ho「izontaIDatum‥□NAD1927　図NAD1983 A6・Attachatieast2photog「aphsofthebu脚ngiftheCerl庸Cateisbejngusedtoobtainfloodinsurance. A7.Bu潮ngDiag「amNumbe「　2A A8.Fo「abuildingwithacrawispaceo「encIosure(S): a)Squa「efootageofc「awIspaceorencIosure(S)　　　　　　　816.00Sqft b)Numbe「ofpermanent¶oodopenings両hec「awIspaceorencIosu「e(S)withinl.OfootaboveadjacentgradeN/A C)Totainetareaof¶oodopenjngsinA8.b　　　　　　　N/Asqin d)Engineered¶oodopenings?　□Yes　図No A9・Forabu=dingwithanattachedga「age: a)Squarefootageofattachedga「age　　　　　　　　　　　　sqft b)Numbe「ofpermanent¶oodopeningsintheattachedgaragewithinl.Ofootaboveadjacentg「ade C)TotaInetareaoffroodopeningsinA9.b　　　　　　　　　　sqin d)Engineered[oodopenings?　□Yes　□No SECTIONB-FLOODINSURANCERATEMAP(FiRM)INFORMATiON Bl.NFiPCommunityName&CommunityNumbe「　　　　B2.CountyName　　　　　　　　　　　　　B3.State TownofYa「mouth250015　　　　　　　　　　　　　　　　　BamstabIe　　　　　　　　　　　　　　　　　　Massachusetts B4糟評　B5SuffLXIB6謹一ndex　B7謀議誹鵠d　B9器鵠諜藍Depth) 25001CO588　　　J　　　　　O7-16-2014　　　　　O7-16-2014　　　　　AE　　　　　　　= BlO.indicatethesou「ceoftheBaseFIoodEIevation(BFE)datao「baseflooddepthenteredinltemB9: □FISP「of=e図FIRM　□CommunityDete「mined□Other/Sou「ce‥ B「l.lndicateelevationdatumusedfo「BFEinltemB9:□NGVD1929　因NAVD1988　□Other/Sou「ce: B12.lsthebu胴nglocatedinaCoastalBar「ierResou「∞SSystem(CBRS)areaorOtherwiseP「otectedArea(OPA)?□Yes図No DesignationDate:　　　　　　　　　□CBRS　□OPA FEMA Form O86-0-33 (12119)　　　　　　　　RepIaces aIi p「evious edit-OnS・　　　　　　　　　　　　Form Page l of 6 ELEVATION CERTIFICA丁E　　　　　　　　　　　　　　欝:浩欝駕。mb。. 3。. 2。22 lMPORTANT:1nthesespaces,COPytheco「respondinginformationfromSectionA, FORINSURANCECOMPANYUSE BuiIdingSt「eetAddress(inciudingApt.,Unit,Suite,and/orBIdg.No.)orP.O.RouteandBoxNo. Po=cyNumber: 12VermontAvenue City　　　　　　　　　　　　　　　　　　　　　　state　　　　　　　ziPCode CompanyNAICNumbe「 WestYarmouth　　　　　　　　　　　　　　　　　Massachusetts　　　O2673 SEC丁看ONC-BUlしDiNGELEVATlONINFORMATION(SURVEYREQUIRED) Cl.Buildingeievationsarebasedon‥　□Const「uctionD「awings“□Bu脚ngUnderConstruction*　図FinishedConstruction *AnewEIevationCe輔CateW=ibe「equi「edwhe=COnSt「uCtionofthebu脚ngiscompiete. C2.Elevations-ZonesA千丁A30,AE,AH,A(WithBFE),VE,V千二V30,∨(WithBFE),AR,AR/A,AR/AE,AR/Al-A30,AR/AH,AR/AO. 　CompleteltemsC2.a-hbelowacco「dingtothebu=dingdiagramspecifiedinItemA7.一nPuertoRicoon-y,ente「mete「S. BenchmarkU軸zed:LocalBenchma「k　　　　　　　　VerticaiDatum:NAVD1988 lndicateeIevationdatumusedfo「theelevationsinitemsa)throughh)below. □NGVD1929図NAVD1988□Other/Source: Datumusedfo「buildingelevationsmustbethesameasthatusedfo「theBFE. Checkthemeasurementused. a)Topofbottom¶oor(incIudingbasement,C「aWispace,O「enCIosurefloo「)　　　　　　　3.3　図feet　□meters b)Topofthenexthighe「floo「　　　　　　　　　　　　　　　　　　　　　　　　7.9　図feet　□mete「s C)Bottomofthelowestho「jzontaIst「ucturaImembe「(VZonesonIy)　　　　　　　　　N/A　□feet　□mete「s d)Attachedga「age(topofsIab)　　　　　　　　　　　　　　　　　　　　　　　N/A　□feet　□mete「s e)#罵鵠盤籍器憩蔦器薯蕊群buiid-ng　　　　　4.7図feet　□meters f)Lowestadjacent(帥shed)g「adenexttobujiding(LAG)　　　　　　　　　　　　　5.4　図feet　□mete「s g)Highestadjacent(finished)gradenexttobuilding(HAG)　　　　　　　　　　　　　6.3　図feet　□mete「s h)#諜言辞「adeatlowesteIevationofdecko「sta-rS両uding　　　　　5.6図f。。