Flood Control - Elevation Certificate - 1166 E Lone Shore Drive - Lonesome Dove Sub - 4/4/2013O.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY
\altmral1-1:„Ilnsurance Prr,grrmr Important: Read the instructions on pages 1 -9.
P% r ounuuiy w-lut s ivtlme r aunion rropen:es, LLI,
OMB No. 1660 -0008
Expiration Date: July 31, 2015
SECTION A — PROPERTY INFORMATION I FOR INSURANCE COMPANY USE
A2 Bui'ding Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No Company NAIC
1166 East Lone Shore Drive
tiny Eagle State ID ZIP Code 83616
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Lot 17 Bock 8 Lonsome Dove Subdiv sion
A4. Building Use (e.g., Residential Non- Residentiat, Addition. Accessory, etc.) Residential
A5, Latitude /Longitude: Lat N43 "41'13 77" Long. W116 °20'20.89" Horizontal Datum ❑ NAD 1927 j8 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): A9 For a building with an attached garage
a) Square footage of crawlspace or enclosure(s) NIA sq 0 a) Square footage of attached garage 69 sq ft
b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage
or enclosure(s; within 1 0 foot above adjacent grade NIA within 1.0 foot above adjacent grade NIA
c) Total net area of flood open ngs in A8.b NIA sq in c) Total net area of flood openings in A9.b NIA sq in
d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes ® No
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number I B2. County Name
Eagle, City of 160003 Ada
B4. MaplPanel Number B5. Suffix I B6. FIRM Index Date B7. FIRM Panel B8. Flood
16001 CO162 H October 2, 2003 Effective /Revised Date Zone(s)
— R February 19, 2003 AE
B10 Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 139,
® FIS Profile ❑ FIRM ❑ Community Determined ❑ Other /Source
B11 Indicate elevation datum used for BFE in Item 139: ❑ NGVD 1929 ® NAVD 1988 ❑ Other /Source:
B12 Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)?
Designation Dale: ❑ CBRS ❑ OPA
B3. Stale
ID
B9 Base Flood Elevation(s) (Zone
AO, use base flood depth)
2566.65
❑ Yes ® No
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' ® Finished Construction
"A new Elevation Certifcale will be required when construction of the building is complete
C2. Elevations — Zones Al —A30, AE, AH, A (with BFE;, VE, V1 —V30, V (with BFE), AR, ARIA, AR /AE, AR/A1 —A30, AR/AH, AR/AO Complete Items C2 a —h
below according to the building diagram specified in Item AT In Puerto Rico only, enter meters
Benchmark Utilized: Proiect Benchmark Vertical Datum NAVD 88
Indicate elevation datum used for the elevations in items a; through h) below ❑ NGVD 1929 ® NAVD 1988 ❑ Other /Source
Datum used for building elevations must be the same as that used for the BFE.
a Top of bottom floor (including basement, crawlspace, or enclosure floor)
b) Top of the next higher floor
c) Bottom of the lowest horizontal structural member (V Zores only)
d) Attached garage (top of slab)
e) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments)
Q Lowest adjacent (finished) grade next to building (LAG)
g) Highest adjacent (finished) grade next to building (HAG;
h) Lowest adjacent grade at lowest elevation of deck or stairs, including 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 thr`s 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.
❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a '+ i
❑ Check here if attachments. licensed land surveyor? ®Yes ❑ No
Certifiers Name Aaron L. Ballard License Number 12459
Title PLS Company Name KM Engineering, LLP
Address 9233 W State Street City Buise State ID ZIP Code 83714
Signature Date y•y .)! Telephone 208 - 639 -6939
Ic
OF
1 L jam'
FEMA Form 086 -0 -33 (7112) See reverse side for continuation. Replaces all previous editions.
Check the measurement used.
256960
® feel
❑ meters
NIA ®_
❑ feet
❑ meters
NIA
❑ feet
❑ meters
256926
® feet
❑ meters
256925
® feet
❑ meters
256836
® feel
❑ meters
25678.93
® feet
❑ meters
NIA __
❑ feet
❑ meters
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 thr`s 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.
❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a '+ i
❑ Check here if attachments. licensed land surveyor? ®Yes ❑ No
Certifiers Name Aaron L. Ballard License Number 12459
Title PLS Company Name KM Engineering, LLP
Address 9233 W State Street City Buise State ID ZIP Code 83714
Signature Date y•y .)! Telephone 208 - 639 -6939
Ic
OF
1 L jam'
FEMA Form 086 -0 -33 (7112) See reverse side for continuation. Replaces all previous editions.
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Bu Id ng Str•.0 Address (including Apt, Unit, Suita, ,arffor Bldg No.) or P.O Route and Box No Policy Number
1166 East Lone Shore Drive
C ty Eag'e State ID ZIP Codr Mi:16 Company NAIC Number,
SECTION D – SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenl1company, and (3) building owner.
Comments Per C2e) the elevation shown is for an AC pad outside at the northwest corner of the garage
(5, o"_ , Y- 1 -zor3
Signature Date
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 Cert ficate is intended to support a LOMA or LOMR -F request, complete Sections A, B
and C For Items E1 -E4 use natural grade, if aval,able. Check the measurement used In Puerto Rico only, enter meters
E1 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, crawispace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG
E2 For Build ng Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8-9 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 ❑ below the HAG
E4 Top of platform of machinery and /or equipment servicing the building is — ` ❑ feet El meters ❑ above or C] below the HAG.
E5 Zone AO only: If no flood depth number is available, is the top of the bottom Floor elevated .n accordance with the community's floodplatn 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 Owners or Owner's Authorized Representative's Name
Address
City
State ZIP Code
Signature Date Telephone
Comments
-- __ __ _- ...__.�_. _❑ Check here .f attachments
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 Cert ficate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8–G10 In Puerto R co only, enter meters
G1 ❑ 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 a evation 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 ❑ The follow ng information (Items G4 –G10) is provided for community floodplain management purposes
G4. Permit Number J.–G-5- Date Permit Issued G6. 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 ❑ meters Datum
G9 BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum
G10 Community s design flood elevation: ❑ feet ❑ meters Datum
Local Officials Name
Community Name
Signature
Comments
Title
Telephone
Date
Check here if attachments
FEMA Form 086 -0 -33 (7112) Replaces all previous editions.
ELEVATION CERTIFICATE, page 3 Building Photographs
r
See Instructions for Item A6
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address (including Apt Un t Suite and or Btdg No ) or P O Route and Box No Policy Number
1166 East Lone Shore drive
City Eagle State IQ ZIP Code 83616 Company NAIC Number
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
FEMA Form 086 -0.33 (7112) Replaces all previous editions.
ELEVATION CERTIFICATE, page 4 Building Photographs
Continuation Page
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:
1166 East Lone Shore Drive
City Eagle State 1D ZIP Code 83616 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.
FEMA Form 086 -0 -33 (7/12) Replaces all previous editions