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Home My WebLink AboutELEVATION CERTIFICATE National Hood Insurance Program i 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: GROVE STREET NOMINEE TRUST A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Company NAIC Number: Box No. 9 VERNON STREET City State ZIP Code WEST YARMOUTH Massachusetts 02673 A3. Property Description (Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) ASSESSORS 20, PARCEL 34.TITLE IN DEED BOOK 28035, PAGE 47 A4. Building Use(e.g.,Residential, Non-Residential,Addition,Accessory,etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 41.6463 Long. -70.2694 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 5 A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) 0.00 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 0.00 sq in d) Engineered flood openings? ❑Yes ❑ No A9. For a building with an attached garage: a) Square footage of attached garage 0.00 sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A9.b 0.00 sq in d) Engineered flood openings? ❑ Yes ❑ No SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION B1. NFIP Community Name&Community Number B2. County Name B3. State YARMOUTH 250015 BARNSTABLE Massachusetts B4. Map/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth) Revised Date 25001C0569 J 07-16-2014 07-16-2014 VE 13 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 ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ 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)? ❑ Yes ❑x No Designation Date: ❑ CBRS ❑ OPA FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 1 of 6 CLCvm ii Iv.. vr....... .... I IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE I n u..: :_ ,.. ot. ..t Arid, /inch irtinn Ant t Init. Suite.and/or Bldg. No.)or P.O.Route and Box No. Policy Number: I ' 9 VERNON STREET State ZIP Code Company NAIC Number City YARMOUTH Massachusetts 02673 WEST SECTION C-BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings" ❑ 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. D NGVD 1929 ® 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,crawispace,or enclosure floor) 16.5 ❑x feet ❑ meters 25.5 0 feet ❑ meters b) Top of the next higher floor x❑ feet r]meters c) Bottom of the lowest horizontal structural member(V Zones only) 15.1 ❑ feet ❑ meters d) Attached garage(top of slab) N/A e) Lowest elevation of machinery or equipment servicing the building 15.5 0 feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 6.4 U feet ❑ meters g) Highest adjacent(finished)grade next to building(HAG) 7.9 0 feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs,including 6 9 0feet ❑ 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? lillYes ❑No ❑Check here if attachments. Certifier's Name License Number KIERAN J. HEALY 48135 (1- OFMpss,�Title cy� SURVEY MANAGER Company Name �% KIERAN J. --, BSC GROUP,INC �u NO.HEALY4813 °' 5 0 Address `�C 349 ROUTE 28, UNIT D , �s -GIsTER- \?- O,n'R L L Ado s City State ZIP Code YARMOUTH Massachusetts 02673 WEST Date Telephone Ext. Signatur 09-28-2022 (508)778-8919 4586 Cop all pages this Eleva Certificate and all attachments for(1)community official, (2)insurance agent/company,and(3)building owner. Comments(including pe of equipment and location, per C2(e),if applicable) THIS BUILDING IS SET ON PILINGS WITH NO ENCLOSED AREA UNDER THE ELEVATED FIRST FLOOR. THE LOWEST FLOOR INDDICATED IS THE ELEVATED FINISHED FIRST FLOOR. FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 2 of 6 OMB No. 1660-0008 ELEVATION CERTIFICATE Expiration Date: November 30, 2022 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: 9 VERNON STREET 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 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 ❑ below the HAG. b) Top of bottom floor(including basement, crawlspace, or enclosure)is ❑feet ❑meters ❑above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 1-2 of Instructions), the next higher floor(elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or ❑below the HAG. E3. Attached garage (top of slab)is ❑feet ❑ meters ❑above or E below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑feet ❑meters ❑above or ❑below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F—PROPERTY OWNER(OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A(without a FEMA-issued or community-issued BFE)or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments. FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 r _ - --- -•••i�••••�.. ✓u �. vV VG1i1VGl JV, LVGG 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: 9 VERNON STREET 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. Gi. ❑ 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. H 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. ❑i New Construction L1 Substantial Improvement G8. Elevation of as-built lowest floor(including basement) of the building: II 1 feet ❑ meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑ feet j I 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) Check here if attachments. FEMA Form 086-0-33 (12/19) 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, 2022 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: 9 VERNON STREET 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. 1 R . f lfr m ! I J 1 ('� Photo One Photo One Caption FRONT/EAST SIDE Clear Photo One i . 4. `` ; ,__------.2__________ „... .i 1 r �. . a ___.._- '51�- ' „vi ;� -- s , . Photo Two Photo Two Caption REAR/WEST SIDE Clear Photo Two FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 5 of 6 LJ'.. L IJ r% rr ri'.J V'L7 rtM r-no OMB No. 1660-0008 PI FVATIIf11J �`FRTIFIf_ATG �___ • ,. .. , a __ I -- -. .. .. . . ..v��.��•'..0 ".'" uy... LA�.111 tlUUI L,d te. IVV VGIIIUCI JV. LVLG IMPORTANT: In these spaces,copy the corresponding information from SP_f:tion 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: 9 VERNON STREET 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. .:„,.,.,,..,.„,.... ..:.-.,,..,..,... . , i,, �� » ,�¢tr.i ; FU/11SU 10ffyf' ' , . - J t Hill 111111111111 .l„.l „•- ,„„0 riii' :Ij/` ,„,, 4 j ,.,. s, --- • • '1- _ ., - x F . ; i :- i _ .. vr . -- _, -- ;,-.-;. --. „_ ..._ iii - > Photo Three Photo Three Caption ELEVATED UTILITIES Clear Photo Three e \ lip ...____ 1411 . -----T---71- ---- ---'-'''--- '.114k r 1. I la, .. __ .$ _ Photo Four Photo Four Caption Clear Photo Four FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 6 of 6