t　□m。t。.S SECTIOND-SURVEYOR,ENGINEER,ORARCHITECTCERT冊CA丁ION 器諾諾認諾誤読諾嵩畿誤読欝霊鵠諾親密舘握誓∩ WereiatitudeandiongitudeinSectionAp「ovidedbyaiicensediandsurveyo「?□Yes図No　　□checkhereifattachments. Certifie「isName　　　　　　　　　　　　　　　　　　　　LicenseNumber くつ No「manG.H町PE　　　　　　　　　　　　　　　　　　31887 Title P「esident CompanyName LandPianning,lnc. Add「ess 1115MainStreet City　　　　　　　　　　　　　　　　　　　　　　　　state　　　　　　　ziPCode Hanson　　　　　　　　　　　　　　　　　　　　　　　　Massachusetts　　　O2341 Slgnature　,%多///　器2。22　#蒜44　Ext Copya岬agesofthisEiev急ionCe輔cateandaiiattachmentsfo「(1)communityo醐aI,(2)insu「a=Ceagent/company,and(3)bu脚ngowne「, Comments(inciudingtypeofequipmentandlocation,PerC2(e)言fapplicabIe) LatitudeandIongitudewhe「etakenfromMassMapperGiSwebsite. FEMA Form O86-0-33 (12I19)　　　　　　　　　RepIaces all p「evious editions.　　　　　　　　　　　　　　Form Page 2 of 6 ELEVATION CERT!FiCATE　　　　　　　　　　　　　　諾器欝籍。m。。r 3。, 2。22 11VIPORTANT: in these spaces章COPy the cor「esponding info「mation from Section A.FOR INSURANCE COMPANY USE Bu=ding St「eetAdd「ess (including Apt., Unit, Suite, and/O「 Bldg. No.) or P.O. Route and Box No. 1 2 Vermont Avenue Po=cy Number: State ZiP Code West Yarmouth Massachusetts O2673 Company NAiC Number SEC丁ION E - BUILDING EしEVATiON INFORMAT看ON (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (W看THOUT BFE) Fo「 Zones AO and A (Without BFE), COmPIete ltems El-E5. 1f the Ce輔Cate is intended to support a LOMA o「 LOMR-F 「equest, COmPiete Sections A, B,and C. For ltems El-E4' uSe naturaI grade言f avaiIable. Check the measu「ement used. ln Puerto Rico oniy, ente「meters. El. Provide eIevatio= jnformation for the foiiowing and check the approp「iate boxes to show whethe「 the eievation is above or beiow the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, CraWIspace, Or enCIosure) is b) Top of bottom ¶oo「 (including basement, C「aWispace, O「 enCiosu「e) is 口feet □mete「s　□aboveor □beIowtheHAG. □feet □mete「s　□aboveo「 □beIowtheLAG. E2. For Building Diagrams 6-9 with pe「manent frood openings p「ovided in Section A ltems 8 and/or 9 (See PageS l-2 of Instructions), the next highe「 floor (elevation C2.b in the diag「ams) ofthe bu湘ng is E3. Attached garage (top of siab) is E4・ Top of piatfo「m of machine「y and/o「 equipment ServiCmg the building is □feet □meters　□aboveor □beiowtheHAG. □feet □meters　□aboveo「 □beIowtheHAG. □feet　口meters　□aboveo「 □beiowtheHAG. E5. Zone AO only: lf no ¶ood depth number is available, is the top of the bottom ¶oor e-evated in acco「dance with the community's floodpiain managementordinance? □ Yes　□ No　□ Unk=OWn. The iocai officiaI mustce噂this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER’S REPRESENTA丁iVE) CERTIFiCATION 霊盟擢諾萌七島部盤譜認諾盤掴ま龍認終結藍霊船籍嵩よ豊盤豊 P「operty Owne「 o「 Owner’s Autho「ized Rep「esentative's Name State ZiP Code Date Telephone □ check he「e if attachments. FEMA Fo「m O86-0-33 (12I19)Repiaces aIi p「evious editions.Form Page 3 of6 ELEVA丁iON CER丁看FICATE　　　　　　　　　　　　　　諾‡計上駕篭。m。。「 3。, 2。22 lMPORTANT: In these spaces’COPy the co「「esponding information from Section A,FOR INSURANCE COMPANY USE Building StreetAdd「ess (incIuding Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. 12 Ve「mont Avenue PoIicy Numbe「: State ZiP Code West Yarmouth Massachusetts O2673 Company NAIC Number SECTION G - COMMUNiTY INFORMATION (OPTIONAL〉 The locai offlcial who is authorized by iaw o「 ordina=Ce tO administe「 the communityis fioodpiain management ordinance can complete Sections A, B, C (O「 E), and G of this Elevation Ce輔cate. CompIete the appiicable item(S) and slgn beIow Check the measu「ement used in ltems G8-GlO. ln Puerto Rico oniy, enter mete「S. Gl. □ The information in Section C was taken f「om other documentation that has been signed and seaIed by a licensed surveyor, engInee「, O「 a「Chitect who is autho「ized by law to certify eievation information. (lndicate the sou「ce and date of the elevation data in the Comments area below.) G2. □ A commurty o冊Ciai completed Section E fo「 a bu剛g Iocated in Zone A (Without a FEMA-issued or community-issued BFE) G3. □ The following information (ltems G4-GlO) is p「ovided for community fioodpiain management purposes G4　Pe「mitNumber G5　Date Permit lssued G6. Date Certificate of Compliance/Occupancy issued G7. ThlS Pe「mit has been issued for:　　□ New Const「uction □ Substantfa=mprovement G8. Elevation of as-bui看t lowest floor (incIuding basement) Ofthe bu=ding: G9. BFE o「 (in Zone AO) depth offlooding at the building site: GlO. Communftys design fiood elevation: □feet □ mete「s Datum □feet □ meters Datum □feet □ mete「s Datum Locai O簡CiaI's Name 丁itIe Communfty Name 丁eIephone Signatu「e Date Comments (incIuding type of equipment and location, Per C2(e)言f appiicabIe) □ Check he「e if attachments. FEMA Form O86-0-33 (12/19)Replaces a= p「evious editions.Form Page 4 of6 FEMA Fo「m O86-O-33 (12/19)Replaces a= p「evious editions.Fo「m Page 5 of6 ELEVAT-ON CER丁-FICATE BUtLD豊器謹誓APHS g器nl欝駕em。。「 3。, 2。22 FEMA Form O86-0-33 (12/1 9)Replaces all p「evious editions.Fo「m Page 6 of6